Cord blood platelet rich plasma (PRP) as a potential alternative to autologous PRP for allogenic preparation and regenerative applications

As an abundant supplier of growth factors, chemokines and other bioactive molecules, platelet rich plasma (PRP) become a leading therapy for tissue regeneration. The PRP therapy is an inexpensive and feasible source of growth factor compared to commercial products however, the better source of platelets is the major challenge. Many researchers are skeptical about cord blood as an alternative source for the allogenic preparation of PRP. In the present study, we have compared adult peripheral and cord blood PRP for their regenerative capacity and immuno-modulatory nature. ELISA data indicates that the cord PRP contained a considerably higher amount of growth factors compared to adult PRP. In-vitro results indicate a significant increase in cell proliferation and migration with cord PRP treatment. The immunomodulatory evaluation shows cord blood PRP has better potential in switching activated macrophages to anti-inflammatory markers when compared with adult PRP, as well as the cytokines production indicates a significant reduction in the release of IFN-γ in cord PRP treatment. The study shows the beneficial effects of using cord blood PRP over adult PRP however, future studies are required to validate cord blood PRP as a permanent source for regenerative therapy.

A Novel Protozoa Parasite-Derived Protein Adjuvant Is Effective in Immunization with Cancer Cells to Activate the Cancer-Specific Protective Immunity and Inhibit the Cancer Growth in a Murine Model of Colorectal Cancer

Cancer-specific CD8+ cytotoxic T cells play important roles in preventing cancer growth, and IFN-γ, in addition to IL-12 and type I interferon, is critical for activating CD8+ cytotoxic T cells. We recently identified the capability of the amino-terminus region of dense granule protein 6 (GRA6Nt) of Toxoplasma gondii, an intracellular protozoan parasite, to activate IFN-γ production of microglia, a tissue-resident macrophage population. Therefore, in the present study, we examined whether recombinant GRA6Nt protein (rGRA6Nt) functions as an effective adjuvant to potently activate cancer-specific protective immunity using a murine model of MC38 colorectal cancer (CRC). When mice were immunized with non-replicable (either treated with mitomycin C or irradiated by X-ray) MC38 CRC cells in combination with rGRA6Nt adjuvant and received a challenge implantation of replication-capable MC38 tumor cells, those mice markedly inhibited the growth of the implanted tumors in association with a two-fold increase in CD8+ T cell density within the tumors. In addition, CD8+ T cells of the immunized mice secreted significantly increased amounts of granzyme B, a key mediator of the cytotoxic activity of CD8+ T cells, and IFN-γ in response to MC38 CRC cells in vitro when compared to the T cells from unimmunized mice. Notably, the protective effects of the immunization were specific to MC38 CRC cells, as the immunized mice did not exhibit a significantly inhibited growth of EL4 lymphoma tumors. These results indicate that rGRA6Nt is a novel and effective protein adjuvant when used in immunizations with non-replicable cancer cells to potently activate the protective immunity specifically against the cancer cells employed in the immunization.

Immunization with the amino-terminus region of dense granule protein 6 (GRA6) of Toxoplasma gondii activates CD8+ cytotoxic T cells capable of removing tissue cysts of the parasite through antigen presentation by human HLA-A2.1

CD8+ T cells from HLA-A2.1-transgenic mice, but not wild-type mice, immunized with the amino-terminus region (aa 41-152) of dense granule protein 6 (GRA6Nt) of Toxoplasma gondii secreted large amounts of perforin and granzyme B in response to GRA6Nt through antigen presentation by HLA-A2.1 in vitro. When those CD8+ T cells were transferred into chronically infected HLA-A2.1-expressing NSG mice deficient in T cells, cerebral cyst burden of the recipients of HLA-A2.1-transgenic T cells, but not of WT T cells, became significantly less than that of control mice with no cell transfer. Furthermore, the significant reduction of the cyst burden by a transfer of the HLA-A2.1-transgenic CD8+ immune T cells required an expression of HLA-A2.1 in the recipient NSG mice. Thus, antigen presentation of GRA6Nt by human HLA-A2.1is able to activate anti-cyst CD8+ T cells that eliminate T. gondii cysts through antigen presentation by human HLA-A2.1.

