Electrospinning Auricular Shaped Scaffolds for Tissue Engineering

Poly(ɛ)caprolactone scaffolds have been electrospun directly into an auricular shaped conductive mould. Bovine chondrocytes were harvested from articular cartilage and seeded onto 16 of the produced scaffolds, which received either an ethanol (group A) or a plasma treatment (group B) for sterilisation before seeding. The seeded scaffolds were cultured for 3 weeks in vitro and analysed with regard to total DNA and GAG content as well as the expression of AGG, COL1, COL2, MMP3 and MMP13. Rapid cell proliferation and GAG accumulation was observed until week 2. However, total DNA and GAG content decreased again in week 3. qPCR data shows a slight increase in the expression of anabolic genes and a slight decrease for the catabolic genes, with a significant difference between the groups A and B only for COL2 and MMP13.

A longitudinal study of Type-B aortic dissection and endovascular repair scenarios: computational analyses

Conservative medical treatment is commonly first recommended for patients with uncomplicated Type-B aortic dissection (AD). However, if dissection-related complications occur, endovascular repair or open surgery is performed. Here we establish computational models of AD based on radiological three-dimensional images of a patient at initial presentation and after 4-years of best medical treatment (BMT). Computational fluid dynamics analyses are performed to quantitatively investigate the hemodynamic features of AD. Entry and re-entries (functioning as entries and outlets) are identified in the initial and follow-up models, and obvious variations of the inter-luminal flow exchange are revealed. Computational studies indicate that the reduction of blood pressure in BMT patients lowers pressure and wall shear stress in the thoracic aorta in general, and flattens the pressure distribution on the outer wall of the dissection, potentially reducing the progressive enlargement of the false lumen. Finally, scenario studies of endovascular aortic repair are conducted. The results indicate that, for patients with multiple tears, stent-grafts occluding all re-entries would be required to effectively reduce inter-luminal blood communication and thus induce thrombosis in the false lumen. This implicates that computational flow analyses may identify entries and relevant re-entries between true and false lumen and potentially assist in stent-graft planning.

Varicella zoster virus reactivation after autologous SCT is a frequent event and associated with favorable outcome in myeloma patients.

The occurrence of varicella zoster virus (VZV) reactivation is increased after allogeneic transplantation, whereas limited data are available for herpes zoster (HZ) after autologous SCT (ASCT). We determined the incidence and the prognostic significance of HZ and its correlation with VZV serology in 191 consecutive myeloma patients undergoing high-dose melphalan chemotherapy with ASCT. We found that VZV reactivation occurred in 57 (30%) patients, in 8.5% during induction and in 21.5% after ASCT peaking at 8 months after ASCT. Disease burden due to HZ was assessed as high or rather high in 70% of the patients. By immune fluorescence and Serion Elisa VZV IgG assessment, 90.8% of all patients had specific anti-VZV antibodies at ASCT. Lower specific antibody titers at transplantation were observed in patients with HZ after ASCT than in those without reactivation (P=0.009). Finally, OS was better in myeloma patients with HZ after ASCT compared with patients without HZ (P=0.007). Our data indicate that VZV reactivation after ASCT is a frequent event carrying a significant disease burden and it is associated with improved survival. Low levels of specific VZV antibodies at ASCT suggest increased vulnerability for VZV reactivation.Bone Marrow Transplantation advance online publication, 19 January 2015; doi:10.1038/bmt.2014.290.

Tumor immunization strategies for enhancing the graft versus tumor activity of allogeneic bone marrow transplantation

