Effects of human umbilical cord mesenchymal stem cells on inflammatory factors and miR-181a in T lymphocytes from patients with systemic lupus erythematosus.

OBJECTIVES: The present study aimed to explore the effect of umbilical cord mesenchymal stem cells (UC-MSCs) on the modulation of T lymphocytes from system lupus erythematosus (SLE) patients and the possible mechanism. METHODS: A total of 24 hospitalized SLE patients and 28 healthy individuals were enrolled. T lymphocytes were sorted using Miltenyi magnetic beads. After the addition of recombinant human interleukin (IL)-2 and CD3CD28 T-cell activator, cells were loaded onto six-well plates pre-inoculated or not with UC-MSCs for 1 week of culture. The supernatants were collected for testing inflammatory factors by enzyme-linked immunosorbent assay. Meanwhile, T lymphocytes were collected to assess the expression levels of genes, proteins in relation to SLE and miR-181a by polymerase chain reaction and Western blot. RESULTS: Compared with T lymphocytes cultured alone, interferon-γ, IL-4, IL-6 and IL-10 levels were significantly decreased in T lymphocytes from SLE patients co-cultured with UC-MSCs. In addition, the gene and protein expression levels of TNF alpha, osteopontin and nuclear factor-kappa B in T lymphocytes were significantly decreased, while miR-181a expression was markedly elevated (p < 0.05 or 0.008). CONCLUSION: UC-MSCs have showed certain immunomodulatory and inhibitory effects in vitro on T lymphocytes from SLE patients, which could potentially be a beneficial treatment of the disease. UC-MSCs may up-regulate miR-181a and down-regulate inflammation-related gene expression.

Haemorrhoidectomy: Ferguson's (closed) vs Milligan Morgan's technique (open).

This study was done to compare the efficacy of closed Vs open haemorrhoidectomy. The study design was unblinded randomised control trial at Dhulikhel Hospital, Kathmandu University Hospital. Total number of patients was 56 all with 3rd and 4th degree haemorrhoids. Post operative pain was taken as main outcome measures. Operation time varied from 200 seconds for each haemorroidal cushion with open technique to 626 seconds by closed technique. The blood loss was not quantifiable in closed technique. Pain was scored on visual analogue scale. In closed group, the pain score was 4.9 immediate post operative period and 2.3 (24 hours later). In the other group, the scores were 7.8 and 6.9. These differences were significant. At the end of study we came to a conclusion that haemorrhoidectomy using closed technique has more advantages.

Management of urethral strictures and their outcome.

Urethral stricture is a challenging surgical problem since the ancient time. Its outcome is very poor because of the high recurrence rate 40.0-50.0% whatever procedure is conducted to treat the condition. Between January 2004 to December 2007, 61 cases with urethral stricture were treated in our hospital. Management of stricture was decided according to the grading of urethral stricture. Of 61 cases, 42 (68.8%) had grade I-II, 10 (16.4%) had grade III and 9 (14.8%) had grade IV strictures. They were treated with optical internal urethrotomy (OIU), modified railroading and end to end anastomotic urethroplasty respective to gradings. During the average 2 years follow up period, outcome of strictures were analyzed. Recurrence of stricture was noted 31.0% in grade I-II after OIU and 11.0% in grade IV after urethroplasty. However, in cases with grade III stricture recurrence rate was observed in 60.0% after modified railroading. During the follow up period, 50.0% of the grade III strictures were converted to urethroplasty. It is suggested that, OIU is still a gold standard procedure to manage the lower grade (I-II) strictures with low morbidity, minimally invasive and success rate is 69.0%. End to end anastomotic urethroplasty for grade IV stricture has very good result (89.0%) but needs skilful mobilization of distal urethra to prevent chordee. However, grade III stricture needs open urethroplasty or modified railroading by using flexible cystoscopy which may reduce recurrence rate.

A comparative study of pre-operative with operative diagnosis in acute abdomen.

In this observational study (from August 2000 to January 2001) 102 patients of all age group with non-traumatic acute abdomen were studied to see the negative laparotomy rate and the diagnostic accuracy and predictive values of different investigations in acute abdomen. The disease was most common in the age group 20-29 years with male predominance. More than half of the acute abdomen was due to the acute appendicitis. Neutrophil leucocyte count had the highest sensitivity (91.5%) while Plain X-ray abdomen showed the highest specificity (88.8%) and positive predictive value (88.6%) in diagnosing acute abdomen. Urinalysis showed the highest negative predictive value (93.3%). Overall diagnostic accuracy was 78.4%, which was statistically significant (p<0.05). Diagnostic accuracy was highest in bowel obstruction (82.4%) and lowest in peritonitis due to viscus perforation (69.0%). Negative laparotomy rate was 17.6% in the study, which was statistically significant (p<0.05). It was highest with peritonitis due to viscus perforation (20.7%), and lowest in bowel obstruction (11.8%).