SDF-1α-Releasing Microspheres Effectively Extend Stem Cell Homing after Myocardial Infarction.

Ischemic heart disease (IHD) is one of the main focuses in today's healthcare due to its implications and complications, and it is predicted to be increasing in prevalence due to the ageing population. Although the conventional pharmacological and interventional methods for the treatment of IHD presents with success in the clinical setting, the long-term complications of cardiac insufficiency are on a continual incline as a result of post-infarction remodeling of the cardiac tissue. The migration and involvement of stem cells to the cardiac muscle, followed by differentiation into cardiac myocytes, has been proven to be the natural process, though at a slow rate. SDF-1α is a novel candidate to mobilize stem cells homing to the ischemic heart. Endogenous SDF-1α levels are elevated after myocardial infarction, but their presence gradually decreases after approximately seven days. Additional administration of SDF-1α-releasing microspheres could be a tool for the extension of the time the stem cells are in the cardiac tissue after myocardial infarction. This, in turn, could constitute a novel therapy for more efficient regeneration of the heart muscle after injury. Through this practical study, it has been shown that the controlled release of SDF-1α from biodegradable microspheres into the pericardial sac fourteen days after myocardial infarction increases the concentration of exogenous SDF-1α, which persists in the tissue much longer than the level of endogenous SDF-1α. In addition, administration of SDF-1α-releasing microspheres increased the expression of the factors potentially involved in the involvement and retention of myocardial stem cells, which constitutes vascular endothelial growth factor A (VEGFA), stem cell factor (SCF), and vascular cell adhesion molecules (VCAMs) at the site of damaged tissue. This exhibits the possibility of combating the basic limitations of cell therapy, including ineffective stem cell implantation and the ability to induce the migration of endogenous stem cells to the ischemic cardiac tissue and promote heart repair.

The Challenge of Graft Nephrectomy after Transplant Tourism.

The morbidity and mortality rates of transplant nephrectomy are closely related to the indications of nephrectomy. This study evaluates the indications, etiology, and complications of graft nephrectomies for commercial kidney transplantation (CKT). Data were analyzed retrospectively for graft nephrectomies for CKT from January 2009 to December 2017 at the Royal Hospital, Muscat, Oman. Four hundred and three patients received CKT and 34 patients required a nephrectomy. Twenty-five patients had a nephrectomy within 10 weeks of CKT in the early group, and nine patients in the late group had the graft removed later than 10 weeks. Indications for nephrectomy in the early group were acute bleeding, infarcted kidney, and pyonephrosis in 7, 11, and 7 patients, respectively; in the late group, the indications were: pain, hematuria, fever, hypertension, and infection. Overall, seven patients had major blood loss, and those patients who had a pseudoaneurysm had tissue cultures that were positive for the fungus. Postoperative complications occurred in 26 patients. There was acute bleeding in three patients from the external iliac artery at the site of the previous anastomosis, and, in all three cases, the external iliac artery was ligated. There were 12 major wound infections, and three patients died from overwhelming sepsis and disseminated intravascular coagulation. Commercial transplants carry a high risk of immunological, vascular, and infectious complications, resulting in significant morbidity and mortality.

Emphysematous Pyelonephritis Disparities observed in the use of percutaneous drainage techniques.

Objectives: The recent drop in the mortality rates of emphysematous pyelonephritis, a serious medical condition, is attributable to renal percutaneous drainage (PCD) techniques that have also reduced the necessity for surgery. Since the difference in the objectives of the two specific techniques, i.e. PCD and percutaneous nephrostomy (PCN), is often overlooked, this study aimed to highlight the inconsistencies in the use of these two techniques. Methods: A retrospective study of 17 patients was conducted over a 10-year period from January 2008 to December 2017 at The Royal Hospital, Muscat, Oman. All patients had undergone abdominal computerised tomography. The obtained images were reviewed and categorised based on Huang and Tseng's classification. Results: From the sample, 13 patients (76%) were categorised as class I and II, three (17%) as class IIIA and one (6%) as class IIIB. Five patients from the class I and II categories underwent drainage of the pelvicalyceal system, four by PCN and one by a double-J stent insertion. PCN was performed on all the class IIIA and IIIB patients. One class IIIB patient required PCD for localised gas and fluid collection but later underwent emergency nephrectomy. There were no mortalities. Conclusion: The favourable outcome of this study was in keeping with those of the more recent studies. However, despite the present classifications and guidelines, wide variations were reported in the use of percutaneous drains with PCD, ranging from 2.5-91%. The lack of precise guidelines may be a cause of these disparities in clinical management.

