Efficacy and safety of stem cell transplantation for multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

Multiple sclerosis (MS) is a common autoimmune neurological disease affecting patients' motor, sensory, and visual performance. Stem Cell Transplantation (SCT) is a medical intervention where a patient is infused with healthy stem cells with the purpose of resetting their immune system. SCT shows remyelinating and immunomodulatory functions in MS patients, representing a potential therapeutic option. We conducted this systematic review and meta-analysis that included randomized control trials (RCTs) of SCT in MS patients to investigate its clinical efficacy and safety, excluding observational and non-English studies. After systematically searching PubMed, Web of Science, Scopus, and Cochrane Library until January 7, 2024, nine RCTs, including 422 patients, were eligible. We assessed the risk of bias (ROB) in these RCTs using Cochrane ROB Tool 1. Data were synthesized using Review Manager version 5.4 and OpenMeta Analyst software. We also conducted subgroup and sensitivity analyses. SCT significantly improved patients expanded disability status scale after 2 months (N = 39, MD = - 0.57, 95% CI [- 1.08, - 0.06], p = 0.03). SCT also reduced brain lesion volume (N = 136, MD = - 7.05, 95% CI [- 10.69, - 3.4], p = 0.0002). The effect on EDSS at 6 and 12 months, timed 25-foot walk (T25-FW), and brain lesions number was nonsignificant. Significant adverse events (AEs) included local reactions at MSCs infusion site (N = 25, RR = 2.55, 95% CI [1.08, 6.03], p = 0.034) and hematological disorders in patients received immunosuppression and autologous hematopoietic SCT (AHSCT) (N = 16, RR = 2.33, 95% CI [1.23, 4.39], p = 0.009). SCT can improve the disability of MS patients and reduce their brain lesion volume. The transplantation was generally safe and tolerated, with no mortality or significant serious AEs, except for infusion site reactions after mesenchymal SCT and hematological AEs after AHSCT. However, generalizing our results is limited by the sparse number of RCTs conducted on AHSCT. Our protocol was registered on PROSPERO with a registration number: CRD42022324141.

A finite element analysis study on different angle correction designs for inclined implants in All-On-Four protocol.

BACKGROUND: The aim of this study is to investigate, through finite element analysis (FEA), the biomechanical behavior of the built-in angle corrected dental implant versus implant with angled multiunit abutment used in All-On-Four treatment protocol. METHODS: Two (3D) finite element models of a simplified edentulous mandible were constructed with two different posterior implant designs based on the All-On-Four protocol. Four implants were placed in each model, the two anterior implants were positioned vertically at the lateral incisor/canine sites. Depending on the implant fixture design in posterior area, there are two models created; Model I; the mandible was rehabilitated with four co-axis (4 mm in diameter × 15 mm in length) implants with distally built-in angle corrected implants (24-degree angle correction) .While Model II, the mandible was rehabilitated with four conventional (4 mm in diameter × 14 mm in length) implants with a distally inclined posterior implants (25 degree) and angled multiunit abutments. CAD software (Solidworks© 2017; Dassault Systems Solidworks Corp) was used to model the desired geometry. Axial and inclined Loads were applied on the two models. A Finite element analysis study was done using an efficient software ANSYS© with specified materials. The resultant equivalent Von-Misses stresses (VMS), maximum principal stresses and deformation analysis were calculated for each part (implants and prosthetic components). RESULTS: When applying axial and non-axial forces, model II (angled multiunit model) showed higher deformation on the level of Ti mesh about 13.286 µm and higher VMS 246.68 MPa than model I (angle corrected implant). Model I exhibited higher maximum stresses 107.83 MPa than Model II 94.988 MPa but the difference was not statistically significant. CONCLUSION: Within the limitation of the FEA study, although angle correcting implant design is showing higher values in maximum principle stresses compared with angled multiunit abutments, model deformation and resultant VMS increased with angled multiunit abutments. The angle correcting designs at implant level have more promising results in terms of deformation and VMS distribution than angle correction at abutment level.

Bee venom as an alternative for antibiotics against Staphylococcus aureus infections.