Allogeneic bone marrow transplantation (BMT) is known to induce a beneficial anti-tumor immune response called graft-versus-tumor (GVT) activity. However, GVT activity is closely associated with graft-versus-host disease (GVHD), a potentially fatal immune response against antigens on normal recipient tissues. The T-cell populations mediating these two processes are often overlapping, but studies have shown that some donor T-cells can be tumor-specific. Therefore, the goal of this study was to develop strategies for preferentially activating donor T-cells capable of mediating GVT activity but not GVHD. The three hypotheses tested were: (1) Pre-transplant immunization of BMT donors with a recipient-derived tumor cell vaccine will induce a relative increase in GVT activity as compared to GVHD. (2) Post-transplant tumor immunization of BMT recipients will enhance GVT activity without exacerbating GVHD. (3) Pre-transplant immunization of BMT donors against a tumor-specific antigen will enhance GVT activity without exacerbating GVHD. ^ To test the first two hypotheses, C3H.SW mice (MHC-matched donors) were immunized with a C57BL/6 (recipient)-derived tumor cell vaccine (leukemia or fibrosarcoma) prior to BMT, or recipients were immunized starting one month after BMT. Both donor and recipient immunization led to a significant increase in GVT activity (enhanced recipient survival and decreased tumor growth). However, donor immunization also increased fatal GVHD, which was at least partially due to activation of alloreactive T-cells recognizing the immunodominant minor histocompatibility antigen B6dom1. GVT immunity following recipient immunization was not associated with an exacerbation of GVHD or a response to B6dom1. ^ To test the third hypothesis, influenza nucleoprotein (NP) was used as a model tumor antigen. C3H.SW donors were immunized against NP prior to BMT, which led to a significant increase in GVT activity. Although recipients were not completely protected against growth of antigen loss variant tumors, there was no increase in GVHD. ^ In conclusion, (1) immunization of allogeneic BMT donors with a recipient-derived tumor cell vaccine substantially increases GVT activity but also exacerbates GVHD, (2) post-transplant tumor immunization of allogeneic BMT recipients significantly increases GVT activity and survival without exacerbating GVHD, and (3) immunization of allogeneic BMT donors against a tumor-specific antigen significantly enhances GVT activity without exacerbating GVHD. ^

A novel treatment planning methodology for high dose 166Ho-DOTMP therapy in patients with multiple myeloma

Bone marrow ablation, i.e., the complete sterilization of the active bone marrow, followed by bone marrow transplantation (BMT) is a comment treatment of hematological malignancies. The use of targeted bone-seeking radiopharmaceuticals to selectively deliver radiation to the adjacent bone marrow cavities while sparing normal tissues is a promising technique. Current radiopharmaceutical treatment planning methods do not properly compensate for the patient-specific variable distribution of radioactive material within the skeleton. To improve the current method of internal dosimetry, novel methods for measuring the radiopharmaceutical distribution within the skeleton were developed. 99mTc-MDP was proven as an adequate surrogate for measuring 166Ho-DOTMP skeletal uptake and biodistribution, allowing these measures to be obtained faster, safer, and with higher spatial resolution. This translates directly into better measurements of the radiation dose distribution within the bone marrow. The resulting bone marrow dose-volume histograms allow prediction of the patient disease response where conventional organ scale dosimetry failed. They indicate that complete remission is only achieved when greater than 90% of the bone marrow receives at least 30 Gy. ^ Comprehensive treatment planning requires combining target and non-target organ dosimetry. Organs in the urinary tract were of special concern. The kidney dose is primarily dependent upon the mean transit time of 166 Ho-DOTMP through the kidney. Deconvolution analysis of renograms predicted a mean transit time of 2.6 minutes for 166Ho-DOTMP. The radiation dose to the urinary bladder wall is dependent upon numerous factors including patient hydration and void schedule. For beta-emitting isotopes such as 166Ho, reduction of the bladder wall dose is best accomplished through good patient hydration and ensuring a partially full bladder at the time of injection. Encouraging the patient to void frequently, or catheterizing the patient without irrigation, will not significantly reduce the bladder wall dose. ^ The results from this work will produce the most advanced treatment planning methodology for bone marrow ablation therapy using radioisotopes currently available. Treatments can be tailored specifically for each patient, including the addition of concomitant total body irradiation for patients with unfavorable dose distributions, to deliver a desired patient disease response, while minimizing the dose or toxicity to non-target organs. ^

Vasculogenesis: A process of vessel formation and its role during Ewing's sarcoma development

