Stem Cell Therapy in the Treatment of Patients With Autism Spectrum Disorder: a Systematic Review and Meta-analysis.

OBJECTIVE: Assess the safety and efficacy of upcoming stem cell treatments and analyze their effects on the cognitive and behavioral impairments in patients diagnosed with autism. METHODS: We included controlled and noncontrolled, randomized and non-randomized trials evaluating stem cell therapy as a treatment in patients with autism spectrum disorder compared to placebo or without comparator. DATA SOURCES: Scopus, Web of Science, MEDLINE and EMBASE. Risk of bias was assessed using Cochrane's Risk of Bias tool and the NIH's Quality Assessment Tool for Studies With No Control Group. RESULTS: Eleven trials including 461 patients proved eligible. ABC scale meta-analysis showed a mean raw of -11.97 in the intervention groups (95 % CI -91.45 to 67.52, p < 0.01). CARS scale reported a mean raw of -9.08 (95 % CI -15.43 to -2.73, p < 0.01). VABS scale was reported by their domains: communication domain reported a mean raw of 2.69 (95 % CI 1.30 to 4.08, p = 0.92); daily living domain, 1.99 (95 % CI 0.83 to 3.15, p = 0.51); motor domain, 1.06 (95 % CI -0.37 to 2.48, p = 0.20); socialization domain, 3.09 (95 % CI 1.71 to 4.48, p = 0.61); adaptive behavior domain, 2.10 (95 % CI 1.04 to 3.16, p = 0.36). Furthermore, the most common side effects reported included fever, hyperactivity, vomit, headache, and aggressiveness; no serious adverse events were reported. CONCLUSIONS: The body of evidence suggests that stem cell therapy significantly improves scales in patients with autism spectrum disorder, hence, future studies should help us have more confidence in the results. We found no serious adverse events related to the stem cell therapy.

Does glitazone treatment have a role on the prevention of Parkinson's disease in adult diabetic population? A systematic review.

Lately, focus on the relation between Parkinson's disease (PD) and Diabetes has risen greatly, as neuroprotective properties have been attributed to insulin use. Several studies have assessed the effect of glitazones, an insulin-sensitizing agent, in diabetic population on PD future risk. However, reports on the effect of their use have been heterogeneous. We aimed to synthesize the available scientific evidence which assesses the effect of glitazone use in type 2 diabetes patients on PD incidence. A systematic review was performed on multiple electronic databases. Considered for inclusion were studies that assessed the incidence of PD in type 2 diabetes glitazone users. Two reviewers worked independently and in duplicate to assess all studies, extract information and assess the methodological quality in each included study. Four high quality retrospective cohorts fulfilled inclusion criteria. Comparison groups varied across studies. In each study, incidence of PD was lower in glitazone-exposed patients compared to their respective comparison group. Pooled analysis showed lesser risk of PD in ever versus never glitazone users (RR 0.75 [95% C.I. 0.67-0.85; p < .0001; I2 = 0]). Our pooled analysis showed lesser risk of PD in glitazone versus non glitazone users, however, we advise to take results with caution since results are non-adjusted to possible confounding variables, furthermore, different glitazone-exposure time, follow up and comparison groups are aspects that also need to be pointed out. More clinical research focused on glitazone use and its relation with PD is needed, as this could result in new potential treatment modalities.

Determination of the Ratio of the Decantation Time and the Separation of Components in Lipoaspirate.

Decantation of the lipoaspirate is one of the most common techniques used to prepare the fat graft. The aim of the study was to determine the ideal time of decantation that provides the best separation of the components without compromising the viability of the adipocytes. METHODS: Thirty milliliters of fat were obtained from 11 healthy adults and decanted at room temperature for 0, 30, and 60 minutes. After decantation, the infiltration liquid and the remnant fat were measured with a volumetric pipette. Once the solution was removed, the remnant fat was centrifuged at 3000 rpm for 5 minutes to separate any residual solution, to measure the amount of actual fat obtained at that time point. Viability was determined with trypan blue staining for all the samples. RESULTS: After decantation, 9.4 ± 0.79 mL of fat was obtained at time 0, whereas 7.7 ± 1.56 mL was obtained at 30 minutes and 6.9 ± 0.92 mL at 60 minutes. Actual fat volume was 6.6 ± 1.56 mL, 5.5 ± 1.39, and 5.26 ± 1.3 mL, respectively. Viability at time 0 was 73.33 ± 0.06%, 72.57 ± 0.1% at 30 minutes, and 59.3 ± 0.09% at 60 minutes (P = 0.004). RESULTS: The fat grafting, processed by decantation, will have the best performance within a period of 30 minutes after harvesting, where the best rate of viability and separation of components will be achieved.

Transferencia articular vascularizada: Reporte de caso / Free vascularized joint transfer: Case report

La articulación interfalángica proximal otorga la mayor contribución al arco total de movimiento digital, por lo tanto, la pérdida de movimiento normal de la articulación tiene un impacto considerable en la función y fuerza de agarre. El único método que asegura la preservación a largo plazo de la arquitectura cartilaginosa, así como una curación ósea rápida tras destrucción articular traumática o patológica es la transferencia articular vascularizada. Es definida como un trasplante articular parcial o completo con preservación o restauración inmediata del flujo de sangre. Se presenta el caso de un masculino de 20 años, con antecedente de trauma contuso-cortante en borde cubital de 3er dedo de mano izquierda zona II a quien se realiza cierre primario. Siete meses después a presentó deformidad articular e incapacidad funcional para la flexión de articulación interfalángica proximal. Se realizó procedimiento de reconstrucción articular, mediante transferencia articular vascularizada de 2° dedo del pie derecho. Posteriormente se dio seguimiento a través de consulta externa a las 2, 4, 6 y 8 semanas, 6 meses y 12 meses. A los 6 meses fue sometido a capsulotomía, liberación de placa volar, retiro de placas de osteosíntesis y adelgazamiento de isla cutánea. Se alcanzaron rangos de movimiento pasivo de extensión de 85° y activo de 70°. En base a la experiencia de nuestro centro se demuestra que el uso de transferencia articular en 2 etapas de reconstrucción, se pueden mantener rangos de movimiento tanto activo como pasivo suficiente para una adecuada función.

The proximal interphalangeal joint provides the greatest contribution to the total arc of digital movement, therefore, the loss of normal movement of the joint has a considerable impact on function and grip strength. The only method that ensures the long-term preservation of the cartilaginous architecture, as well as a rapid recovery of traumatic or pathological joint destruction, is vascularized joint transfer. It is defined as a partial or complete partial transplant with preservation or immediate restoration of blood flow. We present the case of a 20-year-old man, with a history of contusive-cutting trauma on the ulnar border of the third finger of the left hand, area II, who underwent primary closure. Seven months after the presentation of the joint and functional disability for proximal interphalangeal joint flexion. A joint reconstruction process was performed, by means of a vascularized joint transfer of the 2nd toe of the right foot. Subsequently, follow-up was carried out through the outpatient clinic at 2, 4, 6 and 8 weeks, 6 months and 12 months. At 6 months he was subjected capsulotomy, volar plate release, osteosynthesis plates removal and cutaneous island thinning. Ranges of passive movement of extension of 85° and active of 70° were reached. Based on the experience of our center, it is shown that the use of the transfer was made in 2 stages of reconstruction, the range of both active and passive movements can be maintained for an adequate function.