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Stem Cell Research Oct 2019Adipose-derived Stem Cells (ASCs) present great potential for reconstructive procedures. Currently, isolation by enzyme digestion and culturing using xenogenic...
BACKGROUND
Adipose-derived Stem Cells (ASCs) present great potential for reconstructive procedures. Currently, isolation by enzyme digestion and culturing using xenogenic substances remain the gold standard, impairing clinical use.
METHODS
Abdominal lipo-aspirate and blood samples were obtained from healthy patients. A novel mechanical isolation method for ASCs was compared to (the standard) collagenase digestion. ASCs are examined by flowcytometry and multilineage differentiation assays. Cell cultures were performed without xenogenic or toxic substances, using autologous plasma extracted from peripheral blood. After eGFP-transfection, an in vivo differentiation assay was performed.
RESULTS
Mechanical isolation is more successful in isolating CD34/CD31/CD45/CD13/CD73/CD146 ASCs from lipo-aspirate than isolation via collagenase digestion (p <0 .05). ASCs display multilineage differentiation potential in vitro. Autologous plasma is a valid additive for ASCs culturing. eGFP-ASCs, retrieved after 3 months in vivo, differentiated in adipocytes and endothelial cells.
CONCLUSION
A practical method for human ASC isolation and culturing from abdominal lipo-aspirate, without the addition of xenogenic substances, is described. The mechanical protocol is more successful than the current gold standard protocol of enzyme digestion. These results are important in the translation of laboratory-based cell cultures to clinical reconstructive and aesthetic applications.
Topics: Adipose Tissue; Animals; Antigens, CD34; Cell Differentiation; Cell Separation; Cells, Cultured; Culture Media; Female; Humans; Mesenchymal Stem Cells; Mice; Mice, Nude
PubMed: 31421383
DOI: 10.1016/j.scr.2019.101532 -
World Journal of Gastrointestinal... Feb 2016New endoscopic techniques for hemostasis in nonvariceal bleeding were introduced and known methods further improved. Hemospray and Endoclot are two new compounds for... (Review)
Review
New endoscopic techniques for hemostasis in nonvariceal bleeding were introduced and known methods further improved. Hemospray and Endoclot are two new compounds for topical treatment of bleeding. Initial studies in this area have shown a good hemostatic effect, especially in active large scale oozing bleeding, e.g., tumor bleedings. For further evaluation larger prospective studies comparing the substanced with other methods of endoscopic hemostasis are needed. For localized active arterial bleeding primary injection therapy in the area of bleeding as well as in the four adjacent quadrants offers a good method to reduce bleeding activity. The injection is technically easy to learn and practicable. After bleeding activity is reduced the bleeding source can be localized more clearly for clip application. Today many different through-the-scope (TTS) clips are available. The ability to close and reopen a clip can aid towards good positioning at the bleeding site. Even more important is the rotatability of a clip before application. Often multiple TTS clips are required for secure closure of a bleeding vessel. One model has the ability to use three clips in series without changing the applicator. Severe arterial bleeding from vessels larger than 2 mm is often unmanageable with these conventional methods. Here is the over-the-scope-clip system another newly available method. It is similar to the ligation of esophageal varices and involves aspiration of tissue into a transparent cap before closure of the clip. Thus a greater vascular occlusion pressure can be achieved and larger vessels can be treated endoscopically. Patients with severe arterial bleeding from the upper gastrointestinal tract have a very high rate of recurrence after initial endoscopic treatment. These patients should always be managed in an interdisciplinary team of interventional radiologist and surgeons.
PubMed: 26962402
DOI: 10.4253/wjge.v8.i4.205 -
Journal of Substance Abuse Treatment Jan 2023This narrative describes my experience with substance use disorder. It includes a trip through the criminal legal system, recovery, higher education, and a career in...
This narrative describes my experience with substance use disorder. It includes a trip through the criminal legal system, recovery, higher education, and a career in research. I convey key points from a history of using substances and committing crimes and how these created barriers to collegiate and professional aspirations, despite long-term recovery. The substance use services research field has come to value lived experience such as mine, lowering barriers for people with substance use and criminal histories. I hope that my work, built upon this experience, not only helps improve services, but also clears the way for more people in recovery to pursue a career in research.
