Umbilical Cord Stem Cell Lysate: A New Biologic Injectate for the Putative Treatment of Acute Temporomandibular Joint Inflammation.

Objective: To compare in vivo, the acute anti-inflammatory effects of a lysate derived from human umbilical perivascular mesenchymal cells with the cells themselves in both an established hind-paw model of carrageenan-induced inflammation and also in the inflamed temporomandibular joint. Study Design: Human umbilical cord perivascular cells were harvested and cultured in xeno- and serum-free conditions to P3. In addition, P3 cells were used to prepare a proprietary 0.22 micron filtered lysate. First, CD1 immunocompetent mice underwent unilateral hind-paw injections of carrageenan for induction of inflammation, followed immediately by treatment with saline (negative control), 1% cell lysate, or viable cells. The contralateral paw remained un-injected with carrageenan. Paw circumference was measured prior to injections and 48 hr later and myeloperoxidase and TNF-alpha concentrations were measured post-sacrifice in excised tissue. Second, immunocompetent Male Wistar rats underwent unilateral intra-articular temporomandibular (TMJ) injections from the same treatment groups and were sacrificed at 4 and 48 hr post-injection. The contralateral TMJ remained un-injected with carrageenan. Articular tissue and synovial aspirates, from the treated TMJ were obtained for histologic and leukocyte infiltration analyses. Results: The lysate and cell-treated hind-paw demonstrated reduced tissue edema, and significantly lower concentrations of myeloperoxidase and TNF-alpha at 48 hr compared to untreated controls. Treated TMJs demonstrated lower concentrations of leukocytes in the synovium compared to controls and histologic evidence, in the peri-articular tissue, of reduced inflammation. Conclusion: In this preliminary study, both the human umbilical perivascular cells and a highly diluted lysate produced therefrom were anti-inflammatory.

Cell-free DNA topology depends on its subcellular and cellular origins in cancer.

Cancer cells release large quantities of cell-free DNA (cfDNA) into the surrounding tissue and circulation. As cfDNA is a common source of biomarkers for liquid biopsy and has been implicated as a functional mediator for intercellular communication, fundamental characterization of cfDNA topology has widespread biological and clinical ramifications. Whether the topology of cfDNA is such that it exists predominantly in membrane-bound extracellular vesicles (EVs) or in nonvesicular DNA-protein complexes remains poorly understood. Here, we employed a DNA-targeted approach to comprehensively assess total cfDNA topology in cancer. Using preclinical models and patient samples, we demonstrate that nuclear cfDNA is predominantly associated with nucleosomal particles and not EVs, while a substantial subset of mitochondrial cfDNA is membrane protected and disproportionately derived from nontumor cells. In addition, discrimination between membrane-protected and accessible mitochondrial cfDNA added diagnostic and prognostic value in a cohort of head and neck cancer patients. Our results support a revised model for cfDNA topology in cancer. Due to its abundance, nuclear cfDNA within nucleosomal particles is the most compelling liquid biopsy substrate, while EV-bound and accessible mitochondrial cfDNA represent distinct reservoirs of potential cancer biomarkers whose structural conformations may also influence their extracellular stability and propensity for uptake by recipient cells.

"To See With My Own Eyes": Experiences of Family Visits During Phase 1 Recovery.

PURPOSE: Long separations are a characteristic of the day of surgery, keeping patients and their family members waiting and apart. At a time of high vulnerability, these separations can cause anxiety and worry. The purpose of this study was to identify the outcomes and experiences of patients and family members who engaged in a 5- to 10-minute supervised family visit during phase I postanesthesia recovery. DESIGN: This was a descriptive, single-group, mixed-methods study. METHODS: Quantitative data, gathered on the day of surgery, was obtained from patients (vital signs, state anxiety scores) and their designated family members (state anxiety scores); satisfaction with the visit was also measured. An optional second, qualitative phase included a semi-structured interview examining the remembered experiences of patients and family members. FINDING: A statistically significant drop in state anxiety was discovered after the visit, and satisfaction with the visit was exceedingly high. Qualitatively, patients and family members described their overwhelming relief to be able "to see with my own eyes" how well each was doing. CONCLUSIONS: This study supports that family visits in the postanesthesia care unit are safe and profoundly important as an independent nursing intervention. Recommendations include implementation of family visits during postanesthesia care unit recovery for all patients and family members who desire them.

New hope and help for forgotten youth.

TOPIC: Juvenile sex offender treatment programs have been at the forefront of discussion among some policy-makers and certainly those who provide treatment for these youth. While the research in this area supports the use of community-based treatment strategies, clinicians with strong training background are rare. PURPOSE: There is a need for a certificate training program to develop clinicians who are specifically trained to treat juvenile sex offenders. Through a unique academic/community initiative providing a multimodal approach to treatment, a collaborative 2-day national conference related to treatment of juvenile sex offenders was established. The program core was a 9-month clinical treatment certificate training program. This article describes the community program, and outlines in detail its purpose, goals, trainee requirements, conceptual areas for competency development, and the content areas. CONCLUSIONS: The Mental Health Policy Institute for Leadership and Training of Baltimore and the School of Nursing of the University Maryland jointly recognized a need to address the quality and efficacy of community-based treatment and expand the number of trained clinicians to work with sex offending youth. As a result of positive program evaluations, this community program will be provided annually.