Five-year follow-up of the local autologous transplantation of CD133+ enriched bone marrow cells in patients with myocardial infarction.

BACKGROUND: The implantation of a CD133+ bone marrow cell population into an ischemic myocardium has emerged as a promising therapeutic modality for myocardial regeneration and restoration of ventricular contractility. While previous studies have documented the short-term safety and efficacy of CD133+ cell transplantation in patients with acute myocardial infarction, there are few reports of long-term follow-up results. Here, we present the results of long-term follow-up of our acute myocardial infarction patients who were treated with intramyocardial injection of CD133+ cells after coronary bypass graft. METHODS: After five years, 13 patients in the cell transplantation group and 5 patients in the control group underwent safety and efficacy investigations by New York Heart Association classification and two-dimensional echocardiography (2D echo). RESULTS: During the five-year study period, no major cardiac adverse events were reported among patients who received CD133+ stem cells. Regarding efficiency, we observed no statistically significant treatment effects for the echocardiographic parameters [left ventricular end-diastolic and end-systolic volumes, and resting ejection fraction] measured during the follow-up period. However, detailed analysis of regional wall motion revealed an improvement in the Wall Motion Score Index from baseline to the six month follow-up, which was maintained during the follow-up period. CONCLUSION: Taken together, the long-term results of the present study indicate that transplantation of CD133+ is a safe and feasible procedure; however, we could not show any major benefits in our patients. Thus, this issue needs to be addressed by conducting other studies with more patients.

The relationship between serum 25-hydroxy vitamin D concentration and obesity in type 2 diabetic patients and healthy subjects.

BACKGROUND: Both obesity and type 2 diabetes are associated with hypovitaminosis D. The aims of this study were to investigate the association of serum 25-hydroxy vitamin D (25(OH) D) and parathyroid hormone (PTH) concentration with body mass index (BMI) in type 2 diabetic patients compared to control subjects and their predicting role in obesity. METHODS: This cross-sectional study was conducted on 200 subjects (100 type 2 diabetics and 100 healthy controls). Concentration of 25(OH) D, calcium, phosphorous, parathyroid hormone (PTH), fasting blood glucose, HbA1c, serum insulin, homeostasis model assessment of insulin resistance (HOMA-IR) was determined in the fasting samples. Anthropometric measurements including body mass index (BMI) were also measured. RESULTS: Eighty-five percent of type 2 diabetics and 79% of healthy subjects were suffering from vitamin D deficiency or insufficiency. Serum concentration of 25(OH) D (22.08 ± 15.20 ng/ml) (r = -0.11, P = 0.04) and calcium (8.94 ± 0.59 mg/dl) (r = -2.25, P = 0.04) has significant statistically with BMI in type 2 diabetic patients. Serum concentration of PTH has non-significantly associated with BMI in diabetic patients and healthy subjects. CONCLUSION: Serum levels of vitamin D inversely and PTH positively are associated with BMI after adjusted for age, gender and serum calcium in both type 2 diabetic patients and healthy subjects. These associations were statistically significant for serum concentration of vitamin D and calcium only in diabetic patients. So the status of vitamin D is considered as an important factor in type 2 diabetic patients.

Does tranexamic acid reduce blood loss in off-pump coronary artery bypass?

The hemostatic effect of tranexamic acid on the bleeding tendency and transfusion requirements in patients undergoing off-pump coronary artery bypass surgery was assessed in a prospective randomized double-blind study. Of 66 patients undergoing elective operations, 33 were given tranexamic acid (15 mg x kg(-1) before infusion of heparin and 15 mg x kg(-1) after protamine infusion), and the other 33 received only saline. Postoperative bleeding, transfusions, complications, hematological variables, and plasma D-dimer levels were recorded. Postoperative blood loss was significantly less in the tranexamic acid group compared to the control group (320 +/- 38 vs 480 +/- 75 mL). Patients in the tranexamic acid group received significantly less allogeneic blood products (0.46 vs 0.94 units per patient), and they had lower postoperative D-dimer levels. No postoperative thrombotic complications were observed in either group. Although off-pump coronary artery bypass surgery is associated with reduced frequency of hemorrhagic disorders, defective hemostasis still occurs, and tranexamic acid effectively reduces postoperative blood loss and the need for allogeneic blood products.