Topics: Humans; Prisons; Substance-Related Disorders; Criminals; Crime
PubMed: 36327616
DOI: 10.1016/j.jsat.2022.108922 -
Clinical Rheumatology Jan 2021Homelessness is a public health crisis. Homeless individuals have significantly worse health outcomes than the general population. We have begun examining challenges of... (Review)
Review
Homelessness is a public health crisis. Homeless individuals have significantly worse health outcomes than the general population. We have begun examining challenges of caring for homeless patients with rheumatic and musculoskeletal diseases. Difficulties include physical environment, food and financial insecurity, access to healthcare, low health literacy, and comorbid mental illness, and substance abuse. Based on known prevalences of rheumatic and musculoskeletal diseases (RMSDs), we extrapolate that there are thousands of homeless with rheumatoid arthritis (RA), systemic lupus erythematosus, psoriatic arthritis, gout, and osteoarthritis. We present preliminary observations of disparities in the care of homeless patients with RA seen at the Los Angeles County Medical Center of the Keck School of Medicine of the University of Southern California. They tended to be African American males, missed appointments, utilized emergency services frequently, tended not to be on medications, and exhibited severe disease. We reviewed the available literature on homelessness and homeless healthcare to consider what further studies might be helpful and what interventions might improve the care of patients with RMSDs. We identified several aspirational and practical recommendations. These include ensuring access to healthcare for the homeless (indeed for all); reducing disparities through policy, tailored care, and enhanced social services; and recognizing and treating disease early. Developing better approaches for the care of these homeless has obvious and important implications for other underserved populations needing rheumatologic care, patients with early arthritis, or situations where rheumatologists are unavailable. We believe that physicians have a special responsibility to mitigate inequities in this particularly disadvantaged population.
Topics: Ill-Housed Persons; Humans; Los Angeles; Male; Mental Disorders; Musculoskeletal Diseases; Prevalence; Substance-Related Disorders
PubMed: 33200302
DOI: 10.1007/s10067-020-05505-6 -
Journal of Substance Use and Addiction... Mar 2023Ongoing recovery from addiction often happens outside of formal "treatment" settings. Collegiate recovery programs (CRPs) have existed in higher education institutions...
Ongoing recovery from addiction often happens outside of formal "treatment" settings. Collegiate recovery programs (CRPs) have existed in higher education institutions in the United States since the 1980s as part of vital "recovery ready ecosystems" (Ashford et al., 2020) for those with educational aspirations. Aspiration often begins with inspiration and Europeans are now beginning their own journeys with CRPs. In this narrative piece, I use my own lived experience of addiction and recovery through a life course that highlights mechanisms of change that are entwined with academia. This life course narrative maps well on to extant literature on recovery capital and illuminates some of the stigma-based boundaries that still stand in the way of progress in this field. The hope is that this narrative piece will inspire aspirations for both individuals and organizations thinking about setting up CRPs in Europe, and further a field, and also inspire people in recovery to consider education as an aspiration for their continued growth and healing.