Dense granule protein 3 of Toxoplasma gondii plays a crucial role in the capability of the tissue cysts of the parasite to persist in the presence of anti-cyst CD8+ T cells during the chronic stage of infection

Toxoplasma gondii establishes chronic infection by forming tissue cysts, and this chronic infection is one of the most common parasitic infections in humans. Our recent studies revealed that whereas CD8+ T cells of genetically resistant BALB/c mice have the capability to remove the tissue cysts of the parasite through their perforin-mediated activities, small portions of the cysts are capable of persisting in the presence of the anti-cyst CD8+ T cells. It is currently unknown how those small portions of the cysts resist or escape the T-cell immunity and persist in the hosts. In the present study, we discovered that the cysts, which persisted in the presence of the perforin-mediated CD8+ T-cell immunity, have significantly greater mRNA levels for four dense granule proteins, GRA1, GRA2, GRA3, and GRA7, and one rhoptry protein, ROP35, than the total population of the cysts present in the absence of the T cells. In addition, increased levels of mRNA for GRA1, GRA3, and ROP35 in the cysts significantly correlated with their successful persistence through the condition in which greater degrees of reduction of the cyst burden occurred through anti-cyst CD8+ T cells. In addition, GRA3-deficient T. gondii displayed significantly enhanced elimination of the cysts by anti-cyst CD8+ T cells when compared to the wild-type parasite. These results indicate that GRA3 is a key molecule that mediates in the capability of T. gondii cysts to persist by resisting or evading the anti-cyst activity of CD8+ T cells during the later stage of infection.

Biomaterial-based platforms for modulating immune components against cancer and cancer stem cells

Immunotherapy involves the therapeutic alteration of the patient's immune system to identify, target, and eliminate cancer cells. Dendritic cells, macrophages, myeloid-derived suppressor cells, and regulatory T cells make up the tumor microenvironment. In cancer, these immune components (in association with some non-immune cell populations like cancer-associated fibroblasts) are directly altered at a cellular level. By dominating immune cells with molecular cross-talk, cancer cells can proliferate unchecked. Current clinical immunotherapy strategies are limited to conventional adoptive cell therapy or immune checkpoint blockade. Targeting and modulating key immune components presents an effective opportunity. Immunostimulatory drugs are a research hotspot, but their poor pharmacokinetics, low tumor accumulation, and non-specific systemic toxicity limit their use. This review describes the cutting-edge research undertaken in the field of nanotechnology and material science to develop biomaterials-based platforms as effective immunotherapeutics. Various biomaterial types (polymer-based, lipid-based, carbon-based, cell-derived, etc.) and functionalization methodologies for modulating tumor-associated immune/non-immune cells are explored. Additionally, emphasis has been laid on discussing how these platforms can be used against cancer stem cells, a fundamental contributor to chemoresistance, tumor relapse/metastasis, and failure of immunotherapy. Overall, this comprehensive review strives to provide up-to-date information to an audience working at the juncture of biomaterials and cancer immunotherapy. STATEMENT OF SIGNIFICANCE: Cancer immunotherapy possesses incredible potential and has successfully transitioned into a clinically lucrative alternative to conventional anti-cancer therapies. With new immunotherapeutics getting rapid clinical approval, fundamental problems associated with the dynamic nature of the immune system (like limited clinical response rates and autoimmunity-related adverse effects) have remained unanswered. In this context, treatment approaches that focus on modulating the compromised immune components within the tumor microenvironment have garnered significant attention amongst the scientific community. This review aims to provide a critical discussion on how various biomaterials (polymer-based, lipid-based, carbon-based, cell-derived, etc.) can be employed along with immunostimulatory agents to design innovative platforms for selective immunotherapy directed against cancer and cancer stem cells.

Human MHC class I molecule, HLA-A2.1, mediates activation of CD8+ T cell IFN-γ production and the T cell-dependent protection against reactivation of cerebral Toxoplasma infection

To examine whether the HLA-A2.1, one of the most common MHC class I molecules in humans, activates the protective immunity against reactivation of cerebral infection with Toxoplasma gondii, HLA-A2.1-transgenic and wild-type (WT) mice were infected and treated with sulfadiazine to establish chronic infection in their brains. One month after discontinuation of sulfadiazine, which initiates reactivation of the infection, mRNA levels for tachyzoite (the acute stage form)-specific SAG1 and numbers of the foci associated tachyzoites were significantly less in the brains of the HLA-A2.1-transgenic than WT mice. Greater numbers of IFN-γ-producing CD8+ T cells were detected in the spleens of infected transgenic than WT mice, and CD8+ T cells from the former produced markedly greater amounts of IFN-γ than the T cells from the latter in response to tachyzoite antigens in vitro. When their CD8+ T cells were systemically transferred to infected immunodeficient NSG mice expressing the HLA-A2.1, the CD8+ T cells from HLA-A2.1-transgenic mice inhibited reactivation of the cerebral infection in the recipients more efficiently than did the WT T cells. Furthermore, the inhibition of reactivation of the infection by CD8+ T cells from the transgenic mice was associated with increased cerebral expression of IFN-γ and effector molecules against tachyzoites in the recipients when compared to the WT CD8+ T cell recipients. Thus, the human HLA-A2.1 is able to effectively activate IFN-γ production of CD8+ T cells against T. gondii tachyzoites and confer a potent protection against reactivation of cerebral infection with this parasite through the CD8+ T cells activation.

