Cartilage Regeneration in Humans with Adipose Tissue-Derived Stem Cells and Adipose Stromal Vascular Fraction Cells: Updated Status.

Adipose tissue-derived stem cells (ASCs) in the form of stromal vascular fraction (SVF) and cultured expansion have been applied in clinical settings in some countries to treat osteoarthritis (OA) of knees, one of the most common debilitating, incurable disorders. Since the first report of successful cartilage-like tissue regeneration with autologous adipose SVF containing ASCs, there has been a gradual increase in the number of publications confirming such results. Thus far, most of the reports have been limited to treatments of OA of knees. Recently, successful applications of adipose SVF in treating OA of ankles and hips have been reported. In addition, several groups have reported modified methods of applying adipose SVF, such as combining bone marrow stimulation with adipose SVF or adding additional extracellular matrix (ECM) in treating OA. Here, we present an updated, systematic review of clinical effectiveness and safety in treating OA of knees, ankles, and one hip since 2016 using ASCs in the form of adipose SVF or in cultured expansion, along with a description and suggestion of potential biological mechanisms of cartilage regeneration.

Binaural advantages in users of bimodal and bilateral cochlear implant devices.

This paper investigates to what extent users of bilateral and bimodal fittings should expect to benefit from all three different binaural advantages found to be present in normal-hearing listeners. Head-shadow and binaural squelch are advantages occurring under spatially separated speech and noise, while summation emerges when speech and noise coincide in space. For 14 bilateral or bimodal listeners, speech reception thresholds in the presence of four-talker babble were measured in sound-field under various speech and noise configurations. Statistical analysis revealed significant advantages of head-shadow and summation for both bilateral and bimodal listeners. Squelch was significant only for bimodal listeners.

EMT en Español Para Autismo: A Collaborative Communication Intervention Approach and Single Case Design Pilot Study.

The primary purpose of the current pilot study was to test the effects of an adapted and collaborative intervention model with a systematic teaching approach on Latina Spanish-speaking caregivers' use of EMT en Español Para Autismo strategies with their young children on the autism spectrum. A multiple baseline across behaviors single case design was replicated across two dyads. A series of family interviews and a direct therapist-child intervention phase supported individualization of the intervention. Families were provided speech generating devices as part of their children's intervention protocol. Caregivers were taught to use EMT en Español Para Autismo strategies with aided language input. Strategies included contingent target-level and proximal target-level language modeling, linguistic expansions, and communication elicitations. Secondary variables measured included generalization of strategy use to unsupported interactions and at a 2-month follow-up, child communication outcomes, and social validity. There was a strong functional relation for one dyad between the adapted and collaborative intervention and caregiver use of EMT strategies. The functional relation was weakened by behavioral covariation for the other dyad. Children increased the quantity and diversity of their communication during the study. Caregivers generalized their use of most EMT strategies and reported most aspects of the approach to be socially valid. The current study provides an initial demonstration of an effective model for adaptation and individualization of naturalistic developmental behavioral interventions for Latino Spanish-speaking families with children on the autism spectrum.

Comparing Interventions With Speech-Generating Devices and Other Augmentative and Alternative Communication Modes: A Meta-Analysis.

PURPOSE: Optimal augmentative and alternative communication (AAC) systems for children with complex communication needs depend in part on child characteristics, child preferences, and features of the systems themselves. The purpose of this meta-analysis was to describe and synthesize single case design studies comparing young children's acquisition of communication skills with speech-generating devices (SGDs) and other AAC modes. METHOD: A systematic search of published and gray literature was conducted. Data related to study details, rigor, participant characteristics, design information, and outcomes were coded for each study. A random effects multilevel meta-analysis was performed using log response ratios as effect sizes. RESULTS: Nineteen single case experimental design studies with 66 participants (M age = 4.9 years) met inclusion criteria. All but one study featured requesting as the primary dependent variable. Visual analysis and meta-analysis indicated no differences between use of SGDs and picture exchange for children learning to request. Children demonstrated preferences for and learned to request more successfully with SGDs than with manual sign. Children who preferred picture exchange also learned to request more easily with picture exchange than with SGDs. CONCLUSIONS: Young children with disabilities may be able to request equally well with SGDs and picture exchange systems in structured contexts. More research is needed comparing AAC modes with diverse participants, communication functions, linguistic complexity, and learning contexts. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22111181.

Long-Term Effects of Early Communication Interventions: A Systematic Review and Meta-Analysis.

PURPOSE: Early language and communication interventions for children with language impairments have been shown to be effective in assessments administered immediately after treatment. The purpose of the current systematic review and meta-analysis was to assess the overall durability of those effects over time and whether durability was related to outcome type, etiology of child language impairments, implementer of intervention, magnitude of posttest effects, time between intervention and follow-up, and study risk of bias. METHOD: We conducted a systematic search of online databases and reference lists to identify experimental and quasi-experimental group design studies. All studies tested the effects of early communication interventions at least 3 months post-intervention. Participants were children 0-5 years old with language impairments. Coders identified study features and rated methodological quality indicators for all studies. Effect sizes at long-term timepoints and associations with potential moderators were estimated using multilevel meta-analysis with robust variance estimation. RESULTS: Twenty studies with 129 long-term outcome effect sizes met inclusion criteria. Studies included children with developmental language disorders or language impairment associated with autism. The overall average effect size was small and significant (g = .22, p = .002). Effect size estimates were larger for prelinguistic outcomes (g = .36, p < .001) than for linguistic outcomes (g = .14, p = .101). Significant factors were the posttest effect sizes, the risk of bias for randomized trials, and etiology of language impairment for linguistic outcomes. Time post-intervention did not significantly predict long-term effect sizes. CONCLUSIONS: Outcomes of early language and communication interventions appear to persist for at least several months post-intervention. More research is needed with collection and evaluation of long-term outcomes, a focus on measurement, and consistency of primary study reporting. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23589648.

