Cartilage regeneration using human umbilical cord blood derived mesenchymal stem cells: A systematic review and meta-analysis

Background and Objectives: Human umbilical-cord-blood-derived mesenchymal stem cells (hUCB-MSCs) have recently been used in clinical cartilage regeneration procedures with the expectation of improved regeneration capacity. However, the number of studies using hUCB-MSCs is still insufficient, and long-term follow-up results after use are insufficient, indicating the need for additional data and research. We have attempted to prove the efficacy and safety of hUCB-MSC treatment in a comprehensive analysis by including all subjects with knee articular cartilage defect or osteoarthritis who have undergone cartilage repair surgery using hUCB-MSCs. We conducted a meta-analysis and demonstrated efficacy and safety based on a systematic review. Materials and Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. For this study, we searched the PubMed, Embase, Web of Science, Scopus, and Cochrane Library literature databases up to June 2022. A total of seven studies were included, and quality assessment was performed for each included study using the Newcastle–Ottawa Quality Assessment Scale. Statistical analysis was performed on the extracted pooled clinical outcome data, and subgroup analyses were completed. Results: A total of 570 patients were included in the analysis. In pooled analysis, the final follow-up International Knee Documentation Committee (IKDC) score showed a significant increase (mean difference (MD), −32.82; 95% confidence interval (CI), −38.32 to −27.32; p < 0.00001) with significant heterogeneity (I2 = 93%, p < 0.00001) compared to the preoperative score. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at final follow-up were significantly decreased (MD, 30.73; 95% CI, 24.10–37.36; p < 0.00001) compared to the preoperative scores, with significant heterogeneity (I2 = 95%, p < 0.00001). The visual analog scale (VAS) score at final follow-up was significantly decreased (MD, 4.81; 95% CI, 3.17–6.46; p < 0.00001) compared to the preoperative score, with significant heterogeneity (I2 = 98%, p < 0.00001). Two studies evaluated the modified Magnetic Resonance Observation of Cartilage Repair Tissue (M-MOCART) score and confirmed sufficient improvement. In a study analyzing a group treated with bone marrow aspiration concentrate (BMAC), there was no significant difference in clinical outcome or M-MOCART score, and the post-treatment International Cartilage Repair Society (ICRS) grade increased. Conclusion: This analysis demonstrated the safety, efficacy, and quality of repaired cartilage following hUCB-MSC therapy. However, there was no clear difference in the comparison with BMAC. In the future, comparative studies with other stem cell therapies or cartilage repair procedures should be published to support the superior effect of hUCB-MSC therapy to improve treatment of cartilage defect or osteoarthritis

Trust-based Service Composition and Binding for Tactical Networks with Multiple Objectives

Abstract —Tactical networks must select service providers to meet service requirements of an operation while facing resource constraints and high security vulnerability. In such an environment nodes provide services to support various operations and / may request services to support the operations as well. We formulate the problem of service composition and service binding as a multi-objective optimization (MOO) problem, minimizing the service cost, while maximizing the quality of service (QoS) and quality of information (QoI). The MOO problem is essentially a node-to-service assignment problem such that by dynamically formulating service composition, and selecting the right nodes to provide requested services, the network can support concurrent operations while achieving multiple system objectives. We develop a trust-based service composition and binding protocol. We demonstrate that the trust-based scheme outperforms the counterpart non-trustbased scheme. Furthermore, our trust-based scheme can effectively penalize malicious nodes performing self-promotion attacks, thus filtering out malicious nodes and can ultimately lead to high user satisfaction. Keywords—service composition, tactical networks, trust, multiobjective optimization. I