537 Oro-Nasal Fistula: A Very Rare Complication Following Routine Palatal Biopsy

Biopsies of the palate are generally well-tolerated with known complications of pain, bleeding, or infection, that can usually be well-controlled. We report a case of a 63-year-old male who developed a rare complication following a biopsy of an ulcer on the junction between hard and soft palate. Despite an uneventful routine biopsy, the patient presented with an oro-nasal fistula and complaints of nasal discharge. The cause of the fistula was unclear, and the histopathology results excluded malignancy. The possible hypotheses considered for this very rare and unusual complication were infection, vascularity, and underlying systemic co-morbidities. We believe in this case that the cause of wound breakdown was secondary to loss of vascularity of the mucosa from his CPAP device. The patient has since been referred to a tertiary unit for consideration of surgical repair. To the author's knowledge, there are no similar published reports of such complications following routine palatal biopsy.

Biomimicking nanofibrous gelatin microspheres recreating the stem cell niche for their ex-vivo expansion and in-vivo like differentiation for injectable stem cell transplantation

Stem cells based novel treatment modality for degenerative and immune dysfunction diseases created a huge demand of suitable carriers to support ex-vivo production of quality stem cells, and effective in-vivo transplantation of stem cells and their fate. In spite of promising candidature of nanofibrous microspheres (NFM) to recreate native stem cell niches to be used for possible scaling-up for ex-vivo stem cells expansion, it remains fairly unexplored. A systematic study on the stem cell-NFM interaction comparative with commercial microspheres (CM) has been performed for the first time. Gelatin NFM with variable physicochemical properties such as size, surface properties, surface chemistry, and variable degradability were prepared using microemulsion coupled with thermally induced phase separation (TIPS) method. Effect of physicochemical properties of NFM and their cellular interaction such as binding, morphology, metabolic activity and proliferation studies were performed using human bone marrow-derived mesenchymal stem cells (hBMSCs), human dental follicle stem cells (hDFSCs) and human gingival fibroblast (HGF) cells and compared with the commercial and solid microspheres. Gelatin NFM supports excellent cell binding, proliferation, metabolic activities and chemical cues specific differentiation. All out-turns indicate that NFM stand to be an outstanding candidate for ex-vivo cells' expansion and injectable carriers for stem cell transplantation.

The diabetes community exercise programme plus usual care versus usual care in patients with type 2 diabetes: A randomised, two-arm, parallel, open-label trial

BACKGROUND

Exercise is important in type 2 diabetes (T2D) management. Focussing on Māori and Pacific people and those from deprived circumstances, the Diabetes Community Exercise Programme (DCEP) was developed to engage people with T2D in exercise. We report the evaluation of whether being offered DCEP (plus usual care) was more effective than usual care in improving glycaemic control at 1-year.

METHODS

A randomised, two-arm, parallel, open-label trial with blinding of outcome assessor and data analyst. Adults (age ≥35 years) with T2D recruited from two New Zealand (NZ) communities were randomised, using opaque sealed envelopes and stratified by centre with random block lengths, to DCEP or usual care. DCEP comprises twice-weekly, two-hour sessions of exercise and education over 12-weeks, followed by a twice-weekly maintenance exercise class. The primary outcome was between-group differences in mean changes of glycated haemoglobin (HbA1c) from baseline to 1-year follow-up with intention-to treat analysis. This trial is registered with the Australian NZ Clinical Trials Registry (ANZCTR): ACTRN12617001624370p and is closed to new participants.

FINDINGS

From 2018 - 2019, of 294 people screened, 165 (mean age 63·8, SD16·2 years, 56% female, 78·5% European, 14% Māori, 6% Pacific, 27% most deprived) were baseline evaluated, randomised, and analysed at study end (DCEP = 83, control = 82). Multimorbidity (≥2) and polypharmacy (>5 medications) were high (82%, 69%). We found no statistically significant between-groups differences in HbA1c (mmol/mol) change at 15 months (mean 3% higher in DCEP, 95% CI 2% lower to 8% higher, p = 0·23). Twelve-week intervention adherence was good (41% attended >80% available sessions). No adverse events were reported.

INTERPRETATION

DCEP was not effective in improving glycaemic control, possibly due to insufficient exercise intensity. Our attendance demonstrated DCEP's cultural accessibility. DCEP might be good to engage in exercise marginalised people with high Hb1Ac levels, multimorbidity, and high polypharmacy.

