The Effect of Bone Marrow-Derived Mesenchymal Stem Cell Transplantation on Allodynia and Hyperalgesia in Neuropathic Animals: A Systematic Review with Meta-Analysis

Stem cell transplantation has been considered a possible therapeutic method for neuropathic pain. However, no quantitative data synthesis of stem cell therapy for neuropathic pain exists. Therefore, the present systematic review and meta-analysis assessed the efficacy of bone marrow mesenchymal stem cell (BMMSC) transplantation on alleviating pain symptoms in animal models of neuropathic pain. In the present meta-analysis, controlled animal studies assessing the effect of administrating BMMSC on neuropathic pain were included through an extensive literature search of online databases. After collecting data, effect sizes were computed and the standardized mean difference (SMD) with 95 confidence interval (CI) was entered in all analyses. Random-effects models were used for data analysis. Sensitivity and subgroup analyses were performed to investigate expected or measured heterogeneity. Finally, 14 study were included. The analyses showed that BMMSC transplantation lead to significant improvement on allodynia (SMD = 2.06; 95 CI, 1.09 to 3.03; I2 = 99.7; P < .001). The type of neuropathy (P =036), time between injury and intervention (P =02), and the number of transplanted cells (P = 023) influence the improvement of allodynia after BMMSC transplantation. BMMSC transplantation has no effect on hyperalgesia (SMD =3; 95 CI, -1.09 to 1.68; I2 = 100; P <001) unless it occurs during the first 4 days after injury (P =02). The present systematic review with meta-analysis suggests that BMMSC transplantation improves allodynia but does not have any significant effect on hyperalgesia unless it is given during the first 4 days after injury. © 2015 American Society for Blood and Marrow Transplantation

Accuracy of pediatric emergency care applied research network rules in prediction of clinically important head injuries; a systematic review and meta-analysis

Background: The present meta-analysis was designed to determine the value of Pediatric Emergency Care Applied Research Network (PECARN) rule in prediction of clinically important traumatic brain injury (ciTBI). Materials and Methods: Extensive search was conducted in the databases of Medline, Embase, Scopus, Web of Sciences, Cinahl up to the end of August 2017. The search records were screened and summarized by two independent reviewers, and eventually the findings were presented as summary of receiver operating characteristics (SROC), sensitivity, specificity and diagnostic odds ratio with 95 confidence interval (95 CI). Results: Data from 10 studies were included in this meta-analysis. Area under the curve (AUC) of SROC for PECARN model in prediction of ciTBI in children younger than 2 years old was 0.85 (95 CI: 0.82-0.88). Sensitivity, specificity and diagnostic odds ratio of this model were also calculated to be 0.98 (95 CI: 0.92-1.0), 0.56 (95 CI: 0.48-0.64) and 82.53 (95 CI: 16.23-419.63), respectively. AUC of SROC for this model in prediction of ciTBI in children aged 2-18 years old was also found to be 0.97 (95 CI: 0.95-0.98) with a sensitivity, specificity and diagnostic odds ratio of 0.98 (95 CI: 0.95-0.99), 0.60 (95 CI: 0.53-0.67) and 80.73 (95 CI: 30.59-213.05). Conclusion: The findings of this study are indicative of a high screening value for PECARN model in prediction of ciTBI and classification of patients. So it is recommended that the decision rule be used in routine practice for children referring with mild traumatic brain injuries

Accuracy of pediatric emergency care applied research network rules in prediction of clinically important head injuries; a systematic review and meta-analysis