Autologous collagen-induced chondrogenesis: From bench to clinical development

Microfracture is a common technique that uses bone marrow components to stimulate cartilage regeneration. However, the clinical results of microfracture range from poor to good. To enhance cartilage healing, several reinforcing techniques have been developed, including porcine-derived collagen scaffold, hyaluronic acid, and chitosan. Autologous collagen-induced chondrogenesis (ACIC) is a single-step surgical technique for cartilage regeneration that combines gel-type atelocollagen scaffolding with microfracture. Even though ACIC is a relatively new technique, literature show excellent clinical results. In addition, all procedures of ACIC are performed arthroscopically, which is increasing in preference among surgeons and patients. The ACIC technique also is called the Shetty–Kim technique because it was developed from the works of A.A. Shetty and S.J. Kim. This is an up-to-date review of the history of ACIC

You Do (Not) Belong Here: Detecting DPI Evasion Attacks with Context Learning

As Deep Packet Inspection (DPI) middleboxes become increasingly popular, a spectrum of adversarial attacks have emerged with the goal of evading such middleboxes. Many of these attacks exploit discrepancies between the middlebox network protocol implementations, and the more rigorous/complete versions implemented at end hosts. These evasion attacks largely involve subtle manipulations of packets to cause different behaviours at DPI and end hosts, to cloak malicious network traffic that is otherwise detectable. With recent automated discovery, it has become prohibitively challenging to manually curate rules for detecting these manipulations. In this work, we propose CLAP, the first fully-automated, unsupervised ML solution to accurately detect and localize DPI evasion attacks. By learning what we call the packet context, which essentially captures inter-relationships across both (1) different packets in a connection; and (2) different header fields within each packet, from benign traffic traces only, CLAP can detect and pinpoint packets that violate the benign packet contexts (which are the ones that are specially crafted for evasion purposes). Our evaluations with 73 state-of-the-art DPI evasion attacks show that CLAP achieves an Area Under the Receiver Operating Characteristic Curve (AUC-ROC) of 0.963, an Equal Error Rate (EER) of only 0.061 in detection, and an accuracy of 94.6% in localization. These results suggest that CLAP can be a promising tool for thwarting DPI evasion attacks.Comment: 12 pages, 12 figures; accepted to ACM CoNEXT 202

Ease of use and accuracy of a perinatal measuring device (Episiometer) to ensure correct angle and length of a mediolateral episiotomy: a mixed methods study

Introduction: To guide clinicians in performing mediolateral episiotomies (MLEs) at 60‐degrees, a new clinical innovation called the 'Episiometer' was developed. The aim of this study was to assess the usability and accuracy of the Episiometer in guiding clinicians to perform a safe episiotomy in both low‐ and high‐resource settings. Design: A prospective, multi‐site Phase‐I clinical trial was conducted between January 2017 and July 2018, involving three international study sites: Australia; Papua New Guinea; and India. The study design was mixed‐methods, incorporating an explanatory sequential design using surveys, clinician interviews and patient chart review to determine the usability and accuracy of the Episiometer. The patient chart review and results of this are discussed in an accompanying article. Methods: The Episiometer is the clinical innovation designed to attain an episiotomy cutting angle of 60‐degrees. The instrument is designed to assist clinicians to make an accurate and consistent episiotomy cutting angle within a 'safe' green zone between 45–60 degrees and length of at least 4 cm. The instrument also improves the visibility of the 60‐degree line to clinicians, and provides an exact measurement for length (located on the 60‐degree angle line). Clinicians from all three sites were recruited to provide feedback and measurements of incisions performed using the Episiometer (n = 135) following attendance at a minimum of at least one training session with site coordinators. Twenty of these clinicians were then recruited randomly from the sample who responded in the surveys and interviewed face‐to‐face. Patients were followed up 6‐weeks postpartum to monitor potential complications (n = 120). Results: Overall, the Episiometer was well received by clinicians – particularly by more junior staff members who were significantly more likely to report the Episiometer as being beneficial in guiding a safe MLE compared to their more senior counterparts (P = 0.003 and P = 0.011, respectively). In addition, 89% of incisions (107/120) were within the 'safe zone' between 45‐60 degrees, and 40% (48/120) were made at exactly 60‐degrees. No patient had any degree of perineal tear at follow up. Conclusion: The Episiometer is a well‐received clinical innovation in both high‐resource and lower resource settings. When used as directed, the Episiometer produces an accurate and safe incision, and reduces variation in clinicians' performance of episiotomy