FUNDING

Health Research Council of New Zealand.

Crystalline and Amorphous Preparation of Aluminum Hydroxide Nanoparticles Enhances Protective Antigen Domain 4 Specific Immunogenicity and Provides Protection Against Anthrax

Introduction

Aluminum salts, although they have been used as adjuvants in many vaccine formulations since 1926, exclusively induce a Th2-biased immune response, thereby limiting their use against intracellular pathogens like Mycobacterium tuberculosis.

Methods and Results

Herein, we synthesized amorphous and crystalline forms of aluminum hydroxide nanoparticles (AH nps) of 150–200 nm size range. Using Bacillus anthracis protective antigen domain 4 (D4) as a model antigen, we demonstrated that both amorphous and crystalline forms of AH nps displayed enhanced antigen D4 uptake by THP1 cells as compared to commercial adjuvant aluminum hydroxide gel (AH gel). In a mouse model, both amorphous and crystalline AH nps triggered an enhanced D4-specific Th2- and Th1-type immune response and conferred superior protection against anthrax spore challenge as compared to AH gel. Physicochemical characterization of crystalline and amorphous AH nps revealed stronger antigen D4 binding and release than AH gel.

Conclusion

These results demonstrate that size and crystallinity of AH nps play important roles in mediating enhanced antigen presenting cells (APCs) activation and potentiating a strong antigen-specific immune response, and are critical parameters for the rational design of alum-based Th1-type adjuvant to induce a more balanced antigen-specific immune response.

Single-dose Ag85B-ESAT6-loaded poly(lactic-co-glycolic acid) nanoparticles confer protective immunity against tuberculosis

BACKGROUND

Bacillus Calmette-Guérin, the attenuated strain of Mycobacterium bovis, remains the only available vaccine against tuberculosis (TB). However, its ineffectiveness in adults against pulmonary TB and varied protective efficacy (0-80%) speak to an urgent need for the development of an improved and efficient TB vaccine. In this milieu, poly(lactic-co-glycolic acid) (PLGA), is a preferential candidate, due to such properties as biocompatibility, targeted delivery, sustained antigen release, and atoxic by-products.

METHODS

In this study, we formulated PLGA nanoparticles (NPs) encapsulating the bivalent H1 antigen, a fusion of Mycobacterium tuberculosis (Mtb) Ag85B and ESAT6 proteins, and investigated its role in immunomodulation and protection against Mtb challenge. Using the classical water-oil-water solvent-evaporation method, H1-NPs were prepared, with encapsulation efficiency of 86.1%±3.2%. These spherical NPs were ~244.4±32.6 nm in diameter, with a negatively charged surface (ζ-potential -4±0.6 mV).

RESULTS

Under physiological conditions, NPs degraded slowly and the encapsulated H1 antigen was released over a period of weeks. As a proof-of-concept vaccine candidate, H1 NPs were efficiently internalized by the THP-1 human macrophages. Six weeks after a single-dose vaccination, H1 NP-immunized C57BL/6J mice showed significant increase in the production of total serum IgG (P<0.0001) and its isotypes compared to H1 alone, IgG2a being the predominant one, followed by IgG1. Further, the cytokine-release profile of antigen-stimulated splenocyteculture supernatant indicated a strong TH1-biased immunoresponse in H1 NP-vaccinated mice, with ~6.03- and ~2.8-fold increase in IFNγ and TNFα cytokine levels, and ~twofold and 1.6 fold increase in IL4 and IL10 cytokines, respectively, compared to H1 alone-immunized mice. In protection studies, H1 NP-vaccinated mice displayed significant reductions in lung and spleen bacillary load (P<0.05) at 5-week post-Mtb H37Rv challenge and prolonged survival, with a mean survival time of 177 days, compared to H1 alone-vaccinated mice (mean survival time 80 days).

CONCLUSION

Altogether, our findings highlight the significance of the H1-PLGA nanoformulation in terms of providing long-term protection in mice with a single dose.

A niosome formulation modulates the Th1/Th2 bias immune response in mice and also provides protection against anthrax spore challenge

Introduction

In this study, we have investigated the immunogenicity and protective efficacy of a niosomal formulation encapsulating protective antigen (PA) and PA domain 4 (D4) of Bacillus anthracis.

Methods

Nonionic surfactant–based vesicles (NISV) + PA and NISV + D4 were prepared from span-60 and cholesterol by reverse-phase evaporation method and were evaluated for in vitro characteristics and immunological studies.

