Cardioprotective Effects of Wharton Jelly Derived Mesenchymal Stem Cell Transplantation in a Rodent Model of Myocardial Injury

BACKGROUND: Whartons jelly-derived mesenchymal stem cells are a valuable alternative source that possess multipotent properties, easy to obtain and available in large scale compared to BMMSCs. We investigated the possibility of cardiac function improvement post isoproterenol induced cardiac injury in a rat model following human WJMSCs transplantation. MATERIALS AND METHODS: MSCs were extracted and cultured from cord WJ, characterized by morphology, Immunophenotyping and differentiation to osteoblast and adipocytes. WJMSCs were labeled with PKH2 linker dye. Wistar rats were divided into control group, ISO group (injected with 2 doses of isoproterenol) to induce myocardial injury and ISO group transplanted with labelled WJMSCs. ECG, electrocardiographic patterns, cardiac marker enzymes, tracing of labeled MSCs and immunohistochemical analysis of myocardial cryosections were studied. RESULTS AND CONCLUSIONS: WJ derived MSCs were expanded for more than 14 passages while maintaining their un-differentiated state, were positive for MSC markers and were able to differentiate into adipocyte and osteoblast. We demonstrated that intravenously administered WJMSCs were capable of homing predominently in the ischemic myocardium. Cardiac markers were positively altered in stem cell treated group compared to ISO group. ECG and ECHO changes were improved with higher survival rate. WJMSCs could differentiate into cardiac-like cells (positive for cardiac specific proteins) in vivo. WJMSCs infusion promoted cardiac protection and reduced mortality, emphasizing a promising therapeutic role for myocardial insufficiency.

Skull base surgery of non vestibular schwannomas of the posterior cranial fossa

To study the surgical approaches and results of surgery in twenty one patients with non vestibular schwannomas operated upon at the neurosurgery department We retrospectively analyzed a series of 21 patients with histologically verified non-vestibular schwannomas, treated at the Neurosurgery Department, Alexandria University in the period between 2003 and 2008. The age in this group of patients ranged from 20 to 65 years [Mean 38 years]. All patients underwent detailed general and neurological examination and preoperative gadolinium-enhanced magnetic resonance imaging [MRI]. Computerized tomography [CT] scan with thin slices was used in 16 cases to study the bony anatomy. The mean follow-up period was 29 months [range 10 to 61 months]. Twenty one patients with intracranial schwannomas arising from cranial nerves other than the vestibulocochlear were surgically treated in the Neurosurgery department, Alexandria University, in the period between 2003 and 2008. There were 14 males and 7 females and the mean age was 38 years. Seven of our patients underwent surgery elsewhere for partial resection before being referred to our facility; one of these cases underwent fractionated stereotactic radiotherapy for residual tumor after the first surgical intervention. Non-vestibular schwannomas are rare tumors that are best treated by total surgical resection. The location and size of the tumor dictates the surgical approach, however skull base approaches offer better tumor exposure and therefore result in better total tumor resection rate

Methylenetetrahydrofolate reductase C677T polymorphism and relation ship with coronary artery disease

Methylenetetrahydrofolate reductase [MTHFR] is involved in the reduction of 5, 10-methylenetetrahydrofolate to 5-methyltetrahydrofolate. A 677 C/T single nucleotide polymorphism [SNP] localized in the MTHFR gene was associated with both thermo ability and reduced activity of the enzyme and is associated with increased homocysteine levels. The aim of this study was to establish the genetic frequency of MTHFR SNP and whether this MTHFR SNP may affect a homocysteine level and if it is considered as a risk factor for Coronary artery disease [CAD]. This study included 65 subjects [40 cases and 25 controls]. For all participants in this study total lipids profile, Apo Al, homoysteine, blood glucose, folic acid and genetic polymorphism of MTHFR were done. The percentage distribution of the different genotypes in the study population [all subjects] showed that the CC genotype was the most prevalent one followed by CT and then TT [45%, 35%, 20%] respectively. There was no significant association of T Allele in CAD group when compared to control group although plasma homocysteine level was higher in the CAD compared to the control. It seemed that the high levels of homocysteine in CAD are not only dependent on MTHFR activity but also on many factors such as age, sex, and other vitamins which were not measured in this study such as B12 and B6