Vasculogenesis is the process by which Endothelial Precursor Cells (EPCs) form a vasculature. This process has been traditionally regarded as an embryological process of vessel formation. However, as early as in the 60's the concept of postnatal vasculogenesis was introduced, with a strong resurface of this idea in recent years. Similarly, previous work on a mouse skin tumor model provided us with the grounds to consider the role of vasculogenesis during tumor formation. ^ We examined the contribution of donor bone marrow (BM)-derived cells to neovascularization in recipient nude mice with Ewing's sarcoma. Ewing's sarcoma is a primitive neuroectodermal tumor that most often affects children and young adults between 5 and 30 years of age. Despite multiple attempts to improve the efficacy of chemotherapy for the disease, the 2-year metastases-free survival rate for patients with Ewing's sarcoma has not improved over the past 15 years. New therapeutic approaches are therefore needed to reduce the mortality rate. ^ The contribution of BM endothelial precursor cells in the development of Ewing's sarcoma was examined using different strategies to track the donor-derived cells. Using a BMT model that takes advantage of MHC differences between donor and recipient mice, we have found that donor BM cells were involved in the formation of Ewing's sarcoma vasculature. ^ Cells responsible for this vasculogenesis activity may be located within the stem cell population of the murine BM. These stem cells would not only generate the hematopoietic lineage but they would also generate ECs. Bone marrow SP (Side Population) cells pertain to a subpopulation that can be identified using flow cytometric analysis of Hoechst 33342-stained BM. This population of cells has HSC activity. We have tested the ability of BM SP cells to contribute to vasculogenesis in Ewing's sarcoma using our MHC mismatched transplant model. Mice transplanted with SP cells developed tumor neovessels that were derived from the donor SP cells. Thus, SP cells not only replenished the hematopoietic system of the lethally irradiated mice, but also differentiated into a non-hematopoietic cell lineage and contributed to the formation of the tumor vasculature. ^ In summary, we have demonstrated that BM-derived cells are involved in the generation of the new vasculature during the growth of Ewing's sarcoma. The finding that vasculogenesis plays a role in Ewing's sarcoma development opens the possibility of using genetically modified BM-derived cells for the treatment of Ewing's sarcomas. ^

Children with acute leukemia: A comparison of outcomes and cost-effectiveness from allogeneic blood stem cell and bone marrow transplantation

The relative merits of PBSCT versus BMT for children with standard and high risk hematologic malignancies remain unclear. In a retrospective single center study, we compared allogeneic peripheral blood stem cell transplantation (PBSCT) (n=30) with bone marrow transplantation (BMT) (n=110) in children with acute leukemia. We studied recipients of HLA matched sibling stem cells, and of stem cells from alternative donors (HLA mismatched and/or unrelated) and determined whether sourcing the stem cells from PB or marrow affected engraftment, incidence of acute and chronic GvHD, and disease-free survival at 1 year. Our results show a modest reduction in time to engraftment from PB stem cells and no greater risk of GvHD, but illustrate that the severity of the underlying disease is by far the greatest determinant of 1 year survival. Patients in the BMT group had a higher treatment success rate and lower costs than the recipients of the PBSCT within the standard but not the high risk disease group, where the treatment success rate and the cumulative costs were lower in the PBSCT group compared to the BMT group. Our current incremental cost-effectiveness ratio and analysis of uncertainty suggest that allogeneic transplantation of bone marrow grafts was a more cost-effective treatment option compared to peripheral blood stem cells in patients with standard risk childhood acute leukemia disease. For high risk disease our data are less prescriptive, since the differences were more limited and the range of costs much larger. Neither option demonstrated a clear advantage from a cost-effectiveness standpoint.^

A systematic review of clostridium difficile infection in patients with iatrogenic immunesuppression

Background: Incidence of C. difficile infection (CDI) has increased dramatically in the past decade and is the most frequent cause of nosocomial infectious diarrhea. The outcome of infection may range from mild diarrhea to life-threatening pseudomembranous colitis depending on the immunological response of the host, which is highly compromised in this special population that includes bone marrow transplant (BMT), solid organ transplant (SOT) and cancer patients on cytotoxic chemotherapy. ^ Objectives: We conducted a meta-analysis to assess the incidence rates of CDI and the time to onset of infection in patients with iatrogenic immune suppression. ^ Methods: Original studies were identified through an extensive search of electronic databases including PubMed, Ovid Medline (R), RefWorks and Biological Abstracts and their references. The overall incidence rate of CDI in the immune suppressed population was calculated using random effects model and their 95% confidence interval was derived. Differences in the incidence of CDI and time to onset of infection were calculated between the groups and within the groups. Publication bias was assessed using a funnel plot. Results: Twenty nine published articles involving 7,424 patients met the eligibility requirements. The overall incidence of CDI in the immune suppressed population is 11.1% (95% Confidence Interval (CI): 9.2–13.4%). The incidence of CDI was higher in SOT patients (14.2%, 95% CI: 6.8–21.5%); (p-value-0.022) and in cancer patients on cytotoxic chemotherapy (11.4%, 95% CI: 8.4–15.4%); (p = 0.042) than in BMT patients (10.5%, 95% CI: 7.9–13.1%). In a subgroup analysis of BMT population, the incidence of CDI is significantly higher in patients who received allogeneic BMT (15.1%, 95% CI: 11.2–20.0%; p value <0.0001). Similarly, in the SOT population, the incidence of CDI was higher in patients who underwent liver transplantation (11.0%, 95% CI: 5.6–20.3%); (p= 0.0672). The median time to onset of infection was shorter in BMT patients (p=0.0025). ^ Conclusions: It is evident from the combined analysis of these 29 published studies that the incidence of CDI in the immune suppressed population is higher. However, early diagnosis and treatment of CDI will help reduce the morbidity and mortality due to CDI in this special population.^