Results

Particle characterization using transmission electron microscopy and atomic force microscopy analysis showed that the niosomal formulation was spherical in shape. The entrapment efficiency values were calculated to be 58.5% and 44.75% for PA and D4, respectively. Confocal microscopy and flow cytometry studies showed an enhanced uptake of antigen in THP1 macrophages by niosome as compared to antigen only. An in vitro release assay showed a burst release of antigen from niosome within 24 hours followed by a gradual release for 144 hours. Immunological studies showed that both PA- and D4-encapsulated niosome elicited a robust IgG titer. Antibody isotyping and cytokine profile showed that NISV + PA and NISV + D4 enhanced both Th1 and Th2 responses in mice, suggesting a mixed Th1/Th2 response. Both NISV + PA and NISV + D4 elicited high levels of anti-inflammatory cytokine interleukin-10 with low levels of pro-inflammatory cytokine tumor necrosis factor-α, suggesting the anti-inflammatory property of niosome. Both the niosomal formulations were also able to confer protection against BA infection as compared to only PA and D4.

Conclusion

PA and D4 encapsulated NISV formulation could modulate both the Th1 and Th2 adaptive immune system and was found to be a better prophylactic against anthrax.

Trimethyl Chitosan Nanoparticles Encapsulated Protective Antigen Protects the Mice Against Anthrax

Anthrax is an era old deadly disease against which there are only two currently available licensed vaccines named anthrax vaccine adsorbed and precipitated (AVP). Though they can provide a protective immunity, their multiple side-effects owing to their ill-defined composition and presence of toxic proteins (LF and EF) of Bacillus anthracis, the causative organism of anthrax, in the vaccine formulation makes their widespread use objectionable. Hence, an anthrax vaccine that contains well-defined and controlled components would be highly desirable. In this context, we have evaluated the potential of various vaccine formulations comprising of protective antigen (PA) encapsulated trimethyl-chitosan nanoparticles (TMC-PA) in conjunction with either CpG-C ODN 2395 (CpG) or Poly I:C. Each formulation was administered via three different routes, viz., subcutaneous (SC), intramuscular (IM), and intraperitoneal in female BALB/c mice. Irrespective of the route of immunization, CpG or Poly I:C adjuvanted TMC-PA nanoparticles induced a significantly higher humoral response (total serum IgG and its isotypes viz., IgG1, IgG2a, and IgG2b), compared to their CpG or Poly I:C PA counterparts. This clearly demonstrates the synergistic behavior of CpG and Poly I:C with TMC nanoparticles. The adjuvant potential of TMC nanoparticles could be observed in all the three routes as the TMC-PA nanoparticles by themselves induced IgG titers (1-1.5 × 10⁵) significantly higher than both CpG PA and Poly I:C PA groups (2-8 × 10⁴). The effect of formulations on T-helper (T_h) cell development was assessed by quantifying the Th1-dependant (TNF-α, IFN-γ, and IL-2), Th2-dependant (IL-4, IL-6, and IL-10), and Th17-type (IL-17A) cytokines. Adjuvanation with CpG and Poly I:C, the TMC-PA nanoparticles triggered a Th1 skewed immune response, as suggested by an increase in the levels of total IgG2a along with IFN-γ cytokine production. Interestingly, the TMC-PA group showed a Th2-biased immune response. Upon challenge with the B. anthracis Ames strain, CpG and Poly I:C adjuvanted TMC-PA nanoparticles immunized via the SC and IM routes showed the highest protective efficacy of ~83%. Altogether, the results suggest that CpG or Poly I:C adjuvanted, PA-loaded TMC nanoparticles could be used as an effective, non-toxic, second generation subunit-vaccine candidate against anthrax.

Influence of diet and dietary nanoparticles on gut dysbiosis

Human gut comprises of a huge mixture of microorganisms as they had co-existed for millions of years. The change in co-existence of microbial genera leads to dysbiosis, which creates several disorders in humans. Diet and diet associated agents can have a considerable influence on host health by regulating the gut microbiome, which can thereby maintain the homeostasis of the gut. Analysis of the gut microbiome and the agents that can have an influence on the gut need a profound understanding, which is the need of the hour. The current review therefore focuses on the influence of diet and dietary nanoparticles on the gut microbiota and their positive or adverse effect.

Use of Laser Doppler Flowmetry and Transcutaneous Oxygen Tension Electrodes to Assess Local Autonomic Dysfunction in Patients with Frozen Shoulder

The laser Doppler flowmeter (LDF), which measures changes in cutaneous blood flow, and the transcutaneous oxygen electrode which measures cutaneous perfusion, were used to study reflex changes in the microcirculation of the shoulder in 38 patients with frozen shoulder and 10 normal controls. In all controls and 22 patients with frozen shoulder, a normal LDF response to inspiration/expiration was observed. In 16 patients with frozen shoulder, LDF responses were either unilaterally or bilaterally absent. Comparison between the two patient groups showed a significant association (chi 2 = 6.43, P less than 0.02) between abnormality of response and the persistence of pain. TcPO2 was in the normal range in all patients and controls. These findings suggest that the LDF together with the TcPO2 may be a useful method of studying the skin microcirculation over the shoulder.

