The safety and efficacy of umbilical cord blood mononuclear cells in individuals with spastic cerebral palsy: a randomized double-blind sham-controlled clinical trial

INTRODUCTION

The current multi-center, randomized, double-blind study was conducted among children with cerebral palsy (CP) to assess the safety and efficacy of umbilical cord blood mononuclear cell (UCB-MNC). We performed the diffusion tensor imaging to assess the changes in the white matter structure.

METHODS

Males and females aged 4 to 14 years old with spastic CP were included. Eligible participants were allocated in 4:1 ratio to be in the experimental or control groups; respectively. Individuals who were assigned in UCB-MNC group were tested for human leukocyte antigen (HLA) and fully-matched individuals were treated with UCB-MNCs. A single dose (5 × 106 /kg) UCB-MNCs were administered via intrathecal route in experimental group. The changes in gross motor function measure (GMFM)-66 from baseline to one year after treatment were the primary endpoints. The mean changes in modified Ashworth scale (MAS), pediatric evaluation of disability inventory (PEDI), and CP quality of life (CP-QoL) were also evaluated and compared between groups. The mean changes in fractional anisotropy (FA) and mean diffusivity (MD) of corticospinal tract (CST) and posterior thalamic radiation (PTR) were the secondary endpoints. Adverse events were safety endpoint.

RESULTS

There were 72 included individuals (36 cases in each group). The mean GMFM-66 scores increased in experimental group; compared to baseline (+ 9.62; 95%CI: 6.75, 12.49) and control arm (β: 7.10; 95%CI: 2.08, 12.76; Cohen's d: 0.62) and mean MAS reduced in individuals treated with UCB-MNCs compared to the baseline (-0.87; 95%CI: -1.2, -0.54) and control group (β: -0.58; 95%CI: -1.18, -0.11; Cohen's d: 0.36). The mean PEDI scores and mean CP-QoL scores in two domains were higher in the experimental group compared to the control. The imaging data indicated that mean FA increased and MD decreased in participants of UCB-MNC group indicating improvements in white matter structure. Lower back pain, headaches, and irritability were the most common adverse events within 24 h of treatment that were related to lumbar puncture. No side effects were observed during follow-up.

CONCLUSIONS

This trial showed that intrathecal injection of UCB-MNCs were safe and effective in children with CP.

TRIAL REGISTRATION

The study was registered with ClinicalTrials.gov ( NCT03795974 ).

Time-Domain Reflectometry Measurements and Modeling of Firn Meltwater Infiltration at DYE-2, Greenland

Surface meltwater can be retained in an ice sheet if it infiltrates the firn and refreezes. This is an important mass balance process for the Greenland Ice Sheet, reducing meltwater runoff and associated sea-level rise. The processes of meltwater infiltration and refreezing are not fully understood, however, and remain difficult to monitor remotely. We deployed vertical arrays of thermistors and time-domain reflectometry (TDR) probes to 4-m depth in the firn to continuously monitor meltwater infiltration and refreezing processes at DYE-2, Greenland. The observations provide a detailed picture of the coupled thermal and hydrological evolution of the firn through the 2016 melt season, including estimates of firn water content. The thaw and wetting fronts reached a maximum depth of 1.8 m, with meltwater infiltration concentrated in four main pulses of melting and subsurface warming that reached progressively deeper into the firn. The observations were used to constrain a coupled model of firn thermodynamics and hydrology, which was then run over the period 1950-2020, driven by meteorological forcing from GC-Net station data and ERA5 climate reanalyses. Model results suggest that decadal-scale firn evolution at DYE-2 is strongly influenced by extreme melt seasons such as those of 1968, 2012, and 2019, when meltwater infiltration reached depths of 6-7 m. Extreme melt years drive increases in firn temperature, ice content, and density, reducing firn meltwater retention capacity. Such processes are likely to govern future meltwater retention as the percolation zone extends to higher elevations in Greenland in the coming decades.

[Acquired nystagmus in a 12-year-old boy as initial presentation of Lyme disease]

We report the case of a 12-year-old boy presenting with acquired horizontal nystagmus, headaches, and vertigo. CT, MRI, viral tests, and the Lyme disease test were at first negative. We made the diagnosis of neuroborreliosis based on a repeated Lyme disease test and lumbar puncture revealing intrathecal synthesis of specific antibodies. Adjusted antibiotic treatment led to complete disappearance of symptoms. Lyme borreliosis is difficult to diagnose and should be sought in case of unusual neuro-ophthalmic signs, especially in children.

Bilateral macular detachment caused by bilateral optic nerve malformation in a papillorenal syndrome due to a new PAX2 mutation

PURPOSE

Papillorenal syndrome is an autosomal dominant entity due to PAX2 gene mutation, involving optic nerve and renal malformations.

METHODS

The authors report a 19-year-old man with bilateral macular detachment associated with optic nerve pit in one eye and morning glory syndrome in the other eye. The patient underwent three-port pars plana vitrectomy, endolaser photocoagulation, and C3F8 gas tamponade in his best eye. A medical history of vesicoureteric reflux and kidney hypoplasia led to genetic analysis.

RESULTS

Molecular genetic PAX2 analysis revealed a novel nondescribed mutation in exon 3. One year postoperatively, ophthalmologic outcomes were satisfactory with complete flattening of the retina and improvement of the best-corrected visual acuity to 11/10.

CONCLUSIONS

PAX2 is involved in the optic vesicles, genital tracts, kidney, and central nervous system embryogenic development. The association of optic nerve and renal malformations should lead to the suspicion of papillorenal syndrome with PAX2 mutation.

Dorsal neuroma of the feet: a case report

A patient presented with bilateral neuromas of medial dorsal nerves of the great toes. She had a 3-year history of localized tenderness and an "electric" type of pain. At surgery, neuromas of the dorsal medial digital nerves were identified and removed. The patient's symptoms resolved completely.

Arthroscopic view of an irreducible knee dislocation

Irreducible knee dislocation is a rare effection of the knee joint; only 23 cases have been reported in the literature. This is a case report of a 35-year-old man who injured his left knee in a motorcycle accident. Dislocation was documented on radiograph. His neurovascular status was intact. Attempts under sedation and anesthesia and even arthroscopy failed to reduce the dislocation. Eventually, the patient had open reduction of the dislocation. An arthroscopy view of the dislocation showed that the medial femoral condyle was buttonholed through the anteromedial capsule and retinaculum. Arthroscopy was an excellent tool for partial lateral meniscectomy and planning the open surgical procedure.