Perkutana laserska dekompresija diska u psa - prikaz slučaja.

Percutaneous laser disc decompression (PLDD) is a minimally invasive technique for treatment of lumbar disc herniation in human medicine. There is little information available concerning PLDD usage in dogs. The article describes treatment of a disc protrusion in a dog with percutaneous laser disc decompression (PLDD). To the authors’ knowledge the presented technique is described here for the first time in a dog with thoracolumbar disc herniation. The surgical procedure was performed in a dog with Th13-L1 disc protrusion using a photofiber device, which was inserted into the intervertebral space under C-arm control. The purpose of this report is to evaluate PLDD effectiveness in Hansen type II disc herniation in a dog.Perkutana laserska dekompresija diska (PLDD) minimalno je invazivna tehnika za liječenje hernije lumbalnog diska u humanoj medicine. Ima malo informacija o upotrebi PLDD u pasa. U članku je opisano liječenje protruzije diska perkutanom laserskom dekompresijom u psa. U ovom radu ta je tehnika prvi put opisana u psa s hernijacijom torakolumbalnog diska. Kirurški zahvat proveden je na psu s protruzijom Th13-L1 diska upotrebom aparata pomoću kojeg se laserska zraka optičkom niti uvede kroz tanku iglu u intervertebralni prostor pod rendgenskom kontrolom. Svrha je ovog izvješća procijeniti učinkovitost PLDD kod II. stupnja hernijacije po Hansenu u psa

Terapia komórkowa w neurologii — obawy i nadzieje

Opracowanie standardów kontroli bezpieczeństwa i efektywnośc iterapii chorób neurologicznych na podstawie unikatowych właściwości komórek macierzystych stanowi pilne zadanie dl środowiska lekarskiego. Większość z zarejestrowanych do tej pory badań klinicznych oparto na autologicznych przeszczepieniach mezenchymalnych komórek macierzystych (MSC, mesenchymal stem cells, alternatywnie mesenchymal stromal cells) otrzymywanych w warunkach hodowlanych in vitro z różnych, dojrzałych i płodowych tkanek ludzkich, których pierwotne pochodzenie i precyzyjny rodowód pozostają przedmiotem dyskusji. W przeprowadzonych badaniach klinicznych nad terapią komórkami macierzystymi, z których ponad 80% dotyczyło chorób układu nerwowego, nie zaobserwowano poważniejszych powikłań zagrażający życiu i zdrowiu pacjentów. Wskazuje to na wysoki stopień bezpieczeństwa terapii z zastosowaniem komórek macierzystych/progenitorowych pochodzenia tkankowego, jednak ostateczne potwierdzenie tego wniosku wymaga rozszerzonego zakresu badań podstawowych, a przede wszystkim dłuższego czasu obserwacji pacjentów. Należy się także spodziewać, że lepsze poznanie mechanizmów terapeutycznego działania komórek macierzystych wraz z ustaleniem opartych na nich standardów postępowania lekarskiego doprowadzi do zwiększonej skuteczności tych terapii

The feasibility of the CD271+ and CD271– mesenchymal stromal cell enrichment toward nucleus pulposus-like cells

Introduction. Factors promoting nerve cell ingrowth are considered responsible for chronic back pain resulting from the intervertebral disc degeneration (IDD). One of the recent exploratory IDD treatments is stem cell transplantation therapy. The CD271 (low-affinity nerve growth factor receptor) has been identified as a mark­er of the most homogeneous mesenchymal stem cell (MSC) subset. It is capable of promoting differentiation along adipogenic, osteogenic and chondrogenic lineages and producing significantly higher levels of cytokines as compared to the total population of plastic adherence-mesenchymal stem cells (PA-MSCs). We investigated the ability of CD271+ MSCs to differentiate into chondrocyte-like cells of the nucleus pulposus (NP) of intervertebral disc. We also examined CD271– MSCs, using PA-MSCs as a control cell population. Material and methods. Bone marrow derived PA-MSCs and its two subsets, CD271– MSCs and CD271+ MSCs, were seeded in collagen scaffolds. After two weeks of growth in NP-differentiation medium, RNA was isolated from cells-scaffold constructs and was analyzed by q-PCR for expression of NP markers. Glycosaminoglycans were analyzed biochemically directly in cells-scaffold constructs. Results. Expression of NP markers — extracellular matrix components such as aggrecan, collagen type II and glycosaminoglycans on both RNA and the protein levels — was significantly higher in CD271– MSCs compared to the CD271+ MSCs and PA-MSCs cell populations. Conclusions. CD271– MSCs may be superior candidates for NP restorative treatment compared to CD271+ MSCs and PA-MSCs due to their ability of expressing NP-supporting extracellular matrix components at levels higher than the other two studied MSC subsets