A Systematic Review of Augmented Input Interventions and Exploratory Analysis of Moderators.

Purpose Augmented input is the act of concurrently modeling language verbally and on a communication device, and is one strategy for teaching individuals to effectively use aided modes of communication. The purpose of this literature review is to assess the efficacy of augmented input for increasing communication and to identify intervention components, participant characteristics, and instructional contexts related to therapeutic outcomes. Method We double screened all potential sources and double coded all included sources. Database, forward, and backward searches yielded 99 single case designs in 26 sources. We coded characteristics of participants, instructional contexts, independent variables, and dependent variables. We also coded quality/rigor and primary outcomes for each design or comparison. Results Across high-quality studies, two thirds of designs indicated that augmented input was effective compared to baseline conditions and alternative interventions, and exploratory analyses indicated that receptive language skills, age, and diagnoses may moderate intervention efficacy. Most augmented input interventions included additional components that may serve as "active ingredients" (e.g., systematic prompting, contextual reinforcement). Most studies also did not report participant characteristics hypothesized to moderate intervention efficacy (e.g., joint attention skills, imitation repertoire). Results also indicated high risk of publication bias, with peer-reviewed sources twice as likely to include positive effects than dissertations and theses. Conclusions Across high-quality studies, augmented input was inconsistently effective as a stand-alone intervention. Packaged interventions that included augmented input were typically more effective than augmented input in isolation, particularly for individuals who were young, had strong receptive language skills, or had no comorbid diagnoses.

Clinical Protocol of Producing Adipose Tissue-Derived Stromal Vascular Fraction for Potential Cartilage Regeneration.

Osteoarthritis (OA) is one of the most common debilitating disorders. Recently, numerous attempts have been made to improve the functions of the knees by using different forms of mesenchymal stem cells (MSCs). In Korea, bone marrow concentrates and cord blood-derived stem cells have been approved by the Korean Food and Drug Administration (KFDA) for cartilage regeneration. In addition, an adipose tissue-derived stromal vascular fraction (SVF) has been allowed by the KFDA for joint injections in human patients. Autologous adipose tissue-derived SVF contains extracellular matrix (ECM) in addition to mesenchymal stem cells. ECM excretes various cytokines that, along with hyaluronic acid (HA) and platelet-rich plasma (PRP) activated by calcium chloride, may help MSCs to regenerate cartilage and improve knee functions. In this article, we presented a protocol to improve knee functions by regenerating cartilage-like tissue in human patients with OA. The result of the protocol was first reported in 2011 followed by a few additional publications. The protocol involves liposuction to obtain autologous lipoaspirates that are mixed with collagenase. This lipoaspirates-collagenase mixture is then cut and homogenized to remove large fibrous tissue that may clog up the needle during the injection. Afterwards, the mixture is incubated to obtain adipose tissue-derived SVF. The resulting adipose tissue-derived SVF, containing both adipose tissue-derived MSCs and remnants of ECM, is injected into knees of patients, combined with HA and calcium chloride activated PRP. Included are three cases of patients who were treated with our protocol resulting in improvement of knee pain, swelling, and range of motion along with MRI evidence of hyaline cartilage-like tissue.

Dissociating morphological and form priming with novel complex word primes: Evidence from masked priming, overt priming, and event-related potentials.

Recent research suggests that visually-presented words are initially morphologically segmented whenever the letter-string can be exhaustively assigned to existing morphological representations, but not when an exhaustive parse is unavailable; e.g., priming is observed for both hunter→HUNT and brother →BROTH, but not for brothel→BROTH. Few studies have investigated whether this pattern extends to novel complex words, and the results to date (all from novel suffixed words) are mixed. In the current study, we examine whether novel compounds (drugrack→RACK) yield morphological priming which is dissociable from that in novel pseudoembedded words (slegrack→RACK). Using masked priming, we find significant and comparable priming in reaction times for word-final elements of both novel compounds and novel pseudoembedded words. Using overt priming, however, we find greater priming effects (in both reaction times and N400 amplitudes) for novel compounds compared to novel pseudoembedded words. These results are consistent with models assuming across-the-board activation of putative constituents, while also suggesting that morpheme activation may persevere despite the lack of an exhaustive morpheme-based parse when an exhaustive monomorphemic analysis is also unavailable. These findings highlight the critical role of the lexical status of the pseudoembedded prime in dissociating morphological and orthographic priming.

Online learning from input versus offline memory evolution in adult word learning: effects of neighborhood density and phonologically related practice.

PURPOSE: In this study, the authors investigated adult word learning to determine how neighborhood density and practice across phonologically related training sets influence online learning from input during training versus offline memory evolution during no-training gaps. METHOD: Sixty-one adults were randomly assigned to learn low- or high-density nonwords. Within each density condition, participants were trained on one set of words and then were trained on a second set of words, consisting of phonological neighbors of the first set. Learning was measured in a picture-naming test. Data were analyzed using multilevel modeling and spline regression. RESULTS: Steep learning during input was observed, with new words from dense neighborhoods and new words that were neighbors of recently learned words (i.e., second-set words) being learned better than other words. In terms of memory evolution, large and significant forgetting was observed during 1-week gaps in training. Effects of density and practice during memory evolution were opposite of those during input. Specifically, forgetting was greater for high-density and second-set words than for low-density and first-set words. CONCLUSION: High phonological similarity, regardless of source (i.e., known words or recent training), appears to facilitate online learning from input but seems to impede offline memory evolution.