Safety analysis and improved cardiac function following local autologous transplantation of CD133(+) enriched bone marrow cells after myocardial infarction.

The CD133(+) bone marrow cell (BMC) population includes primitive multipotent stem cells which induce neoangiogenesis. Studies suggested transplantation of these cells to infarcted myocardium can have a favorable impact on tissue perfusion and contractile performance. We assessed the feasibility, safety and functional outcomes of autologus CD133(+) BMC transplantation during coronary artery bypass grafting (CABG) in patients with recent myocardial infarction. In a prospective, nonrandomized, open-label study, 27 patients with recent myocardial infarction underwent CABG and intramyocardial injection of autologous bone marrow-derived CD133(+) cells (18 patients, BMC group) or CABG alone (9 patients, control group). At 6 months after CABG, the Wall Motion Score Index (WMSI) was significantly reduced for akinetic/dyskinetic segments treated with CD133(+) cells compared with the control group (P<0.006). Likewise, comparison between baseline and follow up results of dobutamine stress echocardiography and myocardial perfusion scintigraphy showed improvement of myocardial viability and local perfusion of the infarcted zone of the BMC group compared with the control group. No complications related to CD133(+) cell transplantation were noted, either procedurally or during postoperative at a mean of 14 months follow up. In patients with recent myocardial infarction, transplantation of CD133(+) cells to the peri-infarct zone during CABG surgery is feasible and safe, with no evidence of early or late adverse events. Moreover, these cells might restore tissue viability and improve perfusion of the infarcted myocardium, suggesting that they may induce myogenesis as well as angiogenesis.

Effects of tranexamic acid and autotransfusion in coronary artery bypass.

The aim of this study was to compare the effects of intraoperative autotransfusion and tranexamic acid on postoperative bleeding and the need for allogeneic transfusion. In a prospective randomized study, 200 patients undergoing coronary artery bypass were divided into two groups: 100 patients received 1-2 units of autologous blood after termination of cardiopulmonary bypass; and 100 patients were given tranexamic acid 15 mg x kg(-1) before injection of heparin and again before injection of protamine. Postoperative bleeding was significantly lower in the tranexamic acid group (600 mL) than the autotransfusion group (1,100 mL). The percentage of patients transfused in the autotransfusion and tranexamic acid groups was 70% and 65%, respectively. Patients in the autotransfusion group received significantly more whole blood (2.82 vs 1.93 units). Intensive care and hospital stays were shorter in the tranexamic acid group. There was no hospital mortality and no difference in thrombotic complications between groups. Tranexamic acid was more effective than autotransfusion in reducing postoperative blood loss and allogeneic transfusions after coronary bypass.

Clinicopathological features of primary central nervous system lymphoma.

OBJECTIVE: To investigate the anatomic location, immunologic, and clinicopathological features of patients with primary central nervous system lymphoma (PCNSL). METHODS: From May 1993 to December 2004, at Shohada Hospital, Tehran, Iran, the clinical data of 110 PCNSL patients, including the age, sex, duration of symptoms, radiological findings, site of tumors, immune status, and history of immunocompromised state (such as organ transplantation, radiotherapy, steroid therapy or AIDS) were assessed. RESULTS: The mean age of the patients with PCNSL was 47.02 +/- 15.8 years. There were 42 female and 68 male patients. One hundred and six cases (96.3%) were diagnosed as B-cell lymphoma. Most of the PCNSL in our study are unifocal. More than 70% of tumors were in a cerebral hemisphere and periventricular location, usually involving the corpus callosum or basal ganglia. No patients had been in immunocompromised states. Symptoms of increased intracranial pressure or changes in personality, vision, or motor function are most common. Seizures are seen in approximately 10% of patients. The number of PCNSL cases showed a gradual rise in incidence. CONCLUSION: The results of this single hospital 12-year survey of PCNSL are in agreement with data from other single institutions and regional surveys concerning clinical features. However, in contrast with the literature, most of our patients were immunocompetent. The age at diagnosis is also lower than in most reports.