Standardization and safety of alveolar bone-derived stem cell isolation.

Cell therapies utilizing mesenchymal stem cells (MSCs) could overcome limitations of traditional treatments for reconstructing craniofacial tissues. This large-scale study explored a standardized methodology for the isolation and clinical-scale expansion of alveolar bone marrow-derived MSCs (aBMSCs). We harvested 103 alveolar bone marrow samples from 45 patients using 1 of 3 standardized methodologies. Following aBMSC isolation, cells were characterized through cell-surface marker expression and lineage-specific differentiation. Long-term cultures (> 50 population doublings [PDs]) were evaluated for transformational changes through senescence, gene expression, and karyotyping. Finally, aBMSC bone-forming potential was determined in vivo. More than 0.5 cc of bone marrow was needed to predictably isolate aBMSCs, and, regardless of methodology for harvest, cell-surface marker expression of CD73, CD90, CD105, and Stro-1 was similar for aBMSCs, being 89.8%, 98.8%, 93.8%, and 3.2%, respectively; all cells were negative for CD11b, CD19, and CD45. aBMSCs exhibited multipotency, and karyotypes were normal up to 30 PDs, with significant cell senescence beginning following 35 PDs. Additionally, aBMSCs induced ectopic bone formation following subcutaneous transplantation into mice. These findings demonstrate a predictable approach for the isolation and safe clinical-scale expansion of aBMSCs, and thus, their clinical use could be considered for craniofacial regenerative therapies.

Serving rural Australia with reproductive health expertise.

This study aimed to review the use of reproductive health services in Family Planning clinics by women from rural (non-metropolitan) Australia through a retrospective analysis of data collected at clinics of seven state/territory Family Planning Organisations (FPO). From a total of 146 157 client visits to FPO clinics between July 1998 and June 1999, 42 497 (29.1%) were by clients who lived outside metropolitan areas. Some 97% of clients were women. Our results show the use of reproductive health services by women from rural areas was different from the services used by women from metropolitan areas. There were fewer male clients, more women over 40 years of age, and fewer clients from a non-English speaking background. More of the attendees had pension cards and fewer were privately insured. We concluded there is considerable demand for reproductive health services among the rural population and reproductive health care needs to be expanded to reach rural women.

Variations of the hepatic and cystic arteries among Ethiopians.

The anatomy of the hepatic and cystic arteries were investigated in 110 postmortem and cadaveric subjects. The right hepatic artery took origin from the proper hepatic artery (66.3%), the common hepatic artery (18.2%), the superior mesenteric artery (8.2%) or the celiac trunk (7.3%). Ten cases of accessory right hepatic artery originating from the superior mesenteric artery (7 cases), gastroduodenal artery (2 cases) or the left hepatic artery (1 case) were observed. The origin of the left hepatic artery included the proper hepatic artery (71.8%), the common hepatic artery (16.4%), the celiac trunk (10.9%) and the splenic artery (0.9%). The 14 cases of accessory left hepatic arteries originated from the common hepatic artery (5 cases), right hepatic artery (3 cases), gastroduodenal artery (2 cases) or the celiac trunk (4 cases). An extrahepatic branch to the quadrate lobe of the liver, also known as the middle hepatic artery, was observed in 47.3% arising mainly from the right or left hepatic arteries (20% each), the superior mesenteric artery (2.7%) and from the gastroduodenal artery (4.6%). The cystic artery mainly arose from the right hepatic artery (75.5%) but also took origin from the middle hepatic artery (12.7%), gastroduodenal artery (7.3%) or the left hepatic artery (4.5%). When the cystic artery is to the left of the common hepatic artery at its origin (39.1%), it crossed from left to right anterior to the common hepatic duct (28.2%) or posterior to the duct (10.9%). Irrespective of its relationship with the common hepatic duct, the cystic artery passed in the triangle of Calot in 89 cases. There were 11 accessory cystic arteries arising from the right hepatic (6 cases), the middle hepatic (3 cases) or the left hepatic arteries (2 cases). Arterial variations seen in the present study were significantly higher (p < 0.05) than that reported in the literature. This was mainly due to the variations seen in origin of the right hepatic artery in the female subjects which was significantly higher (p < 0.05) than in the male subjects. The significance of this finding needs further investigation.