Topics: Humans; Behavior, Addictive; Ecosystem; Educational Status; Schools
PubMed: 36880901
DOI: 10.1016/j.josat.2022.208949 -
World Journal of Surgery May 1996Enteral nutrition (EN) has several advantages over parenteral nutrition (PN) for postoperative/posttrauma patients. Modern technologies for tube-feeding have made early... (Review)
Review
Enteral nutrition (EN) has several advantages over parenteral nutrition (PN) for postoperative/posttrauma patients. Modern technologies for tube-feeding have made early EN possible. Jejunal tube-feeding has advantages over gastric tube-feeding: faster metabolic recovery, less vomiting, and less risk of regurgitation and aspiration. Immediate or early EN stimulates the splanchnic and hepatic circulations, improves mucosal blood flow, prevents intramucosal acidosis and permeability disturbances, and eliminates the need for stress ulcer prophylaxis. Saliva containing important antimicrobial substances and gastric acidity are important in sepsis prevention. Chewing, saliva, and gastric acidity support gastric nitric oxide (NO) release, important for mucosal blood flow, gastrointestinal (GI) motility, mucus formation, and bacteriostasis. An oral supply of NO-donating substances and chewing of nitrate-rich food, such as lettuce or spinach, can be useful. Oral and mucosa-protective lipids are recommended. H2 blockers and saliva-inhibiting drugs are avoided. Immediate EN should be given, starting with 25 ml/hr and increasing to 100 ml/hr over 24 to 48 hours. For the immunocompromised patient special attention should be given to the purity of water. Bottled water can contain bacteria such as Pseudomonas. Food antioxidants such as glutathione, vitamin E, and beta-carotenes are important. Ingredients for the colonic mucosa are important. Approximately 10% of caloric need is satisfied by so-called colonic food (prebiotics), fermented at the level of the colonic mucosa to produce colonic mucosa nutrients and to prevent gut origin sepsis. More than 10 g of fiber per day is recommended. The fermenting flora (probiotic flora) is deranged owing to disease or antibiotic treatment, and resupply of flora is important. A new concept of ecoimmune nutrition is presented for enteral supply of mucosa-reconditioning ingredients: new surfactants, pseudomucus, fiber, amino acids such as arginine, and mucosa-adhering Lactobacillus plantarum 299.
Topics: Energy Intake; Enteral Nutrition; Food, Formulated; Gastric Acid; Humans; Intestinal Absorption; Intestinal Mucosa; Multiple Organ Failure; Nutritional Requirements; Saliva
PubMed: 8662138
DOI: 10.1007/s002689900075 -
Journal of Ultrasonography Sep 2013Ultrasound examination is becoming more and more common in patients with rheumatoid diseases. Above all, it enables the assessment of articular soft tissues and... (Review)
Review
Ultrasound examination is becoming more and more common in patients with rheumatoid diseases. Above all, it enables the assessment of articular soft tissues and constitutes a non-invasive examination. In a rheumatologist's everyday practice, it is conducted at the stage of initial diagnosis as well as to monitor the treatment and to confirm the remission if the clinical picture is ambiguous. The first sign of arthritis (including rheumatoid arthritis) that is visible on ultrasound examination is the thickening of the synovial membrane of the joint cavities, tendon sheaths or bursae. It is frequently accompanied by the exudate in the joint, sheath or bursa. In a subsequent stage, in Doppler examination, enhanced vascularization of the synovial membrane is observed. Sometimes, the inflammatory process of the tendon sheaths also affects the tendons, which might lead to their damage. Moreover, ultrasound examination also reveals erosions and inflammatory cysts (geodes) which attest to the advancement of the disease. A dynamic ultrasound examination enables to diagnose the capsule-ligamentous contracture of the interphalangeal joints, which occurs due to the lack of rehabilitation that should begin at the moment of the commencement of the inflammation. The ultrasound image does not allow for the differentiation between various rheumatoid entities, including those encompassing the joints in the hand, wrist. The observed changes, i.e. thickening of the synovial membrane, hyperemia, effusions, erosions or tendon damage, may accompany various rheumatoid entities. The purpose of the ultrasound examination is to recognize these irregularities, determine their localization and advancement and, finally, to monitor the course of treatment. Furthermore, ultrasound scan enables to assess the joints and tendons in a dynamic examination in relation to local ailments of the patient as well as to monitor the biopsy, aspiration and medicine administration. Sonography is used for a US-guided administration of radioisotope substances for synoviorthesis.
PubMed: 26673521
DOI: 10.15557/JoU.2013.0033 -
Annals of the Royal College of Surgeons... Sep 2018Vernagel (sodium polyacrylate) is a powder commonly used in hospitals worldwide for the management and disposal of body fluids. It reacts with fluids to form a semisolid...
