Long-Term Effects of Autologous Bone Marrow Stem Cell Treatment in Acute Myocardial Infarction: Factors That May Influence Outcomes

AIMS: To investigate whether there are important sources of heterogeneity between the findings of different clinical trials which administer autologous stem cell treatment for acute myocardial infarction (AMI) and to evaluate what factors may influence the long-term effects of this treatment. METHODS AND RESULTS: MEDLINE (1950-January 2011), EMBASE (1974-January 2011), CENTRAL (The Cochrane Library 2011, Issue 1), CINAHL (1982-January 2011), and ongoing trials registers were searched for randomised trials of bone marrow stem cells as treatment for AMI. Hand-searching was used to screen recent, relevant conference proceedings (2005-2010/11). Meta-analyses were conducted using random-effects models and heterogeneity between subgroups was assessed using chi-squared tests. Planned analyses included length of follow-up, timing of cell infusion and dose, patient selection, small trial size effect, methodological quality, loss of follow-up and date of publication. Thirty-three trials with a total of 1,765 participants were included. There was no evidence of bias due to publication or time-lag, methodological quality of included studies, participant drop-out, duration of follow-up or date of the first disclosure of results. However, in long-term follow-ups the treatment seemed more effective when administered at doses greater than 10(8) cells and to patients with more severe heart dysfunction. CONCLUSIONS: Evaluation of heterogeneity between trials has not identified significant sources of bias in this study. However, clinical differences between trials are likely to exist which should be considered when undertaking future trials

2021 EDUCAUSE Horizon Report :Teaching and Learning Edition

This report profiles key trends and emerging technologies and practices shaping the future of teaching and learning and envisions a number of scenarios and implications for that future. It is based on the perspectives and expertise of a global panel of leaders from across the higher education landscape

TEN YEAR PERFORMANCE EVALUATION OF UNBONDED CONCRETE OVERLAY AND JOINTED PLAIN CONCRETE PAVEMENT: A TORONTO CASE STUDY TEN YEAR PERFORMANCE EVALUATION OF UNBONDED CONCRETE OVERLAY AND JOINTED PLAIN CONCRETE PAVEMENT: A TORONTO CASE STUDY TEN YEAR PERFORMA

ABSTRACT Heavy, slow moving traffic can be extremely damaging to asphalt pavements. The City of Toronto was observing the rapid deterioration of the pavements at an urban intersection with high volumes of transit bus traffic. The heavy traffic was causing severe rutting and other safety concerns. Despite regular maintenance and rehabilitation interventions, the distresses were regularly recurring. In collaboration with the Cement Association of Canada, the City of Toronto elected to rehabilitate the high traffic intersection of Bloor Street and Aukland Road using Portland cement concrete materials in order to mitigate the existing problems. As part of this project, the city constructed its first unbonded concrete overlay and reconstructed an adjacent area as a conventional Jointed Plain Concrete Pavement. The rehabilitation activities were completed during the summer of 2003. Owing to the trial nature of these rehabilitation treatments in Toronto, instrumentation was installed by University of Waterloo researchers to monitor and evaluate the long-term performance of the rehabilitated pavements. This paper presents an overview of the existing conditions, design, construction and instrumentation of the Bloor and Aukland site and a ten year performance evaluation of the rehabilitated pavements. The results of this study show that concrete overlays and inlays are excellent rehabilitation options for urban pavements subjected to high volumes of heavy traffic. Both the unbonded overlay and Jointed Plain Concrete Pavement sections have demonstrated excellent performance to date. The pavements are in very good condition visually, ride quality remains excellent and the recurrence of the regular rutting and shoving problems that were being observed prior to rehabilitation has been mitigated. Significant remaining life is expected from the concrete pavement sections a

Use of probiotics in gastrointestinal disorders: what to recommend?

Perturbation of bacterial microflora of the gastrointestinal (GI) tract may play an important role in the pathophysiology of some GI disorders. Probiotics have been used as a treatment modality for over a century. They may restore normal bacterial microflora and effect the functioning of the GI tract by a variety of mechanisms. Probiotics are not currently regulated and only few randomized controlled trials exist investigating their efficacy in different GI disorders. They are available in a variety of formulations and delivery systems making interpretation and comparison of studies even more difficult. The efficacy of probiotics, either as a single strain or a combination of probiotics, has been tested in antibiotic-associated diarrhea, Clostridium difficile colitis, infectious diarrhea, ulcerative colitis, Crohn’s disease, pouchitis, and irritable bowel syndrome, among other disorders. Results of the studies are reviewed in this article and recommendations for probiotic use in these disorders are made. Although probiotics appear to be generally safe in an outpatient setting, the situation may be different in immunocompromised, hospitalized patients who may be at a greater risk of developing probiotic sepsis. No studies exist addressing the issue of safety specifically. Many questions regarding use of probiotics in GI disorders remain to be answered in future studies, such as most optimal doses, duration of treatment, physiological and immunological effects, efficacy of specific probiotics in specific disease states, and safety in debilitated patients