Anatomical variations of gallbladder and biliary ducts among Ethiopians.

The extrahepatic biliary system was investigated to determine the types and frequency of variations in a group of Ethiopian subjects. A total of 110 specimens were obtained from adult Ethiopian subjects. Each specimen consisting of the whole of the liver, stomach, duodenum and the lesser omentum was removed and dissected carefully to expose the gallbladder and biliary ducts without disturbing their relationship. The majority (51%) of subjects had supramarginal type of gallbladder. The neck and infundibulum of the gallbladder were shorter in the present group compared to reports in other populations. There were significantly more cases of kinking of the gallbladder and Hartmann's pouch in the female than in the male subjects. However, there was no significant difference between the present and previously reported groups as well as the male and female subjects of the present group in the length or course of the cystic, hepatic or bile ducts. The findings in the present study suggest that variations in the gallbladder and the biliary ducts seen in the Ethiopian group are similar to what is reported in other populations. The significantly higher prevalence of kinking of the gallbladder and Hartmann's pouch in the female than in the male subjects may have some contribution to the higher rate of gallstone formation and biliary tract diseases in females.

Regeneration at the predilective damage sites of nerve trunks in treated leprosy.

Superficially located large and medium sized mixed peripheral limb nerves in active leprosy have previously been shown to have well-recognized fusiform swellings. It is generally agreed that these are the sites of predilective nerve involvement where the severest degeneration and fibrosis occur. A semiquantitative histopathological study on one of these sites, the flexor retinaculum region of the posterior tibial nerve, has been carried out on 14 treated leprosy patients who suffered from total sensory loss to the foot for between 2 and 40 years. The following observations were made: (1) large-scale nerve regeneration was present as characterized by numerous Schwann cells and unmyelinated axons which formed regeneration clusters; (2) thick myelinated axons were either absent or present only in very low numbers; (3) the intraneural fibrosis was usually not severe; (4) the presence of active inflammation probably interfered with nerve regeneration; (5) it appeared that this regeneration started shortly after the onset of therapy and persisted for decades; (6) lepromatous cases were characterized by evenly distributed pathology, whereas borderline tuberculoid cases had an unevenly distributed pathology; (7) the massive nerve regeneration observed was functionally ineffective--these findings indicate that the total nerve damage may affect the more peripheral nerve branches.

Damage and regeneration of peripheral nerves in advanced treated leprosy.

Despite the rapidly falling prevalence of leprosy, the disability and handicap resulting from loss of protective sensation, due to irreversible nerve damage, will remain a huge medical problem for many years. To elucidate the location and consequences of permanent nerve damage in treated leprosy, a prospective study involving nine patients who underwent leg amputation was conducted. Full-length nerves dissected from amputated legs were studied with histological and immunohistochemical methods. Our main findings were that: in both lepromatous and tuberculoid leprosy nerve damage increased distally, culminating in total destruction of dermal nerves and sensory nerve endings; after the therapy-related decrease of inflammation large-scale nerve regeneration took place; and that regenerating axons persisted for decades and in tuberculoid leprosy they might reach the subcutaneous fat of the plantar skin. We conclude that nerve regeneration was blocked by fibrous replacement of the distal-most nerves and nerve endings, and that the theoretical basis of nerve grafting in leprosy is in need of further clarification. In some patients, autologous transplantation of skin flaps, probably irrespective of the duration of loss of sensation, might help in regaining protective sensation.

Maternal education and child survival in Addis Ababa

Maternal education is found to be positively associated with child survival and its impact was generally more critical in the step from primary to secondary schooling than from the illiterate group. Although once income/wealth is controlled; differences in maternal education resulted in related little variation on child survival. The result also demonstrated that given the level of maternal education its proportionate effect on child survival improved as one ascends from the lowest to the highest income/wealth category. The findings have important implications for policy and further research