Vernagel (sodium polyacrylate) is a powder commonly used in hospitals worldwide for the management and disposal of body fluids. It reacts with fluids to form a semisolid gel. Its main use is to reduce spillages. If ingested, this substance presents significant risk of asphyxiation. There have been 15 reported cases of Vernagel ingestion in 6 years and 1 death from asphyxiation. We present the case of an elderly patient who was admitted following a fall. He accidentally ingested a sachet of Vernagel during the early hours of the morning. An urgent rigid panendoscopy was performed and the material was evacuated using suction aspiration. Patients should be supervised when using Vernagel on the ward, to avoid ingestion. Ear, nose and throat doctors should be aware of Vernagel and its properties. Owing to the risk of airway obstruction, excellent coordination between the anaesthetist and surgeon is crucial, and prompt management is required.
Topics: Acrylic Resins; Aged; Asphyxia; Endoscopy; Foreign Bodies; Humans; Male; Risk Factors; Suction
PubMed: 29909673
DOI: 10.1308/rcsann.2018.0104 -
ALTEX 2016The recent advent of microphysiological systems - microfluidic biomimetic devices that aspire to emulate the biology of human tissues, organs and circulation in vitro -... (Review)
Review
The recent advent of microphysiological systems - microfluidic biomimetic devices that aspire to emulate the biology of human tissues, organs and circulation in vitro - is envisaged to enable a global paradigm shift in drug development. An extraordinary US governmental initiative and various dedicated research programs in Europe and Asia have led recently to the first cutting-edge achievements of human single-organ and multi-organ engineering based on microphysiological systems. The expectation is that test systems established on this basis would model various disease stages, and predict toxicity, immunogenicity, ADME profiles and treatment efficacy prior to clinical testing. Consequently, this technology could significantly affect the way drug substances are developed in the future. Furthermore, microphysiological system-based assays may revolutionize our current global programs of prioritization of hazard characterization for any new substances to be used, for example, in agriculture, food, ecosystems or cosmetics, thus, replacing laboratory animal models used currently. Thirty-six experts from academia, industry and regulatory bodies present here the results of an intensive workshop (held in June 2015, Berlin, Germany). They review the status quo of microphysiological systems available today against industry needs, and assess the broad variety of approaches with fit-for-purpose potential in the drug development cycle. Feasible technical solutions to reach the next levels of human biology in vitro are proposed. Furthermore, key organ-on-a-chip case studies, as well as various national and international programs are highlighted. Finally, a roadmap into the future is outlined, to allow for more predictive and regulatory-accepted substance testing on a global scale.
Topics: Animal Testing Alternatives; Animals; Cell Line; Hazardous Substances; Lab-On-A-Chip Devices; Stem Cells; Toxicity Tests
PubMed: 27180100
DOI: 10.14573/altex.1603161 -
American Journal of Ophthalmology Case... Apr 2017We describe a case of secondary open-angle glaucoma due to mucin-producing congenital iris stromal cyst in a 4 year old patient.
PURPOSE
We describe a case of secondary open-angle glaucoma due to mucin-producing congenital iris stromal cyst in a 4 year old patient.
OBSERVATIONS
A 4-year old female patient with a history of unilateral congenital iris stromal cyst presented with sudden-onset eye pain and redness, with markedly elevated intraocular pressure and evidence of early optic nerve damage. During the examination under anesthesia, the anterior chamber angle was open and there was no evidence of pupillary block. Ultrasound biomicroscopy revealed mildly echogenic substance filling the anterior chamber suspicious of mucoid material, which was verified by the inability to aspirate the material through a 25 gauge needle. The iris cyst was excised, and the intraocular pressure normalized spontaneously. Pathologic examination confirmed a mucin-secreting iris cyst lined with goblet cells and confirmed the mucogenic mechanism.
CONCLUSIONS AND IMPORTANCE
This is the first reported case of mucogenic glaucoma in a pediatric patient. This rare entity should remain on the differential diagnoses of childhood glaucoma associated with nonacquired ocular anomalies. Surgical excision of the iris cyst may be curative.
PubMed: 29503954
DOI: 10.1016/j.ajoc.2016.12.011