Tissue Oxygenation, Venous Ulcers and Fibrin Cuffs

Skin oxygen tension (TcPo2) was measured at 43°C on patients (n=27) with venous ulcers. Measurements were made at ulcer edge and, proximally on the same limb for control. Similar measurements were also made on healthy volunteers (n=14) in the medial aspects of the distal third of the legs. TcPo2 at ulcer edge was significantly lower (P=0.001) than control values which in turn were lower than that measured on healthy volunteers. TcPo2 reflects skin nutrition. While low TcPo2 at ulcer edges might be the result of pericapillary barriers to oxygen transport, the control values measured on apparently normal skin suggest the need for further studies.

A rare case of bullhorn-injury associated traumatic hernia of anterior abdominal wall managed by laparoscopic sutured tissue-only repair

Traumatic abdominal wall hernias (TAWHs) are relatively uncommon entities. Common mechanisms that predispose to such hernias include motor vehicle accidents, seat belt injuries, fall from height, handlebar injuries, and bullfighting. Bullhorn injury leading to TAWHs is an uncommon mechanism. We report here one such patient who was managed by laparoscopic transperitoneal anatomical repair of the defect using polypropylene suture. The patient recovered well without any complication and is being followed up. Such small defects can be managed laparoscopically and tissue-only repair using a nonabsorbable suture is a feasible option. Our case is the first reported case of bullhorn-injury associated traumatic hernia managed laparoscopically and first reported case of TAWH in an adult which was managed by laparoscopic sutured tissue-only repair.

Low-level laser therapy does not aid the management of tennis elbow

The value of low-level laser therapy (LLLT) as a therapy for painful tennis elbow is dubious since evidence for its efficacy is conflicting. This report presents the results of a randomized, double-blind, controlled study on patients with tennis elbow (n = 29) using a gallium aluminium arsenide laser. Two different methods of assessing pain, visual analogue scores and a Marcy Wedge Pro® exerciser, were used. No significant differences were found between the treatment and placebo groups. This suggests that LLLT at the dosage and duratiion used in this study is without benefit in the short-term management of painful tennis elbow.

Randomized controlled study of ultrasound therapy in the management of acute lateral ligament sprains of the ankle joint

Objective: To determine the efficacy of a fixed dose of ultrasound energy to treat acute lateral ligament sprains of the ankle joint.

Study design: Double-blind randomised controlled trial.

Setting: Accident and Emergency department of University Teaching Hospital.

Subjects: Patients presenting at Accident and Emergency with ankle injuries.

Intervention: Ultrasound or placebo, and Tubigrip.

Outcome measures: Pain measured with visual analogue scales, swelling using a tape measure, range of movement using a fluid-filled goniometer, and weight bearing using two scales simultaneously.

Results: Patients in both groups improved symptomatically. There were no statistically significant differences between groups in any outcome measure. Within groups, statistically significant differences were detected in pain perceived, and range of movement (dorsiflexion).

Conclusion: At the dose and duration used, ultrasound therapy is no better than placebo in the management of lateral ligament injuries.

Changes in Skin Microcirculation at Periulcerous Sites in Patients with Chronic Venous Ulcers during Leg Elevation

Objective:

To investigate the effect of limb elevation on the microcirculation of the skin in patients with venous ulceration of the leg.

Design:

Prospective study in patients receiving in patient treatment for venous ulceration.

Setting:

Health Service teaching hospital.

Patients:

Thirteen patients with venous ulceration of the lower limb for more than two years were investigated.

Interventions:

Patients were admitted to hospital and treated by bedrest with elevation of the lower limbs by 10° above the horizontal.

Main outcome measures:

Laser Doppler fluximetry and transcutaneous oximetry of the skin surrounding the venous ulcers was undertaken.

Results:

The laser Doppler fluximetry in the periculcerous region increased by 10.8 A.U. (95% CI 17 to 4.54). However, the transcutaneous oxygen measurements did not change during the period of treatment.

Conclusions:

Admission to hospital with elevation of the limb for patients with venous ulceration results in ***microcirculatory changes which are probably attributable to reduction in lower limb oedema.

How to Measure Changes in Oedema in Patients with Chronic Venous Ulcers?

objective:

To assess changes in limb volume and oedema in Patients admitted to hospital for treatment of venous ulceration.