Složen protokol liječenja bolesnika s amiotrofičnom lateralnom sklerozom

Amyotrophic lateral sclerosis is a progressive and fatal degenerative neuromuscular disease with few if any treatment options and physical rehabilitation addressing specific deficits is the most frequent form of therapy. Patients also suffer from depression and increased anxiety. Our purpose was to assess the neurorehabilitation effectiveness in a patient with amyotrophic lateral sclerosis who underwent stem cell transplantation but refused physiotherapy due to depression. Disease progression was followed using the revised Amyotrophic Lateral Sclerosis Functional Rating Scale bimonthly for six months pre- and then post-stem cell transplantation. Psychological traits were assessed using six standardized tests. Quantitative electroencephalogram diagnostics was performed before the first and after the last neurofeedback session, and sessions were conducted on a 3-times-a-week basis. The physiotherapy protocol included proprioceptive neuromuscular facilitation, electrical modalities unit applied to the lumbar spine area, and breathing, relaxation and walking exercises, among others. Increased motivation and marked decrease in the pain level was associated with the patient’s willingness to complete physiotherapy, which resulted in improvements in most neuromuscular deficits and in increased respiratory capacity. During the 12 post-rehabilitation months, progression of the disease decelerated, and a positive behavioral change was noted. The study suggested that neurofeedback could be used as a neurorehabilitation component of the personalized complex rehabilitation protocol in patients with amyotrophic lateral sclerosis.Amiotrofična lateralna skleroza je progresivna i smrtonosna degenerativna neuromuskularna bolest za koju postoji malo, ako uopće ijedna mogućnost liječenja pa je najčešći oblik terapije fizikalna rehabilitacija usmjerena na točno određene nedostatke. Ovi bolesnici pate i od depresije te pojačane anksioznosti. Cilj istraživanja bio je procijeniti učinkovitost neurorehabilitacije u bolesnika s amiotrofičnom lateralnom sklerozom koji je podvrgnut transplantaciji matičnih stanica, ali je zbog depresije odbio fizikalnu terapiju. Progresija bolesti praćena je pomoću revidirane Ljestvice za funkcionalnu ocjenu amiotrofične lateralne skleroze svaka dva mjeseca kroz šest mjeseci prije te nakon transplantacije matičnih stanica. Psihološke značajke procjenjivane su pomoću šest standardiziranih testova. Kvantitativna elektroencefalografska dijagnostika provedena je prije prvog i nakon posljednjeg neurofeedback tretmana, koji su se provodili tri puta na tjedan. Protokol fizikalne terapije obuhvaćao je, među ostalim, proprioceptivnu neuromuskularnu facilitaciju, jedinicu električnih modaliteta primijenjenu u području lumbalne kralježnice te vježbe disanja, opuštanja i hodanja. Pojačana motivacija i znatno sniženje razine boli bili su udruženi s bolesnikovim pristankom na potpunu fizikalnu terapiju, što je rezultiralo poboljšanjem većine neuromuskularnih nedostataka i povećanim dišnim kapacitetom. Tijekom 12 mjeseci nakon rehabilitacije progresija bolesti se usporila i zabilježena je pozitivna promjena ponašanja. Ovo istraživanje je pokazalo da se neurofeedback može primijeniti kao neurorehabilitacijska sastavnica personaliziranog složenog protokola rehabilitacije u bolesnika s amiotrofičnom lateralnom sklerozom

Różnicowanie popromiennej martwicy i wznowy złośliwego guza mózgu u pacjentów leczonych przy pomocy brachyterapii Ir 192 metodą HDR w oparciu o analizę spektroskopową widma metabolitów z użyciem H1-MRS

Background: Computerized tomography (CT) with contrast infusion and Magnetic Resonance Imaging (MRI) do not differentiate radionecrosis and malignant tumor recurrence. Proton Magnetic Resonance Spectroscopy seems to be a new radiological method that could solve this problem. The aim of the study was to evaluate the usability of H1-MRS in patients after brachytherapy. Material/Methods: Sixty patients were treated by Ir 192 HDR brachytherapy because of malignant brain tumors (gliomas and brain metastases). Prospectively, 4 months after brachytherapy, 24 patients underwent MRI and H1-MRS examinations. All patients qualified for the prospective study were in good general condition before and after the brachytherapy (Karnofsky Performance Score (KPS) > 60%). Results: Combined assessment of MRI and H1-MRS gave us the possibility to differentiate the observed pathological changes. In 18 cases (75%) there was a decrease in tumor volume. The tumor infiltration area was larger than the necrotic area in 5 cases. An isolated recurrence mass was observed in only one case. Neurosurgical brain decompression with pathological mass resection was needed in 6 patients with increased intracranial pressure and enhanced neurological deficits. Histopathological examination confirmed the diagnosis revealed in the H1-MRS examination in each case. Conclusions: Proton Magnetic Resonance Spectroscopy is helpful in evaluating the influence of radiation on the tumor and the surrounding brain tissue. Moreover, it solves the problem of differentiating between radionecrosis and tumor recurrence