Role of echocardiography in peri-operative assessment of coronary artery bypass graft surgery

Wall motion abnormalities detected by TEE are more common than ST segment changes detected by ECG. TEE is twice as predictive as ECG in identifying patients who have perioperative myocardial infarction. The study included 50 patients with chronic coronary heart disease underwent CABG surgery. Our results showed that the intraoperative post CABG effect in EF is not significant p>0.05, With DTI we can detect early manifestations of ischaemia through assessment of regional diastolic and systolic velocities. Our results have shown that there is intraoperative immediate significant improvement in the segmental wall motion score index. In patients with multivessel disease, intraoperative TEE and tissue Doppler imaging may be valuable and accurate methods to determine any acute changes in function, this would help to identify if complete and successful revascularization had been performed and define territories requiring more grafting

Percutaneous carotid intervention in patients combined carotid and coronary artery disease

Cerebrovascular accidents [CVA] are the third leading cause of death world wide. Carotid stenosis accounts for 20% to 30% of all CVAs. Thromboembolization of the atherosclerotic stenotic carotid arteries leads to cerebrovascular strokes and transient ischemic attacks [TIAs]. By far the most common lesion found in patients with intracranial cerebral vascular disease is an atherosclerotic plaque at carotid bifurcation. Recently carotid angioplasty and stent implantation appears to be a feasible method for the treatment of carotid stenosis. To assess safety and feasibility of percutaneous intervention in the treatment of carotid artery stenosis in patients with concomitant coronary artery disease. Forty patients with concomitant coronary and carotid artery disease were enrolled in this study, their carotid lesions were managed by carotid artery stenting [CAS] and distal protection devices [filter type] were used. Twenty seven males [67.5%] and 13 females [32.5%] were enrolled in this study their age ranged from 49-82 with the mean of 64.3 years, all had ischemic heart disease and internal carotid artery [1CA] stenosis that ranged from 60 to 99% with the mean of 82.4% +/- 10.5. Optimal results were obtained in 38 patients [95%] and the procedure was incomplete in 2 patients [5%]. Mean stenosis post stenting was 6% +/- 4. In recent outcome, mortality rate was 0% while 5 patients [12.5%] developed minor strokes, and 5 patients [12.5%] developed TIAs. In 18 months follow up, 31 patients [81%] were free from major cerebro-vascular events. Coronary artery stenting [CAS] resulted in reduction of neurological symptoms and major cerebral insult and found to be feasible and safe especially in high risk patients [those with severe coronary artery disease] for surgical interventions

Surgical choices for cervical OPLL

Ossification of the posterior longitudinal ligament [OPLL] is a common cause of cervical myelopathy, especially in Japan, and is more common in males. OPLL is classified into four types: segmental, continuous, mixed and focal. Different surgical approaches are being used to treat this disease, including laminectomy, laminoplasty and anterior, either resecting the ligament or decompressing the cord using the floating technique, leaving the ossified ligament in place. This study included sixteen patients with cervical OPLL treated at Alexandria main University Hospital during a period of two years [July 2001 to July 2003]. The age of the patients ranged from 45-67 years, with a mean age of 58.12 years. Fourteen patents were males and two were females. All patients excluding 2 presented with gradual progressive manifestations. The remaining 2 patients presented with acute onset quadriplegia after minor trauma. Upper extremity weakness and clumsiness, gait difficulty, sphincter dysfunction and neck pain were the most common complaints. Clinical evaluation and outcome of the patients was carried out using the Nurick scale. Fifteen of our patients suffered radiculomyelopathy. One patient with focal OPLL suffered radiculopathy in the distribution of right C6 root. Ten patients improved and six patients remained stationary during a follow-up period of six months. Plain x-rays, magnetic resonance imaging and computed tomography scan were done for all patients. Ossification posterior longitudinal ligament was found to be the continuous type in thirteen cases, mixed in two cases and focal in one. The maximal thickness of the OPLL was 7 mm with a range of 3-7 mm and a mean of 4.3 mm. The most commonly affected levels were C2-C4. The effective canal diameter ranged from 5-13 mm with a mean of 9.8 mm. In this study we used conventional laminectomy in eleven cases, open door laminoplasty in four cases and the anterior approach in only one patient with focal OPLL. We measured the improvement according to the Nurick scale. Ten patients improved and six patients remained stationary during a follow-up period of six months. We concluded from this study that OPLL should be kept in mind in the differential diagnosis in cases of cervical myelopathy. The effective canal diameter and the range of motion of the cervical spine are the most important factors affecting the clinical picture in cases of OPLL. Early surgery is recommended for cases of OPLL because better results are obtained in younger patients with short duration of symptoms. Laminectomy is a simple surgical option in cases of continuous type OPLL, with a stable spine as proved by dynamic study. Laminoplasty is better used in extensive involvement of the spine if the dynamic films show a high range of movement. Anterior approach has the risk of neural injury and is better avoided, especially if dural invasion could be identified in the preoperative imaging study. Anterior approach can be used in focal type OPLL and if used in extensive OPLL. The floating technique is safer than other methods to excise the OPLL