The Influence of Anti-Diabetic Drugs on Prostate Cancer.

The incidences of prostate cancer (PC) and diabetes are increasing, with a sustained trend. The occurrence of PC and type 2 diabetes mellitus (T2DM) is growing with aging. The correlation between PC occurrence and diabetes is noteworthy, as T2DM is correlated with a reduced risk of incidence of prostate cancer. Despite this reduction, diabetes mellitus increases the mortality in many cancer types, including prostate cancer. The treatment of T2DM is based on lifestyle changes and pharmacological management. Current available drugs, except insulin, are aimed at increasing insulin secretion (sulfonylureas, incretin drugs), improving insulin sensitivity (biguanides, thiazolidinediones), or increasing urinary glucose excretion (gliflozin). Comorbidities should be taken into consideration during the treatment of T2DM. This review describes currently known information about the mechanism and impact of commonly used antidiabetic drugs on the incidence and progression of PC. Outcomes of pre-clinical studies are briefly presented and their correlations with available clinical trials have also been observed. Available reports and meta-analyses demonstrate that most anti-diabetic drugs do not increase the risk during the treatment of patients with PC. However, some reports show a potential advantage of treatment of T2DM with specific drugs. Based on clinical reports, use of metformin should be considered as a therapeutic option. Moreover, anticancer properties of metformin were augmented while combined with GLP-1 analogs.

Late occurrence of pelvi-ureteric junction obstruction in renal allograft and live-related kidney donor.

Pelvi-ureteric junction (PUJ) obstruction is an enigmatic condition. While in a reasonable majority it is clear cut, the diagnosis and the need for intervention in the remainder is still a challenge. We would like to share the details of two cases, one in a transplant recipient and the other in a living kidney donor, and propose an explanation as to why PUJ obstruction becomes manifest after such a long period of time. In this presentation, we would like to propose that forced drinking of fluids by patients who have an equivocal PUJ and a single kidney could tilt the balance resulting in overt PUJ obstruction.

Synchronous bilateral ureteric metastasis from gastric cancer.

Distant metastasis to the ureters is uncommon. Moreover, isolated ureteric metastasis from gastric cancer is extremely rare and only sporadically reported. It indicates an advanced stage and carrier a very poor prognosis. We describe a case of synchronous bilateral ureteric metastasis from stomach adenocarcinoma after gastrectomy and chemoradiation. To our knowledge, it is the first case published in the literature with such presentation.

Mandibular talon cusps: A Systematic review and data analysis.

OBJECTIVES: The purpose of the present study was to evaluate mandibular talon cusps distribution from the comprehensive literature search and proposal of new classification Material and Methods: The study was a review of articles published in the English language from January 1960 to December 2013. The PubMed/MEDLINE/Google Scholor databases were searched electronically using 'talon cusp', 'dens evaginatus', 'anterior teeth', mandible, 'primary dentition' and ' permanent dentition' as search terms in various combinations. The citation lists from the included references were subsequently examined, and a hand search was also performed in an attempt to identify additional reports. The distribution, characteristics, common tooth type, associated dental anomaly and proposal of new classification have been included in final data analysis. Descriptive statistics were carried out using Chi square test (SPSS, version 17). RESULTS: Overall 37 citations were retrieved from the literature where one was prevalence studies and rest were case reports among those two were duplication. Total 35 articles with 43 patients were reported on mandibular talon cusps. Males were predominantly affected than females (p<0.05). Eight cases (19%) were reported in archeological skulls 81% were clinical reports. Forty cases (93%) were reported in permanent dentition while 7% cases in primary dentition. Lingual mandibular talon are more common than facial type in permanent dentition facial talons (p<0.05). Seven cases (18%) were bilaterally involved. Double tooth (45%) was commonly associated with mandibular talons. Most of the cases reported from Asia and asia derived populations. CONCLUSIONS: Central incisor is the most common tooth type that effected by talon cusp in permanent dentition and lateral incisor is in primary dentition. Lingual talons are common in mandible. Double tooth common dental anomaly associated with mandibular talon cusp. Most of the case reported from Asia. Talon cusps should be classified as facial, lingual, and facial and lingual types. Key words:Double tooth, permanent dentition, primary dentition, mandibular arch, Talon cusp.