The importance and use of stem cells in dermatology

Stem cells are capable of self-renewal of their population and differentiation into specialized cells. There are several “niches” in the skin: 1) interfollicular stem cells – responsible for skin regeneration after injury; 2) in the hair follicle as follicular stem cells (“bulge”) and mesenchymal stem cells in the hair bulb and follicular papilla; 3) stem cells of mesodermal origin associated with blood vessels, giving rise to fibroblasts and myofibroblasts; and 4) melanocyte stem cells. Treatment with stem cells of skin diseases is still considered experimental. Intensive research is being carried out on their use in treating dystrophic epidermolysis bullosa, systemic lupus erythematosus, vitiligo, different types of alopecia and ulcers and slow-healing wounds. Stem cells due to their flexibility and ability to differentiate into other specialized cells create the possibility for regenerative medicine

Związek skuteczności operacyjnego leczenia choroby Cushinga zpatomorfologicznym – immunohistochiemicznym i ultrastrukturalnym – potwierdzeniem obecności gruczolaka kortykotropowego przysadki

Background and purpose The most common cause of Cushing disease (CD) is ACTH-secreting pituitary adenoma. Transsphenoidal selective adenomectomy is the treatment of choice. Frequency of remission varies from 60% to 90%, depending on the site and the surgeon's experience. This study aims to answer the question whether confirmation of corticotroph adenoma in pathological examinations increases the probability of surgical cure for CD. Material and methods The prospective study involved 36 patients with CD operated on with the transsphenoidal approach and followed up for at least 18 months. Following the surgical procedure, the specimen was examined by a pathologist. The study evaluated the significance of positive histological (immunohistochemical and ultrastructural) examination results for achieving surgical cure for CD. Results Twenty-three of 36 patients (63.9%) were regarded as being surgically cured of CD. Persistent CD was confirmed in 13 patients (36.1%). Pituitary insufficiency was found in 5 patients (13.9%), whereas 3 patients (8.3%) were diagnosed with diabetes insipidus. A significant difference was demonstrated between the cured and the non-cured group with reference to the results of pathological examination of surgical specimens. Pathomorphological confirmation of corticotroph adenoma was significantly more frequently observed in the cured group in comparison with the non-cured group (p = 0.028). Conclusions Pathological confirmation of corticotroph pituitary adenoma may be regarded as an important predictor of the surgical cure of CD.Wstęp i cel pracy Najczęstszą przyczyną choroby Cushinga jest gruczolak przysadki wydzielający kortykotropinę (ACTH), a leczeniem z wyboru – przezklinowa selektywna adenomektomia. Częstość remisji waha się od 60% do 90% w zależności od ośrodka i doświadczenia operatora. Celem pracy była odpowiedź na pytanie, czy stwierdzenie gruczolaka kortykotropowego w badaniu histopatologicznym, immunohistochemicznym i ultrastrukturalnym wiąże się z większym prawdopodobieństwem operacyjnego wyleczenia choroby Cushinga. Materiał i metody Prospektywne badanie obserwacyjne, do którego włączono 36 kolejnych pacjentów z chorobą Cushinga operowanych z dostępu przezklinowego, a następnie obserwowanych przez co najmniej 18 miesięcy. Doświadczony patolog ocenił materiał operacyjny. Przeanalizowano związek dodatniego wyniku badania histologicznego, immunohistochemicznego i ultrastrukturalnego z klinicznymi wskaźnikami operacyjnego wyleczenia choroby Cushinga. Wyniki Za wyleczonych operacyjnie z choroby Cushinga uznano 23 z 36 badanych pacjentów (63,9%). U 13 osób (36,1%) potwierdzono przetrwałą chorobę Cushinga. Pooperacyjną niedoczynność przysadki stwierdzono w 5 (13,9%), a trwałą moczówkę prostą w 3 przypadkach (8,3%). Wykazano różnicę pomiędzy grupą wyleczoną i niewyleczoną w odniesieniu do patomorfologicznej oceny materiału pobranego śródoperacyjnie. W grupie wyleczonej istotnie częściej obserwowano obecność histologicznych, immunohistoche-micznych i ultrastrukturalnych cech gruczolaka kortykotropowego w porównaniu z grupą niewyleczoną (p = 0,028). Wnioski Potwierdzenie obecności gruczolaka kortykotropowego przysadki w badaniu patomorfologicznym może być uważane za jeden z czynników rokowniczych operacyjnego wyleczenia choroby Cushinga