Valorización de subproductos agrícolas y forestales como sustratos de cultivo en el estado de Oaxaca (México)

El presente trabajo aborda el aprovechamiento de algunos subproductos agrícolas (bagazo de maguey y fibra de coco) y forestales (corteza de pino) en el Estado de Oaxaca (Sur de México). El objetivo principal se centra en localizar, cuantificar y caracterizar estos con vistas a su aplicación como sustratos o componentes de sustratos en cultivos ornamentales, forestales y hortícolas, y a su uso como enmiendas en cultivos tipo. Así mismo se persigue reducir el uso de la turba y la tierra de monte como sustratos mayoritarios en la actualidad. Para la localización de los subproductos se utilizaron los datos de los registros parcelarios de los productores de coco para la obtención de copra (generadores de fibra de coco) de la región costa y de los productores de mezcal (generadores del residuo de bagazo de maguey) de la región valles centrales, así como las ubicaciones de los aserraderos forestales en el Estado de Oaxaca. Se emplea un Sistema de Información Geográfica (SIG) con una cartografía digitalizada de los elementos del medio (clima, geología y suelo), de los cultivos generadores (bagazo de maguey, fibra de coco y corteza de pino), de la agricultura protegida como receptora (tomate) y de la agricultura extensiva con cultivos receptores de enmienda (café, hule, limón, mango, palma de coco y maguey). La producción anual de los residuos se cartografía y cuantifica con los siguientes resultados: bagazo de maguey 624.000 t, fibra de coco 86.000 m3 y 72.000 t de corteza de pino. Mediante el estudio de las características de los suelos de los cultivos receptores y de los requerimientos de materia orgánica de cada cultivo se calcularon las necesidades totales de materia orgánica para cada suelo. Los resultados de las cantidades globales para cada cultivo en todo el Estado muestran una necesidad total de 3.112.000 t de materia orgánica como enmienda. Con los datos obtenidos y a través de un algoritmo matemático se realiza una propuesta de localización de dos plantas de compostaje (de bagazo de maguey y fibra de coco) y cuatro plantas de compostaje de corteza de pino. Con el fin de conocer los subproductos a valorizar como sustrato o componente de sustrato se caracteriza su composición física‐química, siguiendo Normas UNE‐EN, y se analizan mediante Resonancia Magnética Nuclear (RMN). Para el acondicionamiento de bagazo de maguey y la corteza de pino se realizaron ensayos de compostaje. Al final de 241 días la temperatura y la humedad de ambos procesos se encontraban en los rangos recomendados, indicando que los materiales estaban estabilizados y con calidad para ser utilizados como sustrato o componente de sustrato. Para la fibra de coco se realizó el proceso de molienda en seco de conchas de coco provenientes de la comunidad de Río Grande Oaxaca (Principal zona productora de copra en Oaxaca). Posteriormente se emplean los materiales obtenidos como componentes para sustratos de cultivo. Se estudia el compost de bagazo de maguey y siete mezclas; el compost de corteza de pino y ocho mezclas y la fibra de coco con tres mezclas. Estos sustratos alternativos permiten obtener mezclas y reducir el uso de la tierra de monte, turba, arcilla expandida y vermiculita, siendo por tanto una alternativa sostenible para la producción en invernadero. Se elaboraron mezclas especificas para el cultivo de Lilium hibrido asiático y oriental (siete mezclas), sustratos eco‐compatibles para cultivo de tomate (nueve mezclas), para la producción de planta forestal (siete mezclas) y para la producción de plántula hortícola (ocho mezclas). Como resultados más destacados del bagazo de maguey, corteza de pino y las mezclas obtenidas se resume lo siguiente: el bagazo de maguey, con volúmenes crecientes de turba (20, 30, 50 y 60 %) y la corteza de pino, con volúmenes de turba 40 y 60%, presentan valores muy recomendados de porosidad, capacidad de aireación, capacidad de retención de humedad y