Design:

Prospective study in thirteen patients.

Setting:

Health Service teaching hospital.

Patients:

Thirteen patients with venous ulceration for 2 years.

Interventions:

Patients were admitted to hospital for bed-rest and lower limb elevation for a period of 24 hours

Main outcome measures:

Limb volume was measured by water displacement and impedance plethysmography.

Results:

During limb elevation there was a mean reduction limb volume of 524 mls (95% CI 377–671 mls) after 24 hours of bedrest. This corresponded with a reduction in impedance measured by the impedance plethysmograph of 19–0 ohms (95% CI 24.3 to 15.6 ohms).

Conclusion:

Measurement of the lower limb volume by water displacement and by impedance plethysmography are likely to be useful methods in the investigation of Patients with chronic venous insufficiency.

Non-immunosuppressive FTY720-derivative OSU-2S mediates reactive oxygen species-mediated cytotoxicity in canine B-cell lymphoma

OSU-2S is a FTY720 (Fingolimod) derivative that lacks immunosuppressive properties but exhibits strong anti-tumour activity in several haematological and solid tumour models. We have recently shown OSU-2S to mediate potent cytotoxicity in human mantle cell lymphoma cell lines and primary cells. We report here the pre-clinical activity of OSU-2S in spontaneous B-cell lymphoma of dogs which shares many characteristics of human lymphoma. OSU-2S mediated apoptosis in canine B-cell lines and primary B-cell lymphoma cells obtained from spontaneous lymphoma bearing dogs. OSU-2S induced reactive oxygen species (ROS) in canine lymphoma cells and inhibition of ROS partially rescued OSU-2S-mediated cell death. These studies provide a rational basis for the use of spontaneous lymphoma in pet dogs as a preclinical large animal model for the development of OSU-2S as small molecule for treating people and dogs with lymphoma.

Immunoglobulin G4 related tubulointerstitial nephritis

Tubulointerstitial nephritis is an uncommon manifestation of IgG4 related disease. A case of tubulointerstitial nephritis with special features including isolated renal involvement in this multisystem disorder and the absence of response to steroid therapy in a young male is reported here. There was no nephromegaly, eosinophilia or other organ involvement. The importance of early detection and treatment for preservation of kidney function is highlighted.

Immunoexpression of vascular endothelial growth factor and Ki-67 in human gingival samples: An observational study

Aim:

To evaluate immunohistochemically vascular endothelial growth factor (VEGF) and Ki-67 in human gingival samples and to compare these factors between healthy and diabetic patients.

Materials and Methods:

A total of 50 subjects were included in the study. They were categorized into three groups: Periodontally healthy group, periodontally diseased gingiva without any systemic disease group and periodontally diseased gingiva with controlled type II diabetes mellitus (DM) group. Gingival biopsies were performed and immunohistochemical analysis were done for VEGF and Ki-67 staining in gingival samples.

Results:

The present study found moderate intensity staining for VEGF in periodontitis group and periodontitis with controlled type II DM group and mild intensity staining for VEGF in periodontally healthy group. With regard to Ki-67, negative staining was observed in periodontally healthy group and mild staining in periodontitis group and periodontitis with controlled type II DM group.

Conclusion:

Further investigation needs to be conducted to identify how VEGF and Ki-67 are involved in the tissue inflammation associated processes and the relationship between VEGF and Ki-67 in progression of periodontitis.

Tumor antigen ROR1 targeted drug delivery mediated selective leukemic but not normal B-cell cytotoxicity in chronic lymphocytic leukemia

Selective cytotoxicity to cancer cells without compromising their normal counterparts pose a huge challenge for traditional drug design. Here we developed a tumor antigen targeted delivery of immunonanoparticle carrying a novel non-immunosuppressive FTY720 derivative OSU-2S with potent cytotoxicity against leukemic B cells. OSU-2S induces activation of protein phosphatase 2A, phosphorylation and nuclear translocation of SHP1^S591 and deregulation of multiple cellular processes in chronic lymphocytic leukemia (CLL) resulting in potent cytotoxicity. To preclude OSU-2S mediated effects on these ubiquitous phosphatases in unintended cells and avoid potential adverse effects we developed a OSU-2S targeted delivery immunonanoparticles (2A2-OSU-2S-ILP), that mediated selective cytotoxicity of CLL but not normal B cells through targeting receptor tyrosine kinase ROR1 expressed in leukemic but not normal B cells. Developing a novel spontaneous CLL mouse model expressing human ROR1 (hROR1) in all leukemic B cells, we demonstrate the therapeutic benefit of enhanced survival with 2A2-OSU-2S-ILP in-vivo. The newly developed non-immunosuppressive OSU-2S, its delivery using human CLL directed immunonanoparticles and the novel transgenic mouse model of CLL that expresses hROR1 exclusively in leukemic B cell surface are highly innovative and can be applied to CLL and other ROR1+ malignancies including mantle cell lymphoma and acute lymphoblastic leukemia.