CRISPR/Cas9 Technology as an Emerging Tool for Targeting Amyotrophic Lateral Sclerosis (ALS)

The clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein-9 nuclease (Cas9) is a genome editing tool that has recently caught enormous attention due to its novelty, feasibility, and affordability. This system naturally functions as a defense mechanism in bacteria and has been repurposed as an RNA-guided DNA editing tool. Unlike zinc-finger nucleases (ZFNs) and transcription activator-like effector nucleases (TALENs), CRISPR/Cas9 takes advantage of an RNA-guided DNA endonuclease enzyme, Cas9, which is able to generate double-strand breaks (DSBs) at specific genomic locations. It triggers cellular endogenous DNA repair pathways, contributing to the generation of desired modifications in the genome. The ability of the system to precisely disrupt DNA sequences has opened up new avenues in our understanding of amyotrophic lateral sclerosis (ALS) pathogenesis and the development of new therapeutic approaches. In this review, we discuss the current knowledge of the principles and limitations of the CRISPR/Cas9 system, as well as strategies to improve these limitations. Furthermore, we summarize novel approaches of engaging the CRISPR/Cas9 system in establishing an adequate model of neurodegenerative disease and in the treatment of SOD1-linked forms of ALS. We also highlight possible applications of this system in the therapy of ALS, both the inherited type as well as ALS of sporadic origin

Safety of intrathecal injection of Wharton’s jelly-derived mesenchymal stem cells in amyotrophic lateral sclerosis therapy

Animal experiments have confirmed that mesenchymal stem cells can inhibit motor neuron apoptosis and inflammatory factor expression and increase neurotrophic factor expression. Therefore, mesenchymal stem cells have been shown to exhibit prospects in the treatment of amyotrophic lateral sclerosis. However, the safety of their clinical application needs to be validated. To investigate the safety of intrathecal injection of Wharton’s jelly-derived mesenchymal stem cells in amyotrophic lateral sclerosis therapy, 43 patients (16 females and 27 males, mean age of 57.3 years) received an average dose of 0.42 × 106 cells/kg through intrathecal administration at the cervical, thoracic or lumbar region depending on the clinical symptoms. There was a 2 month interval between two injections. The adverse events occurring during a 6-month treatment period were evaluated. No adverse events occurred. Headache occurred in one case only after first injection of stem cells. This suggests that intrathecal injection of Wharton’s Jelly-derived mesenchymal stem cells is well tolerated in patients with amyotrophic lateral sclerosis. This study was approved by the Bioethical Committee of School of Medicine, University of Warmia and Mazury in Olsztyn, Poland (approval No. 36/2014 and approval No. 8/2016). This study was registered with the ClinicalTrials.gov (identifier: NCT02881476) on August 29, 2016

Diagnostic value of gadolinium-enhanced MR imaging of active sacroiliitis in seronegative spondyloarthropathy

Background: Seronegative spondyloarthropathy (SpA) is a group of diseases including: ankylosing spondylitis, psoriatic spondyloarthrithis, reactive arthritis, spondyloarthrithis associated with inflammatory bowel disease, and undifferentiated spondyloarthritis. One of the diagnostic criteria of SpA is the presence of sacroiliitis. Periarticular bone marrow oedema (histologically corresponding to osteitis) is a primary symptom of the active stage of inflammation, which can be identified by MR using T2-weighted images. Its presence is essential for the therapeutic decision. The aims of this study were: 1. to compare the diagnostic value of T2-weighted images with T1 gadolinium-enhanced fat saturation (FS) images. 2. to establish if T1 gadolinium-enhanced images increase the diagnostic value of the MRI examination. Material/Methods: With the use of a 1.5T MRI scanner, 35 patients aged 19-67 years were examined. They were classified as having SpA or suspicious of SpA. The following findings were assessed: bone marrow oedema, synovitis, capsulitis/enthesistis. They were evaluated and compared on T2 and T1 gadolinium-enhanced FS images. Results: Active sacroiliitis was identified in 21 patients, chronic in 1 patient. Two patients had signs of synovitis without any features of bone marrow oedema. One patient had fracture of the sacral bone. Ten patients had no signs of sacroiliitis. There was no significant difference in the diagnostic value between FSE T2 images and T1 gadolinium-enhanced images with FS in the evaluation of bone marrow oedema and capsulitis/enthesitis. However, T1 gadolinium-enhanced images were more sensitive than FSE T2 images in visualising synovitis. Conclusions: MRI is a very sensitive method to identify active sacroiliitis in SpA. MRI without contrast administration is sufficient to identify bone marrow oedema as a crucial finding in active sacroiliitis. The gadolinium-enhanced images make the diagnosis easier, especially in patients with minimal bone marrow oedema because they reveal or better depict synovitis, while they do not improve visualisation of capsulitis/enthesitis