The misuse of antibiotics has led to antibiotic-resistant bacterial strains, making it even harder to combat and eliminate their infections. Staphylococcus aureus causes various adverse infections and diseases, including skin abscesses, bloodstream infections, pneumonia, and joint infections. In this study, we aimed to test the cytotoxic and antibacterial effects of bee venom-loaded chitosan nanoparticles (BV-loaded CS-NPs) in comparison to gamma-irradiated BV and native BV from Apis mellifera. The physiochemical characterizations of our treatments were determined by Fourier Transform Infrared Spectroscopy (FTIR), Transmission Electron Microscope (TEM), zeta-potential, release rate, and Encapsulation Efficiency (EE). Our study was conducted on both levels, in-vitro and in-vivo. For the in-vitro study, a bacterial model of Staphylococcus aureus with an ATCC number of 6538 was grown in tryptic soy agar (TSA) medium, and the inhibition zones of our drug candidates were measured with the appropriate statistical analysis performed. For the in-vivo study, levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), Creatinine, Urea, and interleukin 6 (IL-6) were analyzed. BV-loaded CS-NPs showed relatively better results than the other alternatives, which are native BV and gamma-irradiated BV. The results showed that the antibacterial effect of BV-loaded CS-NPs was greater than the alternatives. Furthermore, its cytotoxic effect was far less than the native and irradiated bee venom. These outcomes ensure that loading BV on CS-NPs makes it a promising drug candidate for an antibiotic alternative with minimal cytotoxicity and enhanced antibacterial activity.

Epidemiological and clinicopathological analysis of basal cell carcinoma in Egyptian population: a 5-year retrospective multicenter study.

PURPOSE: Basal cell carcinoma (BCC) is the most diagnosed type of cancer accounting for 80% of all keratinocyte malignancies. However, the exact demographic properties and clinicopathological criteria for BCC in Egyptians are not clearly reported. Our aim is to report and analyze the epidemiological and clinicopathological features of BCC in Egyptians. METHODS: We retrospectively reviewed the medical records for patients diagnosed pathologically with BCC during the period from January 2017 to December 2021. Data were recruited from four dermatology centers with different geographical distributions. RESULTS: We registered 544 patients. Their age ranged between 22-91 years with a mean of 61.6 ± 13.2 years. Females showed younger age of onset. The mean duration of the tumor was 3.9 ± 3.8 years. The most common involved region was the head (79.4%), and about one third of patients (32.2%) had a giant lesion (> 5 cm). The most common clinical presentation was ulcerative lesions (44.9%). Pathologically, the nodular type represented the most common variant (50.4%). CONCLUSION: Our results proposed that the annual incidence of BCC is increasing among Egyptians. Ultraviolet radiation is considered a high-risk factor of BCC leading to a higher affection of the head region and more prevalence in men. This study also highlights some criteria of BCC in Egyptians such as the long duration of the tumor, the early onset in females, the higher percentage of giant types, and the predominance of nodular type. To our knowledge, this is the first report describing the characteristic features of BCC among Egyptians.

Lasers for cutaneous lesions: An update.

There are several types of medical settings which use lasers. Dermatologists use lasers as it is non-invasive with preferential cosmetic outcomes and finer wound healing. The types of lasers are relying on their wavelengths and delivery systems. Over time, by using several distinct devices and strategies, new lasers have been generated; as a consequence, they are manipulated in a wide range of dermatological settings. In this review, laser applications in various vascular, infectious, and hyperpigmented cutaneous lesions were framed. We aimed to represent the fitness of phototherapy for each condition as well as the overall challenges that face laser. In addition, low-level laser therapy, and laser resurfacing were noted as the marketable line of lasers in the current time for cosmetic purposes.

The combined effect of CO2 laser, topical diclofenac 3%, and imiquimod 5% in treating high-risk basal cell carcinoma.

BACKGROUND: Some basal cell carcinoma (BCC) patients are considered as a high risk regarding the site, size, histopathological variant, or recurrence. High-risk BCC is a challenging therapeutic problem due to the trial to balance between complete surgical excision from one side and tissue preservation from the other side. AIM: To evaluate the efficacy of combining ablative CO2  laser, imiquimod 5%, and diclofenac 3% as a therapeutic regimen in high-risk and inoperable BCC. PATIENTS/METHODS: The study was conducted on 14 patients that were assessed clinically and pathologically then categorized regarding the site, size, histopathology, and fitness for surgery as high-risk inoperable BCC. They received an ablative session of CO2  laser, followed by application of diclofenac sodium 3% gel once daily for 5 days and imiquimod 5% cream for another 2 days. RESULTS: The study included 11 males and 3 females. Nine lesions were located on the scalp, 4 on the face, and one lesion on the trunk. All lesions were of large size >5 cm in diameter. Histopathology showed 4 patterns: nodular type in 8 patients, infiltrating type in 3 patients, metatypical type in 2 patients, and micronodular type in one patient. At the end of the treatment period, 9 patients showed significant (moderate to marked) improvement while 5 patients showed weak (poor to mild) response. Significant improvement was more observed in nodular type. Relapse was more observed during the 5th to 6th months with 2 patients showed no relapse. CONCLUSION: This combined regimen is a good alternative therapeutic modality in high-risk inoperable BCC especially the nodular pathologic pattern.

Effect of specific retention biomaterials for ball attachment on the biomechanical response of single implant-supported overdenture: A finite element analysis.

