Reviewing the Status of Professional Commitment Principles in the Physician-Patient Communication Models

Much attention is paid to the importance of the relationship between patients and physicians and the ethical issues that have been considered from different perspectives. Moreover, different models have been developed to establish such a relationship. In one of the most advanced methods, Emanuel EJ categorized 4 paternalistic -informative-interpretive models that have been agreed upon by many medical professionals. Each model has its characteristics and in the relationship between a patient and a practitioner, and to some extent, the professional commitment values (professionalism). In other words, the observance of the values of professionalism in each of these models has been based on the definitions of these principles; each is of particular importance, and individual attention has been paid to these values in different models. The present work aimed to evaluate each communication model according to the values of medical resource planning. Analyzing and adapting these models in terms of professional ethics could finally lead to analyzing the comparative approaches to professional commitment values

Assessing Human Embryonic Stem Cell-Derived Dopaminergic Neuron Progenitor Transplants Using Non-invasive Imaging Techniques

Parkinson’s disease (PD) is a neurodegenerative disease that results, in part, from the progressive loss of dopaminergic (DA) neurons in the Substantia Nigra pars compacta (SNpc). Several groups have shown that human Pluripotent Stem Cell (hPSC)- derived dopaminergic neuron Progenitor Cells (DAPCs) can generate mature DA neurons and improve motor function following intrastriatal transplantation in animal models of PD. This has now evolved to the point that the first in human hPSC-based DA neural transplants are being undertaken or are being planned in patients with PD. However, prior to undertaking larger-scale clinical studies, animal experiments are needed to adequately assess the safety of the therapies. Key safety concerns with such therapies for PD and other Central Nervous System (CNS) disorders include the risk that the implanted cells could proliferate and form space-occupying masses and/or migrate to off-target sites within the CNS and/or induce major neuroinflammation. In addition to considering the potential risks, it is also important to monitor the long-term viability and differentiation capacity of implanted cells, as to be effective, they must differentiate into the appropriate phenotype and persist in the brain. Monitoring viability and biodistribution of the DAPCs over time requires non-invasive imaging techniques. In this project, a bimodal imaging strategy based on Bioluminescence (BLI) and Magnetic Resonance Imaging (MRI) to monitor the safety of the human Embryonic Stem Cell (hESC)-based therapy in immunocompromised nude rats has been investigated. BLI is the preferred technique for monitoring viability and proliferation in vivo, but spatial resolution is poor, meaning that it cannot be used to assess intracranial biodistribution. However, this can be overcome by labelling cells with Iron Oxide Particles (IOPs) so that they can be imaged using MRI, a technique that provides very high spatial resolution. RC17 hESCs were transduced with bicistronic Luciferase-ZsGreen lentiviral particles and directed to differentiate to DAPCs. Expression of DAPC markers was assessed to confirm the success of the differentiation. Furthermore, a group of RC17 hESCs were differentiated into DAPCs and labelled using Micron-sized Particles of Iron Oxide (MPIOs) to be visualized using MRI. DAPCs expressing Luciferase-ZsGreen or labelled with MPIOs were transplanted in the striatum of nude rats (n = 6 per group). DAPCs were tracked in vivo using BLI and MR imaging modalities. Transgene silencing in differentiating DAPCs accompanied with signal attenuation due to animal growth, rendered the BLI undetectable by week 2 post intrastriatal transplantation. However, MR imaging of MPIO-labelled DAPCs showed that transplanted cells remained at the site of injection for over 120 days. Post-mortem histological analysis of DAPC transplants demonstrated that labelling with either Luciferase-ZsGreen or MPIOs did not affect the ability of cells to differentiate into mature dopaminergic neurons. Importantly, labelled cells did not elicit increased glial reactivity compared to non-labelled cells

A quality oriented approach towards information requirement determination in equivocal situations