Clinical and radiographic evaluation of demineralized bone matrix (grafton) as a bone graft material in the treatment of human periodontal intraosseous defects

PURPOSE

The purpose of this clinical trial was to evaluate the efficacy of demineralized bone matrix (DBM) as a bone graft material in the treatment of human intrabony periodontal defects as compared with control defects treated by open flap debridement (OFD) alone.

MATERIALS AND METHODS

A controlled clinical trial was carried out for a period of 9 months in 11 patients (4 males and 7 females) with an age group of 25-50 years, contributing to a total of 30 defects. The selected defects were then randomly divided in to experimental sites (OFD + DBM) and control sites (OFD alone). Probing depth, clinical attachment levels and position of the gingival margin were recorded at baseline 3, 6 and 9 months post-operatively. Standardized radiographs (parallel technique) were also documented at these recall intervals.

RESULTS

On completion of 9 months, the mean percentage of probing depth reduction achieved in the experimental sites and control sites was 61.70%, 23.86% respectively. The mean percentage of clinical attachment level gain was 61.34% and 19.37% in the experimental and control sites respectively. In the experimental sites recession was observed to a lesser extent.

CONCLUSION

The use of DBM was more effective than OFD in improving clinical parameters and radiographic bone fill as shown in the present study. However, there is a need for further long term studies.

Tuberculous syringomyelia in an HIV-infected patient: a case report

A 37-year-old HIV-positive Gambian woman presented with spastic weakness of the right leg six years after receiving treatment for tuberculous meningitis (TBM). Magnetic resonance imaging (MRI) of the spine showed a multiloculated syrinx in the thoracic spinal cord extending from the T2 to the T11 level. Syringomyelia and syringobulbia have been reported as complications of TBM. We describe the first case of syringomyelia as an uncommon late complication of treated TBM in the setting of HIV infection. Early recognition of this rare entity may avoid irreversible neurological sequelae.

Clinical evaluation of the biological width following surgical crown-lengthening procedure: A prospective study

BACKGROUND AND OBJECTIVES

The purpose of this study was to evaluate the positional changes of the periodontal tissues, particularly the biological width, following surgical crown-lengthening in human subjects.

MATERIALS AND METHODS

A clinical trial study involving 15 patients was carried out for a period of 6 months. Sites were divided into 3 groups: treated (TT) sites, adjacent (AD) sites and nonadjacent (NAD) sites. Free gingival margin [FGM], attachment level, pocket depth, bone level, biological width [BW] were recorded at baseline, 1, 3 and 6 months. Direct bone level after flap reflection was recorded before and after osseous resection at baseline only. Level of osseous crest was lowered based on BW, and supracrestal tooth structure needed using a combination of rotary and hand instruments.

STATISTICAL ANALYSIS

Student t test and ANOVA were used.

RESULTS

Overall, apical displacement of FGM at TT, AD and NAD sites was statistically significant compared to baseline. The apical displacement of FGM at TT site was more when compared to that at AD and NAD sites at 3 and 6 months. The BW at the TT site was smaller at 1, 3 and 6 months compared to that at baseline. However, at all sites, BW was reestablished to the baseline value at the end of 6 months.

INTERPRETATION AND CONCLUSION

The BW at TT sites was reestablished to its original vertical dimension by 6 months. In addition, a consistent 2-mm gain of coronal tooth structure was observed at the 1, 3 and 6-month examinations.

Modeling electroencephalography waveforms with semi-supervised deep belief nets: fast classification and anomaly measurement

Clinical electroencephalography (EEG) records vast amounts of human complex data yet is still reviewed primarily by human readers. Deep belief nets (DBNs) are a relatively new type of multi-layer neural network commonly tested on two-dimensional image data but are rarely applied to times-series data such as EEG. We apply DBNs in a semi-supervised paradigm to model EEG waveforms for classification and anomaly detection. DBN performance was comparable to standard classifiers on our EEG dataset, and classification time was found to be 1.7-103.7 times faster than the other high-performing classifiers. We demonstrate how the unsupervised step of DBN learning produces an autoencoder that can naturally be used in anomaly measurement. We compare the use of raw, unprocessed data--a rarity in automated physiological waveform analysis--with hand-chosen features and find that raw data produce comparable classification and better anomaly measurement performance. These results indicate that DBNs and raw data inputs may be more effective for online automated EEG waveform recognition than other common techniques.