Background: The present meta-analysis was designed to determine the value of Pediatric Emergency Care Applied Research Network (PECARN) rule in prediction of clinically important traumatic brain injury (ciTBI). Materials and Methods: Extensive search was conducted in the databases of Medline, Embase, Scopus, Web of Sciences, Cinahl up to the end of August 2017. The search records were screened and summarized by two independent reviewers, and eventually the findings were presented as summary of receiver operating characteristics (SROC), sensitivity, specificity and diagnostic odds ratio with 95 confidence interval (95 CI). Results: Data from 10 studies were included in this meta-analysis. Area under the curve (AUC) of SROC for PECARN model in prediction of ciTBI in children younger than 2 years old was 0.85 (95 CI: 0.82-0.88). Sensitivity, specificity and diagnostic odds ratio of this model were also calculated to be 0.98 (95 CI: 0.92-1.0), 0.56 (95 CI: 0.48-0.64) and 82.53 (95 CI: 16.23-419.63), respectively. AUC of SROC for this model in prediction of ciTBI in children aged 2-18 years old was also found to be 0.97 (95 CI: 0.95-0.98) with a sensitivity, specificity and diagnostic odds ratio of 0.98 (95 CI: 0.95-0.99), 0.60 (95 CI: 0.53-0.67) and 80.73 (95 CI: 30.59-213.05). Conclusion: The findings of this study are indicative of a high screening value for PECARN model in prediction of ciTBI and classification of patients. So it is recommended that the decision rule be used in routine practice for children referring with mild traumatic brain injuries

Human adipose-derived stem/stromal cells from children or adults?

Since the emergence of regenerative medicine choosing the best source for extracting stem cells has been one of the most important challenges. Discovering a cell type with the highest efficiency and the least side-effects is one of the priorities of scientists active in this field. Of all the cells, mesenchymal stem cells have been and still are of interest to the researchers for use in pre-clinical and clinical studies due to being easily accessible, pluripotency, secretion of numerous growth factors, low risk of immunological rejection, and not having ethical issues for clinical use. Of all mesenchymal cells, human adipose-derived stem/stromal cells (hADSCs) are more safely and easily accessible, produce more growth factors compared to other mesenchymal stem cells, have the ability to differentiate to various cell lines, secrete high levels of angiogenic factor and their feasibility, safety and efficacy have been confirmed. Therefore, in the last decade, it has received more attention from researchers, compared to other cell sources (1-3). Since distribution and function of adipose tissue is versatile and changes at any age during the lifetime (4), it is expected that at different ages, hADSCs also show different functions and abilities. Therefore, it is hypothesized that autologous implantation is not necessarily always the best choice. Autologous transplantation of hADSCs is only the best choice in ages that these cells have the optimum efficacy. If it is determined in what age these cells have the highest efficacy, choosing the type of implantation (autologous or allogeneic) will be an important factor in achieving the best response to treatment. This matter is even more important regarding pediatric diseases. The results of Guasti et al. study in 2012 showed that a smaller volume of lipo-aspirate is needed for extracting hADSCs from children's adipose tissues compared to adults (20 to 30 times less). In addition, many growth factors required for tissue repair are secreted in children's hADSCs, but not in hADSCs of adults; and hADSCs of children carry more markers of differentiation to various cell lines compared to hADSCs of adults. Therefore, they concluded that hADSCs of children have higher plasticity to differentiate into multiple cell lineages compared to their adult type and are better choices for cell therapy of diseases in children (5). What is sure is that autologous use of children's hADSCs is the best choice for stem cell therapy. In addition, in a study Liao et al. aimed to evaluate autologous bone marrow mononuclear cells in treatment of children with traumatic brain injuries and showed that this treatment method leads to a reduction in the intensity of organ damage and neurointensive care duration significantly decreases (6). But can allogeneic use of children's hADSCs for adults be the best choice? This is a question that definitely cannot be answered without performing further preclinical and clinical studies in this field. © 2017, Int J Pediatr

Particle and Gas Flow Modeling of Wall-impinging Diesel Spray under Ultra-high Fuel Injection Pressures

Advanced models of spray breakup and droplet collision are implemented in OpenFOAM code for comparing the flat-wall impinging and free fuel sprays under ultra-high pressure direct injection diesel engines. The non-evaporating spray and ambient gas flow characteristics are analyzed by a combination of Eulerian and Lagrangian methods for continuous and dispersed phase, respectively. Various injection pressures and two different impinging distances are used. Reynolds Averaged Navier Stokes (RANS) equations are solved using standard k-ε turbulence model. Computational domain and grid size are determined based on a mesh study. Numerical results are validated by published experimental data for free and wall-impinging sprays. The robustness and accuracy of the proposed scheme are confirmed by comparing the main characteristics of spray and surrounding gas against published experimental data. To accomplish this, spray shape, penetration and gas velocity vectors are compared with experimental data and insightful understanding of the spray characteristics are provided. In comparison with free spray, tip penetration has been limited in impinging sprays. Turbulent flow in impinging sprays leads to more induced air motion. Also, impinging spray leads to more pushed-out gas velocity. The obtained results indicate that the numerical findings are generally in good agreement with experimental data in case of ultra-high injection pressures and micro-hole injectors