Analysis of users’ needs is one of the key determinants of any system’s success and the foundation of requirement determination process. Yet because of the complexity of human’s needs, the process of requirement determination for developing systems to meet human’s needs is often ad hoc and poorly understood (Browne & Ramesh, 2002). Poor execution of Information Requirement Determination (IRD) will almost guarantee the failure of the final project, as a result a significant portion of requirement determination activities are dedicated to determining users’ information level requirements (Hickey & Davis, 2004) which in this study is referred to as IRD. There is no commonly accepted IRD method for all situations and therefore IRD methods are leaning toward specialised methods, designed for specific contexts and situations (Siau & Rossi, 2011). However a significant proportion of IRD literature is focused on organisational context while there are other complex contexts which require researchers’ attention. One such situations for which no specialised IRD method could be found in the literature is the context of “Individual Decision Making in Equivocal Situations (IDMES)” which in this study is defined as: Contexts in which an individual should make important decisions in complex and equivocal situations he/she is not an expert in. Examples of IDMES could be identified in healthcare where a patient who is not a trained healthcare professional has to choose between several available treatments for a serious health problem. Complexity of decisions a patient needs to make is comparable to the complex decisions that a manager must make in an organisation. The differentiation is that patients are not healthcare specialists but managers are specialists of the area in which they make decisions. In such situations providing higher amount of information to users may actually increase the uncertainty they face (e.g. overloading a patient with information). Therefore, in developing information systems for supporting decision making in such contexts, extra attention should be paid to determining other characteristics of users’ information needs, namely: quality and source. To establish a theoretical foundation for the IRD method required in this context, a conceptual model labelled as Quality Requirement Determination (QRD) model has been generated in this study. To develop the QRD model, two concepts of Information Quality (IQ) and Information Seeking Behaviour (ISB) have been leveraged. Although both IQ and ISB are mature topics, their applications in IRD methods are not very well studied (Gharib & Giorgini, 2015; Savolainen, 2007, 2008; Sonnenwald, Wildemuth, & Harmon, 2001). To evaluate the QRD model, it has been applied to the case of parenting children with autism. This case has been selected because it meets all the characteristics of IDMES, namely because: 1) autism cause and cure are unknown and therefore selecting from the array of available interventions “is a nightmare for desperate parents” (Crawford, 2013, p. 53). 2) Parents must individually make decisions in a context in which they are not trained experts even though over time they develop a certain level of practical experience. Seventeen parents were interviewed about their information seeking behaviours when they needed to decide on interventions necessary for a specific problem. The results of the data analysis confirm the existence of the relationships between perceived information needs, source preference behaviour and quality requirements proposed in the QRD model. The information requirements which arose from the case of parenting children with autism is embodied in the QRD presentation matrix. It leverages a nine cell matrix with each cell representing a cognitive role played by the information sources in the users’ information horizon1 . The QRD presentation matrix along with the QRD model and associated data collection and analysis techniques are called QRD method. To evaluate the usability of determined information by the QRD method, results of an instrumental case study were presented to a group of IS practitioners. The selected IS practitioners have been chosen from variety of expertise involved in developing information systems to reflect the maximum variety of opinions. The interview results demonstrated the value of the QRD method for a number of key practical activities in the IRD process, namely: context study, problem definition, quality requirement analysis, quality implementation, designing information flow and user interface design

Ethical Considerations in Conducting Clinical Trials

Background: Clinical trials are the golden key in medical science research with human participants. They have always been considered interesting topics by researchers and scientists working in this field. However, the samples are “human participants,” so the research should be carefully conducted.Methods: In the present study, the published articles on the ethical challenges of conducting clinical trials were evaluated between 2010 and 2019 in Google Scholar, PubMed, and Scopus. The English search keywords were “clinical trial,” with at least one of the phrases of “ethical consideration” or “standard”.Results: In this article, we examined the ethical requirements and considerations in these research studies in four stages: research design and question, proposal review and approval, supervision and implementation, and publication of the results. We have examined them using relevant articles published between 2010 and 2019 and identified important and prominent issues or neglected ones. Conclusion: During this study, it was found that the “research design and question” stage was the most discussed and challenging stage, and the authors’ sensitivity about it has been more than the other three stages. On the other hand, the “results publishing” stage has been considered less sensitive with the least number of references in articles

X-Inactive-Specific Transcript: Review of Its Functions in the Carcinogenesis

X-inactive–specific transcript (XIST) is one of the firstly discovered long non-coding RNAs with prominent roles in the process of X inactivation. Moreover, this transcript contributes in the carcinogenic process in different tissues. In addition to interacting with chromatin modifying molecules, XIST can be served as a molecular sponge for miRNAs to modulate expression of miRNA targets. Most of the studies have indicated an oncogenic role for XIST. However, in prostate cancer, a single study has indicated a tumor suppressor role for this lncRNA. Similar result has been reported for XIST in oral squamous cell carcinoma. In hepatocellular carcinoma, breast cancer, ovarian cancer, osteosarcoma, and renal cell carcinoma, different studies have reported inconsistent results. In the present manuscript, we review function of XIST in the carcinogenesis

Self-Assembling Proteins as High-Performance Substrates for Embryonic Stem Cell Self-Renewal