equilibrio agua‐aire. Para la fibra de coco, la procedente de Río Grande presenta mejor valoración que la muestra comercial de fibra de coco de Morelos. Por último se llevó a cabo la evaluación agronómica de los sustratos‐mezclas, realizando cinco experimentos por separado, estudiando el desarrollo vegetal de cultivos tipo, que se concretan en los siguientes ensayos: 1. Producción de Lilium asiático y oriental en cama para flor de corte; 2. Producción de Lilium oriental en contenedor para flor de corte; 3. Producción de plántula forestal (Pinus greggii E y Pinus oaxacana M); 4. Producción de tomate (Solanum lycopersicum L) y 5. Producción de plántula de tomate en semillero (Solanum lycopersicum L). En relación a la producción de Lilium hibrido asiático en cama los sustratos corteza de pino (CPTU 80:20 v/v), corteza de pino + sustrato comercial (CPSC 80:20 v/v) y corteza de pino+turba+arcilla expandida+vermiculita (CPTAEV2 30:40:15:15 v/v) presentan los mejores resultados. Dichos sustratos también presentan adecuados resultados para Lilium hibrido oriental con excepción de la corteza de pino + turba (CPTU 80:20 v/v). En la producción de Lilium hibrido oriental en contenedor para flor de corte, además de los sustratos de CPSC y CPTAEV2, la mezcla de corteza de pino+turba+arcilla expandida+vermiculita (CPTAEV 70:20:5:5 v/v) manifestó una respuesta favorable. En el ensayo de producción de plántulas de Pinus greggii E y Pinus oaxacana Mirov, las mezclas con corteza de pino+turba+arcilla expandida+vermiculita (CPTAEV2 30:40:15:15 v/v) y bagazo de maguey turba+arcilla expandida+vermiculita (BMTAEV2 30:60:5:5 v/v) son una alternativa que permite disminuir el empleo de turba, arcilla expandida y vermiculita, en comparación con el sustrato testigo de turba+arcilla expandida+vermiculita (TAEV 60:30:10 v/v). En la producción de tomate (Solanum lycopersicum L) frente a la utilización actual del serrín sin compostar (SSC), las mezclas alternativas de bagazo de maguey+turba (BMT 70:30 v/v), fibra de coco de Río Grande (FCRG 100v/v) y corteza de pino+turba (CPT 70:30 v/v), presentaron los mejores resultados en rendimientos. Así mismo, en la producción de plántulas de tomate las dos mezclas alternativas de bagazo de maguey+turba+ arcilla expandida+vermiculita (BMTAEV5 50:30:10:10 v/v) y (BMTAEV6 40:40:10:10 v/v) presentaron mejores resultados que los obtenidos en la mezcla comercial (Sunshine 3), mayoritariamente utilizada en México en la producción de plántula de tomate y hortícola. ABSTRACT This paper addresses the use of some agricultural products (maguey bagasse and coconut fiber) and forestry (pine bark) in the State of Oaxaca (southern Mexico). The principal purpose is to locate, quantify and characterize these with the idea of applying them as substrates or substrate components in ornamental crops, forestry, horticultural, and their use as crop amendments. On the other hand, the reduction of peat and forest soil as main substrates is pursued. For the location of the products, registry parcel data from copra producers (coconut fiber generators) of the coastal region and mescal producers (maguey bagasse residue generators) of the central valleys region, as well as the locations of forest mills in the State of Oaxaca. A Geographic Information System (GIS) with digital mapping of environmental factors (climate, geology and soil), crop generators of residues (maguey bagasse, coconut and pine bark) receptors of amendments such as protected agriculture (tomato) and extensive agriculture crops (coffee, rubber, lemon, mango, coconut and agave). The annual production of waste is mapped and quantified with the following results: 624,000t maguey bagasse, coconut fiber 72,000 m3 and 86,000 t of pine bark. Through the study of receiving crops soils properties of and organic matter requirements of each crop, total needs of organic matter for each soil were estimated. The results of the total quantities for each crop across the state show a total of 3,112,000 t of organic matter needed as