PURPOSE: The purpose of this finite element analysis (FEA) was to evaluate the effect of specific retention biomaterials with different elastic modulus on the biomechanical response to the axial and off-axial biting loads of a mandibular midline single implant-supported overdenture (SIO) model. METHODS: Five 3-dimensional (3D) finite element models of an edentulous mandible with SIO were designed as follows: model M with a titanium retentive element for ball attachment, model P with a PEEK retentive element, model S with a silicone resilient liner retentive element, model T with a thermoplastic acrylic resin retentive element made from a CAD-CAM material, and model A with a polyacetal resin retentive element. Posterior bilateral vertical load (PV) at the 1st molar areas and anterior oblique load (AO) at the incisal edge of the mandibular central incisors at a 30-degree angle of 100 N were applied. Stress values were recorded. RESULTS: Stress values were higher for all models under (AO) loading than under (PV) loading. Model M recorded the highest stress values on the implant, its components, cortical, and cancellous bone under both loading conditions. Under (AO) loading condition, the ball abutment von Mises stress value in model S was almost 7 times lower than that of model M (19 and 130 MPa respectively) and the other 3 models (P, T, and A) (119, 121, and 120 MPa respectively). However, model S recorded the highest value of denture base stress at the attachment area. CONCLUSIONS: The elastic modulus of retention materials can affect stresses generated on the implant overdenture components and supporting structures.

Focused, radial and combined shock wave therapy in treatment of calcific shoulder tendinopathy.

Objective: The aim of this work is to compare the clinical, functional, and ultrasonographic outcomes of focused, radial, and combined extracorporeal shock-wave therapy (ESWT) in the treatment of calcific shoulder tendinopathy.Methods: we enrolled 45 patients with calcific shoulder tendinopathy, their ages ranged from 30 to 68 (50.93 ± 9.44) years, classified according to the line of treatment into three groups, all received four sessions of ESWT 1 week apart.Group I: 15 patients received focused shock waves (F-SW) 1500 shocks.Group II: 15 patients received radial shock waves (R-SW) 2000 shocks.Group III: 15 patients received combined focused and radial shock waves (C-SW). All patients were evaluated by musculoskeletal ultrasound (MSK US) before treatment, at 1 week and at 3 months after the last session.Results: In the three studied groups, there was a significant improvement in shoulder pain, active range of motion (ROM), and shoulder function by shoulder disability questionnaire (SDQ) at 1 week after the end of treatment and after 3 months follow up. Moreover, there was a significant sonographic reduction in calcification size in the three groups. At the end of the study, the best improvement as regards a decrease of calcification size was obtained in group III when compared with group I and group II.Conclusion: These results demonstrated clinical, functional, and sonographic improvement in all groups. The best therapy in calcific shoulder tendinopathy appears to be combined focused and radial ESWT compared to interventions alone. Level 1 Evidence Randomized control study.

Improving wear resistance of plasma-sprayed calcia and magnesia-stabilized zirconia mixed coating: roles of phase stability and microstructure.

The phase stability and microstructure of ZrO2-5CaO and ZrO2-24MgO mixed coating (wt%) by air plasma spraying on 304 stainless steel substrates were investigated. A Ni-5Al (wt%) metallic bond coating was firstly sprayed between the substrate and the ceramic top layer. The results were compared with the individual coatings of ZrO2-5CaO and ZrO2-24MgO for a better understanding of the correlation between their microstructures and mechanical properties. Mixed zirconia coating was found to have a mixture of cubic and tetragonal phases that stabilized under different plasma spray conditions. Microscopic observations and elemental composition analysis of as-sprayed mixed coating showed that modified ceramic-matrix grains had been formed. Microsized ZrO2-5CaO particles were embedded in the matrix grain creating an intragranular microstructure. Results indicated that ceramic-matrix grains provided a diffusion barrier for the growth of oxides induced stress near and onto the bond layer that reduced cracks, thereby overcoming the top delamination of the ceramic coating. Moreover, disparity in wear resistance and microhardness behavior of the coatings was influenced by initial feedstock powder and matrix microstructures. Improvement in the wear resistance of the mixed zirconia coating was attributed to a decrease in oxide content, which resulted in an increase in intersplat cohesive strength.

Lung Nodule Detection based on Ensemble of Hand Crafted and Deep Features.

Lung cancer is considered as a deadliest disease worldwide due to which 1.76 million deaths occurred in the year 2018. Keeping in view its dreadful effect on humans, cancer detection at a premature stage is a more significant requirement to reduce the probability of mortality rate. This manuscript depicts an approach of finding lung nodule at an initial stage that comprises of three major phases: (1) lung nodule segmentation using Otsu threshold followed by morphological operation; (2) extraction of geometrical, texture and deep learning features for selecting optimal features; (3) The optimal features are fused serially for classification of lung nodule into two categories that is malignant and benign. The lung image database consortium image database resource initiative (LIDC-IDRI) is used for experimentation. The experimental outcomes show better performance of presented approach as compared with the existing methods.