The development of extracellular matrix mimetics that imitate niche stem cell microenvironments and support cell growth for technological applications is intensely pursued. Specifically, mimetics are sought that can enact control over the self-renewal and directed differentiation of human pluripotent stem cells (hPSCs) for clinical use. Despite considerable progress in the field, a major impediment to the clinical translation of hPSCs is the difficulty and high cost of large-scale cell production under xeno-free culture conditions using current matrices. Here, a bioactive, recombinant, protein-based polymer, termed ZT Fn , is presented that closely mimics human plasma fibronectin and serves as an economical, xeno-free, biodegradable, and functionally adaptable cell substrate. The ZT Fn substrate supports with high performance the propagation and long-term self-renewal of human embryonic stem cells while preserving their pluripotency. The ZT Fn polymer can, therefore, be proposed as an efficient and affordable replacement for fibronectin in clinical grade cell culturing. Further, it can be postulated that the ZT polymer has significant engineering potential for further orthogonal functionalization in complex cell applications

Assessing Human Embryonic Stem Cell-Derived Dopaminergic Neuron Progenitor Transplants Using Non-invasive Imaging Techniques

Abstract: Purpose: Human pluripotent stem cell (hPSC)-derived dopaminergic neuron progenitor cells (DAPCs) are a potential therapy for Parkinson’s disease (PD). However, their intracranial administration raises safety concerns including uncontrolled proliferation, migration and inflammation. Here, we apply a bimodal imaging approach to investigate the fate of DAPC transplants in the rat striatum. Procedures: DAPCs co-expressing luciferase and ZsGreen or labelled with micron-sized particles of iron oxide (MPIOs) were transplanted in the striatum of RNU rats (n = 6 per group). DAPCs were tracked in vivo using bioluminescence and magnetic resonance (MR) imaging modalities. Results: Transgene silencing in differentiating DAPCs accompanied with signal attenuation due to animal growth rendered the bioluminescence undetectable by week 2 post intrastriatal transplantation. However, MR imaging of MPIO-labelled DAPCs showed that transplanted cells remained at the site of injection for over 120 days. Post-mortem histological analysis of DAPC transplants demonstrated that labelling with either luciferase/ZsGreen or MPIOs did not affect the ability of cells to differentiate into mature dopaminergic neurons. Importantly, labelled cells did not elicit increased glial reactivity compared to non-labelled cells. Conclusions: In summary, our findings support the transplantation of hPSC-derived DAPCs as a safe treatment for PD

Leucocyte and Platelet-rich Fibrin: A carrier of autologous multipotent cells for regenerative medicine

The wound healing is a complex process wherein inflammation, proliferation and regeneration evolve according to a spatio-temporal pattern from the activation of coagulation cascade to the formation of a plug clot including fibrin matrix, blood-borne cells and cytokines/growth factors. Creating environments conducive to tissue repair, the haemoderivatives are commonly proposed for the treatment of hard-to-heal wounds. Here, we explored in vitro the intrinsic regenerative potentialities of a leucocyte- and platelet-rich fibrin product, known as CPL-MB, defining the stemness grade of cells sprouting from the haemoderivative. Using highly concentrated serum-based medium to simulate wound conditions, we isolated fibroblast-like cells (CPL-CMCs) adhering to plastic and showing stable in vitro propagation, heterogeneous stem cell expression pattern, endothelial adhesive properties and immunomodulatory profile. Due to their blood derivation and expression of CXCR4, CPL-CMCs have been suggested to be immature cells circulating in peripheral blood at quiescent state until activation by both coagulation event and inflammatory stimuli such as stromal-derived factor 1/SDF1. Expressing integrins (CD49f, CD103), vascular adhesion molecules (CD106, CD166), endoglin (CD105) and remodelling matrix enzymes (MMP2, MMP9, MMP13), they showed a transendothelial migratory potential besides multipotency. Taken together, our data suggested that a standardized, reliable and economically feasible blood product such as CPL-MB functions as an artificial stem cell niche that, under permissive conditions, originate ex vivo immature cells that could be useful for autologous stem cell-based therapies

Secretome of mesenchymal stem cells and its impact on Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is characterized by irreversible loss of lung function that stem from two mechanisms, inflammation and senescence. Crosstalk between these two mechanisms accelerate the development of COPD, thus targeting these two pathways may offer benefits in the treatment of COPD. Growing amount of evidence have shown that mesenchymal stem cells as a promising candidate for the treatment of COPD. Over the years, many studies conducted to decipher the therapeutic effect of MSC in COPD and the mechanisms involve, in the hope of utilizing these cells as new therapeutic strategy for COPD. However, the cell-based therapy by using the MSC presented with many obstacles including low engraftment at the site of injury, the risk of microvascular occlusion, unwanted differentiation, and also the risk of malignant transformation. Recently, recently researchers begin to look at the possibility of using MSC derived extracellular vesicles as an alternative to MSC. Here we review the effect of MSC and MSC derived EV in modulating inflammation, and senescence in COPD. We also review current treatment and the side effect in COPD, and senolytic drugs, a new therapeutic strategy targeting the senescent cells