amendment. Using that data and a mathematical algorithm, the location of two composting plants (agave bagasse and coconut fiber) and four composting plants pine bark was proposed. In order to know the by‐products that were going to be used as substrates or substrate components, their physical‐chemical composition was analyzed following UNE‐EN technics. Furthermore they were analyzed by Nuclear Magnetic Resonance (NMR). For conditioning of maguey bagasse and pine bark, composting essays were conducted. At the end of 241 days the temperature and humidity of both processes were at the recommended ranges, indicating that the materials were stabilized and had reached the quality to be used as a substrate or substrate component. Coconut shells from the community of Rio Grande Oaxaca (Main copra producing area in Oaxaca) were put through a process of dry milling. Subsequently, the obtained materials were used as components for growing media. We studied the maguey bagasse compost and seven mixtures; the pine bark compost and eight blends and coconut fiber with three mixtures. These alternative substrates allow obtaining mixtures and reduce the use of forest soil, peat, vermiculite and expanded clay, making it a sustainable alternative for greenhouse production. Specific mixtures were prepared for growing Lillium, Asian and eastern hybrids (seven blends), eco‐compatible substrates for tomato (nine mixtures), for producing forest plant (seven mixtures) and for the production of horticultural seedlings (eight mixtures). Results from maguey bagasse, pine bark and mixtures obtained are summarized as follows: the maguey bagasse, with increasing volumes of peat (20, 30, 50 and 60%) and pine bark mixed with 40 and 60% peat by volume, have very recommended values of porosity, aeration capacity, water retention capacity and water‐air balance. Coconut fiber from Rio Grande had better quality than commercial coconut fiber from Morelos. Finally the agronomic evaluation of substrates‐mixtures was carried out conducting five experiments separately: 1. Production of Asiatic and Eastern Lilium in bed for cut flower, 2. Production of oriental Lillium in container for cut flower, 3.Production of forest seedlings (Pinus greggii E and Pinus oaxacana M), 4. Production of tomato (Solanum lycopersicum L) and 5. Tomato seedling production in seedbed (Solanum lycopersicum L). In relation to the production of hybrid Asian Lilium in bed, pine bark substrates (CPTU 80:20 v/v), pine bark + commercial substrate (CPSC 80:20 v/v) and pine bark + peat + expanded clay + vermiculite (CPTAEV2 30:40:15:15 v/v) showed the best results. Such substrates also have adequate results for Lilium Oriental hybrid except pine bark + peat (CPTU 80:20 v / v). In the production of Lilium oriental hybrid container for cut flower, besides the CPSC and CPTAEV2 substrates, the mixture of pine bark + peat + vermiculite expanded clay (CPTAEV 70:20:5:5 v / v) showed a favorable response. In the production of Pinus greggii E and Pinus oaxacana Mirov seedlings trial, mixtures with pine bark + peat + expanded clay + vermiculite (CPTAEV2 30:40:15:15 v/v) and maguey bagasse+ peat+ expanded clay + vermiculite (BMTAEV2 30:60:5:5 v / v) are an alternative which allows reducing the use of peat, vermiculite and expanded clay in comparison with the control substrate made of peat + expanded clay+ vermiculite (60:30 TAEV: 10 v/v). In the production of tomato (Solanum lycopersicum L), alternative mixes of maguey bagasse + peat (BMT 70:30 v/v), coconut fiber from Rio Grande (FCRG 100 v / v) and pine bark + peat (CPT 70:30 v / v) showed the best results in yields versus the current use of sawdust without compost (SSC). Likewise, in the production of tomato seedlings of the two alternative mixtures maguey bagasse + peat expanded clay + vermiculite (BMTAEV5 50:30:10:10 v/v) and (BMTAEV6 40:40:10:10 v/v) had better results than those obtained in the commercial mixture (Sunshine 3), mainly used in Mexico in tomato seedling production and horticulture.