Haemophilus influenzae meningitis at the Abbassia Fever Hospital 1982 to 2001

The aim of this work was to study the prevalence, clinical presentation, outcome of patients with H. influenza meningitis and to determine the efficacy and safety of new therapeutic regimens that could be used in the treatment of the disease and test the susceptibility of the isolates to different antibiotics. During the period from January 1982 to December 2001, 472 children with H. influenza meningitis were admitted to El-Abbassia Fever Hospital, Meningitis Ward in Cairo. The study indicated that H. influenzae is the main causative organism in Egypt accompanied high morality and morbidity rates. Although there has been no increase in the number of cases over the year, a steady increase in the resistance to the traditional drugs has occurred. Thus, it was recommended to use third generation cephalosporins for treatment and Hib vaccines in children

Placenta growth factor [PGF] in cases of normal pregnancy and preeclampsia

This study was designed to assess serum levels of placenta growth factor [PGF] throughout normal pregnancy and in cases of preeclampsia admitted to department of Gynecology and Obstetric, Zagazig University Hospital, and Zagazig General Hospital. Serum samples were collected from: 1] Thirty healthy pregnant women throughout normal gestation i.e 10[th] week [1[st] trimester], 20[th] week [2[nd] trimester], 30[th] week [3[rd] trimester] and at term]. 2] Thirty preeclamptic patients divided into 8 mild to moderate and 22 severe preeclampsia according to the level of the arterial blood pressure, the magnitude of proteinuria /24h and the presence of generalized edema in addition to serum uric acid level. Moreover, in order to evaluate the effect of the mode of delivery on serum levels of PGF,maternal and cord blood samples were taken from cases of normal pregnancy delivered either by uncomplicated vaginal delivery [n = 30] or by cesarean section [n = 30]. PGF levels were determined with an antigen - capture enzyme - linked immunosorbent assay [ELISA]. It was found that maternal PGF levels during normal pregnancy increased significantly from the 10[th] week to the 20[th] week, to reach a very highly statistically significant level at the 30[th] week, then significantly declined from 30 weeks gestation to delivery. However, at term PGF levels remained significantly higher than that in the 1[st] trimester [10[th] week]. Significantly less maternal PGF levels [P < 0.001] were found in pregnancies complicated by preeclampsia despite insignificant change in placental mass. However, a significant difference in PGF levels - between severe and mild to moderate cases of preeclampsia was detected. On the other hand, it was found that

Role of joint molecular markers in assessing physical therapy modalities in traumatic knee effusion