Redescription of Acmella tersa (Benson, 1853), the Type Species of Acmella W.T. Blanford, 1869 (Gastropoda: Assimineidae), from Meghalaya, Northeast India

The type species of the assimineid genus Acmella W.T. Blanford, 1869 is Cyclostoma tersum Benson, 1853, originally described from ‘Musmai’ [Mawsmai], Meghalaya, Northeast India. No specimens from Benson’s type series can be traced, and contemporary shells collected from the type locality in museum collections are extremely worn. It has therefore been impossible to examine shell microsculpture, an important taxonomic character in the diagnosis of species of Assimineidae, using museum specimens. In order to provide better diagnostic characters for the genus Acmella, we redescribe and illustrate Acmella tersa from newly collected specimens, one of which is designated as the neotype. We also provide a list of all known species attributed to Acmella

A neo-institutional perspective on ethical decision-making

Drawing on neo-institutional theory, this study aims to discern the poorly understood ethical challenges confronted by senior executives in Indian multinational corporations and identify the strategies that they utilize to overcome them. We conducted in-depth interviews with 40 senior executives in Indian multinational corporations to illustrate these challenges and strategies. By embedding our research in contextually relevant characteristics that embody the Indian environment, we identify several institutional- and managerial-level challenges faced by executives. The institutional-level challenges are interpreted as regulative, normative and cognitive shortcomings. We recommend a concerted effort at the institutional and managerial levels by identifying relevant strategies for ethical decision-making. Moreover, we proffer a multi-level model of ethical decision-making and discuss our theoretical contributions and practical implications

Gel-type autologous chondrocyte (Chondron™) implantation for treatment of articular cartilage defects of the knee

<p>Abstract</p> <p>Background</p> <p>Gel-type autologous chondrocyte (Chondron™) implantations have been used for several years without using periosteum or membrane. This study involves evaluations of the clinical results of Chondron™ at many clinical centers at various time points during the postoperative patient follow-up.</p> <p>Methods</p> <p>Data from 98 patients with articular cartilage injury of the knee joint and who underwent Chondron™ implantation at ten Korean hospitals between January 2005 and November 2008, were included and were divided into two groups based on the patient follow-up period, i.e. 13~24-month follow-up and greater than 25-month follow-up. The telephone Knee Society Score obtained during telephone interviews with patients, was used as the evaluation tool.</p> <p>Results</p> <p>On the tKSS-A (telephone Knee Society Score-A), the score improved from 43.52 ± 20.20 to 89.71 ± 13.69 (P < 0.05), and on the tKSS-B (telephone Knee Society Score-B), the score improved from 50.66 ± 20.05 to 89.38 ± 15.76 (P < 0.05). The total improvement was from 94.18 ± 31.43 to 179.10 ± 24.69 (P < 0.05).</p> <p>Conclusion</p> <p>Gel-type autologous chondrocyte implantation for chondral knee defects appears to be a safe and effective method for both decreasing pain and improving knee function.</p

Institutions and frugal innovation: The case of Jugaad

International audienceMultinationals from emerging markets are embracing frugal innovation. While resource constraints and business opportunities targeting the underserved have been identified as core reasons for the same, we heed to researchers calls for a fine-grained understanding of the formal and informal institutions that promote frugal innovation. Using jugaad – an ingenious form of indigenous frugal innovation practiced by Indian multinationals as a study context, we utilize a neo-institutional theoretical lens to explore its antecedents and outcomes while explicating the organizational characteristics that enable and sustain jugaad. Our qualitative study with eight Indian multinationals finds that jugaad is a response to a complex combination of myriad institutional factors that challenge these multinationals to innovate frugally, enabled by specific organizational characteristics that ultimately lead to jugaad outcomes. Our findings are presented in a conceptual framework that advances the understanding of jugaad and extends neo-institutional theory to this context. We also provide some future direction for this contemporary stream of research. © 2019, Springer Science+Business Media, LLC, part of Springer Nature