Applying Different Strategies within OpenFOAM to Investigate the Effects of Breakup and Collision Model on the Spray and in-Cylinder Gas Mixture Attribute

In the current study, a 3-D numerical simulation of two-phase flow has been conducted in a direct injection CI engine using the Eularian-Lagrangian approach and a new breakup model. The newly modified breakup scheme has been implemented for simulating the ultra-high pressure diesel injection. The effects of droplet breakup and collision model on the spray and in-cylinder gas characteristics have been examined using the open source code OpenFOAM. Spray penetration and cone angle are investigated as spray properties and surrounding gas motion are studied by in-cylinder gas velocity and pressure distribution for non-evaporating conditions. In addition, vapor penetration of the evaporating spray is presented to study the effects of current scheme on the evaporating condition. The continuous field is described by RANS equations and dynamics of the dispersed droplet is modeled by Lagrangian tracking scheme. Results of the proposed modified KHRT model are compared against other default methods in OpenFOAM and favorable agreement is achieved. Robustness and accuracy of different breakup schemes and collision models are also verified using the published experimental data. It is demonstrated that the proposed breakup scheme and Nordin collision model display very accurate results in the case of ultra-high pressure injection

NEURAL STEM/PROGENITOR CELL TRANSPLANTATION FOR SPINAL CORD INJURY TREATMENT; A SYSTEMATIC REVIEW AND META-ANALYSIS

—Despite the vast improvements of cell therapy in spinal cord injury treatment, no optimum protocol has been developed for application of neural stem/progenitor cells. In this regard, the present meta-analysis showed that the effi- cacy of the neural stem/progenitor cell (NSPC) transplantation depends mainly on injury model, intervention phase, transplanted cell count, immunosuppressive use, and probably stem cell source. Improved functional recovery post NSPC transplantation was found to be higher in transection and contusion models. Moreover, NSPC transplantation in acute phase of spinal injury was found to have better functional recovery. Higher doses (>3 � 106 cell/kg) were also shown to be optimum for transplantation, but immunosuppressive agent administration negatively affected the motor function recovery. Scaffold use in NSPC transplantation could also effectively raise functional recovery. � 2016 Published by Elsevier Ltd. on behalf of IBR

Efficacy of neuromodulation in fecal incontinence in children; a systematic review and meta-analysis

Background: The results of existing studies regarding the use of neuromodulation in fecal incontinence (FI) are contradictory and therefore, a definitive conclusion cannot be made in this regard. Therefore, the aim of the present study was to evaluate the effectiveness of neuromodulation in controlling FI in children through a systematic review.. Materials and Methods: A decision was made to perform the search in electronic databases of Medline, Embase, Web of Science, CINAHL and Scopus until end of October 2017. In the second step, the abstracts of the extracted studies were evaluated by 2 researchers independently and recorded in the data extraction form. Finally, all studies were summarized and categorized based on the evaluated outcomes and overall effect size was presented. . Results: Five studies were included in the present meta-analysis (including 115 children and adolescent). Pooled analysis also showed that the odds of improvement in the group under treatment with nerve stimulation was up to 20 times higher (OR = 20.29; 95 CI: 8.67 to 47.45; p<0.0001). In addition, using nerve stimulation leads to a significant improvement in fecal incontinence score of patients (SMD = 2.32; 95 CI: 1.12 to 3.52; p<0.0001). Conclusion: It can be concluded that neuromodulation can seemingly be an effective measure in controlling FI in children. However, the lack of standard clinical trials in this field is highly felt and it is suggested to assess the effect of neuromodulation on FI by performing blinded randomized clinical trials in future studies