Facile Synthesis, Characterization, and Antimicrobial Evaluation of Novel Heterocycles, Schiff Bases, and N-Nucleosides Bearing Phthalazine Moiety.

The present work describes convenient synthesis of the novel Schiff bases 5a and b by reacting phthalazinones 4a and b with 4-methoxybenzaldehyde Reaction of the Schiff bases with phenylisothiocyanate afforded diazetidine derivatives 7a and b. Also, compounds 4a and b reacted with 2-bromoglucoside tetraacetate giving peracetylated N-glycosides 6a and b, which were deacetylated to afford N-glycosylated phthalazinones 8a and b. On the other hand, when compound 3 was treated with POCl3/PCl5 and/or ethyl chloroacetate, chlorophthalazine and ethyl acetate derivatives 9 and 10 were obtained, respectively. Hydrazinolysis of compounds 9 and 10 produced the hydrazino and hydrazide derivatives 11 and 12, respectively. When compound 11 reacted with 2-furanaldehyde, acetic anhydride, and/or carbon disulphide, it gave compounds 13-15, respectively. Treatment of the hydrazide 12 with aromatic aldehydes, acetic anhydride, ethyl acetoacetate, acetyl acetone, ammonium thiocyanate, and/or phthalic anhydride furnished compounds 17-21. Meanwhile, reacting Schiff base 22 with the chlorophthalazine derivative 9 produced compound 23, which on treatment with furoyl chloride produced compound 24. The structures of the novel compounds were confirmed by IR, (1)H-NMR, (13)C-NMR, MS, and elemental analysis. The newly synthesized compounds were tested against Bacillus subtilis and Staphylococcus aureus as Gram-positive bacteria, Escherichia coli and Pseudomonas aurignosa as Gram-negative bacteria, and Candida albicans and Aspergillus niger as fungi strains. Compounds 5a and b, 23, and 24 showed greater antimicrobial activity than the stranded compounds, suggesting that they could be considered as promising antimicrobial agents.

Does Platelet-Rich Fibrin Enhance Bone Quality and Quantity of Alveolar Cleft Reconstruction?

BACKGROUND: Recently, platelet-rich fibrin (PRF) was described as a second-generation platelet concentrate. PRF is known as a rich source of autologous cytokines and growth factors and is universally used for tissue regeneration in clinical medicine. OBJECTIVE: The aim of the current study was to evaluate the effect of PRF on the quality and quantity of bone formation in unilateral maxillary alveolar cleft reconstruction. PATIENTS AND METHODS: Twenty-four patients with unilateral alveolar cleft underwent bone reconstruction. Patients were randomly divided into two groups. Group A consisted of patients grafted with PRF combined with autogenous anterior iliac crest bone graft. Group B patients were grafted using autogenous bone graft alone (control group). Computed tomography was performed 6 months postoperatively to assess the quality and quantity of the newly formed bone. RESULTS: The percentage of newly formed bone (quantity) in group A ranged from 79.74% to 88.4%, with a mean percentage of 82.6% ± 3.9%. In group B, the percentage of bone formation ranged from 60.3% to 76.4%, with a mean percentage of 68.38% ± 6.67%. There was a statistically significant increase in the percentage of newly formed bone in group A. The mean bone density (quality) of the newly formed bone was lower in group A than group B, but the difference was not statistically significant (P < .05). CONCLUSIONS: PRF in combination with autogenous bone was beneficial in improving the volume of newly formed bone in alveolar cleft reconstruction and does not enhance bone density.

Immunohistochemical and histopathological findings of ovine pulmonary adenocarcinoma (Jaagsiekte) in Egyptian sheep.

Ovine pulmonary adenocarcinoma (OPA) is a naturally occurring retrovirus-induced transmissible lung cancer in sheep. Lungs and associated (bronchial and mediastinal) lymph nodes of seven sheep with OPA were examined. Lungs had few multifocal consolidated slightly elevated gray to white masses ranging from 0.5 to 3 cm in diameter. Histopathologically, these masses appeared as well-differentiated acinar adenocarcinoma with little evidence of anaplasia. The acini composed of well-differentiated cuboidal to low columnar epithelium with clear or vacuolated cytoplasm and low mitotic index. No metastases were observed in the bronchial and mediastinal lymph nodes of any animal. The presence of Jaagsiekte sheep retrovirus (JSRV) was demonstrated in the lungs by immunohistochemistry. JSRV protein was detected in all tumor epithelial cells, histologically normal alveolar type II cells, and few bronchiolar epithelial cells, alveolar macrophages, lymphocytes, and plasma cells. This study is the first to confirm the presence of natural OPA in Egypt.