To study the role of joint molecular markers in assessing physical therapy modalities in traumatic knee effusion, 60 athletes, 36 males and 24 females, aged 17-24 y with a mean age of 2l +/- 1.8 y with acute knee injury [ACL and MEN] associated with marked knee effusion. All subjects were subjected to diagnostic arthroscopy, pre- and post physical therapy program knee aspiration. Subjects are classified into three groups, each group consisted of 20 subjects, 8 female athletes and 12 male athletes. All participants are subjected to routine physical therapy [PT] program of post-traumatic knee synovitis, group one received only the routine PT program, group two received beside routine PT program a pulsed ultrasonic treatment, group three received routine PT program and laser treatment. Concentrations of proteoglycan [PGS] cartilage oligomatric protein [COMP], bone sialoprotein [BSP], interlukin-l beta [IL-1 beta], turmor necrosis factor-alpha [TNF-alpha] and interlukin-6 [IL-6] were measured in synovial fluid [SF] of all patient for the pre- and post PT program. Total PGS was measured using a dyebinding method and COMP, BSP, IL-lbeta, TNF-alpha and IL-6 by ELISA. The concentrations of PGS, COMP, BSP, IL-1 beta and TNF-alpha were high in the pre-PT program but that of IL-6 was in the normal level for all the participants [n=60]. Post PT measurement of laser and US groups showed a highly statistical reduction in PGS, COMP, BSP, IL-1 beta and TNF-alpha compared to the control group, IL-6 was significantly elevated in laser and US group compared to the control group. The finding of the present study suggested that PT modalities had a significant roll in controlling cartilage degradation process through inhibition of the catabolic factors and stimulating the inhibitors, suggesting that molecular markers can successfully assess PT rnodalities in various traumatic and rheumatic affections and also PT modalities can act as a prophylaxis against early OA

Comparison of resistance of two types of heat-curing resins to impact force

Accidental fracture of acrylic dental appliances is common during denture service. Recent efforts had been made to improve this deficiency by developing different polymers bases upon polymethyl methacrylate with the addition of rubber. In this study, specimens were prepared according to the British St and ard Specification No. 771 to evaluate the impact of strength of high impact type and conventional heat-cure polymethyl methacrylate in relation to two different curing techniques. The fracture surfaces of two specimens of each group were examined using scanning electron microscope in order to study their microstructure. The results obtained from this study demonstrated a significant increase in the impact strength of high impact type [group 2] than conventional heat-cure polymethyl methacrylate [group 1]. A high significant increase in impact strength was observed in group 4 of high impact type when cured for long time at constant temperature and this technique may reduce the accidental fracture of acrylic dental appliances

Estimation of ventricular DP/DT by continuous wave doppler echocardiography

The present study was carried alit on 30 patients in sinus rhythm with mitral regurgitation, twenty patients have rheumatic heart disease "group I" five have dilated cardiomyopathy "group II" and five have ischemic heart disease "group III". To drive Doppler RRR, two points were arbitrarily selected on the steepest rising segment of the CW mitral regurgitation velocity curve "point A [ml/sec,] point B [3m/sec]" and the time interval between them was measured. Following Benroulli equation, the pressure rise between point A and B is 32 mmHg "4VB2-4VA2" and the rate of pressure rise is 32 mmHg/t. Peak dp/dt obtained at cardiac catheterization by dividing the ascending limb of LV pressure curve into segments of equal time intervals of 40 msec. The pressure rise during these intervals is divided by these intervals P/40 msec to obtain dp/dt. The highest value is the peak dp/dt. We obtained the following group I: Analysis of this group shows no statistically significant difference between results obtained by both methods P0.05 with a good correlation coefficient "r = 0.83". Group II: an excellent correlation coefficient " r=0.98 ". Group III "r=0.97"

Evaluation of functional impression techniques for mandibular bilateral distal extension cases

This study was conducted to compare two functional impression techniques with the mucostatic one in construction of mandibular class I kennedy classification. Six partially edentulous patients were selected and prepared for construction of cobaltchromium removable partial denture against complete denture. For each patient, mucostatic impression was made and the resulted cast compared with two casts poured from functional impression techniques; the frist was a static function impression material and the other was dynamic functional relining impression using korecta Wax IV. The two functional casts were made by altering the mucostatic one and compared with it as regard the degree of compression produced by each functional impression technique to the mobile compressible tissues over the ridge