Wharton's jelly and osteoarthritis of the knee.

INTRODUCTION: The existing treatment modalities for knee osteoarthritis (OA) do not actually address the pathology. Biological therapies, including those using material derived from perinatal tissues, represent a ground-breaking approach to alleviating the symptoms of OA of the knee. SOURCE OF DATA: Current scientific literature published in PubMed (MEDLINE), Embase and Scopus databases. Trials registered in various clinical trial databases. AREAS OF AGREEMENT: Perinatal tissues including Wharton's jelly (WJ) and associated mesenchymal stem cells (MSCs) can be used for the management of knee OA. AREAS OF CONTROVERSY: The efficacy of WJ and associated MSCs in the management of knee OA is still controversial. GROWING POINTS: The use of WJ and associated MSCs in the management of knee OA is safe and appears to be effective. AREAS TIMELY FOR DEVELOPING RESEARCH: The present published evidence suggests that WJ tissue and associated MSCs offer an encouraging alternative for the management of knee OA. The published in vitro, preclinical and clinical investigations demonstrate the therapeutic potential of WJ and promote further research in this field to provide symptomatic relief to patients suffering from OA, aiming also to regenerate the osteoarthritic hyaline cartilage, with disease-modifying effects. Future adequately powered randomized controlled trials should be undertaken to establish whether WJ is helpful in the management of OA of the knee.

Continuous ambulatory peritoneal dialysis catheter insertion by open technique: 20-year experience from a single center.

Introduction: Continuous ambulatory peritoneal dialysis (CAPD) catheter placement is a part of renal replacement therapy. We describe our 20-year experience in using the open technique and assess its safety, efficacy, and outcome in the treatment of end-stage renal disease patients. Methods: In a retrospective study, we analyzed data of all patients who had a CAPD catheter placed using our open dissection technique using local anesthesia over the previous 20 years, with minimum 1 year of follow-up. Intraoperative data, postoperative data, and complications were noted. Results: A total of 1410 cases were included in the study. The mean duration of follow-up was 72 ± 18 months (range 12-120 months). The mean operative time was 19 ± 7.5 min and mean hospital stay was 3 ± 1 days. No major intraoperative complications were noted. We observed a peritonitis rate of 0.49 episodes/patient/year. The most common reason for permanent catheter removal was refractory peritonitis in 21%, followed by flow failure in 7%, and ultrafiltration failure in 6.5%. The death-censored technical survival rate was 94.3%, 83.2%, 75.9%, 69.2%, and 60.6% patients at 1 year, 2 years, 3 years, 4 years, and 5 years, respectively. Conclusions: The open dissection method of peritoneal dialysis catheter insertion using local anesthesia at well-experienced center is a simple, painless, and uncomplicated procedure with excellent outcomes. Optimal exposure, judicious use of energy source, and using appropriate technique provide good technical success rate with lesser complications.

The Urological Society of India survey on urinary incontinence practice patterns among urologists.

INTRODUCTION: The Urological Society of India guidelines panel on urinary incontinence (UI) conducted a survey among its members to determine their practice patterns in the management of UI. The results of this survey are reported in this manuscript. METHODS: An anonymous online survey was carried out among members of the USI to determine their practice patterns regarding UI using a predeveloped questionnaire on using SurveyMonkey®. A second 4-question randomized telephonic survey of the nonresponders was performed after closure of the online survey. Data were analyzed by R software 3.1.3 (P < 0.05 significant). RESULTS: A total of 468 of 2109 (22.2%) members responded to the online survey. Nearly 97% were urologists, 74.8% were working at a private, and 39.4% were in an academic institution. Almost all were managing UI. 84.2% had local access to a urodynamics (UDS) facility. 85.8% would check postvoid residual urine for all the patients. Voiding diary, symptom scores, quality of life scores, pad test, Q-tip test, stress test, uroflow, and cystoscopy were ordered as part of evaluation by 86.0%, 49.8%, 24.4%, 22.0%, 6.0%, 71.8%, 69.2%, and 34.7%, respectively. 47.6% would order a UDS for patients with urgency UI who fail conservative treatment. 36.9% would get UDS prior to all stress UI surgery. Seventy-five percent would make a diagnosis of intrinsic sphincter deficiency. Solifenacin was the first choice for urgency UI in general and darifenacin was preferred in elderly. Botulinum was the first choice for refractory urgency UI. Midurethral sling was the commonest procedure for surgical management of SUI (95.1%). 147 of the 1641 non responders were randomly sampled telephonically. Telephonic respondents had similar access to UDS facility but had performed fewer lifetime number of post-prostatectomy incontinence (PPI) surgeries. Combining data from both surveys, total number of artificial sphincters and PPI surgeries ever performed by USI members was estimated at 375 and 718 respectively. CONCLUSION: This survey provides important new data and elicits critical differences in management practices based on demographics.

Distinct neurogenic potential in the retinal margin and the pars plana of mammalian eye.

Unlike many other vertebrates, a healthy mammalian retina does not grow throughout life and lacks a ciliary margin zone capable of actively generating new neurons. The isolation of stem-like cells from the ciliary epithelium has led to speculation that the mammalian retina and/or surrounding tissues may retain neurogenic potential capable of responding to retinal damage. Using genetically altered mouse lines with varying degrees of retinal ganglion cell loss, we show that the retinal margin responds to ganglion cell loss by prolonging specific neurogenic activity, as characterized by increased numbers of Atoh7(LacZ)-expressing cells. The extent of neurogenic activity correlated with the degree of ganglion cell deficiency. In the pars plana, but not the retinal margin, cells remain proliferative into adulthood, marking the junction of pars plana and retinal margin as a niche capable of producing proliferative cells in the mammalian retina and a potential cellular source for retinal regeneration.

Hepatocellular carcinoma arising in a testicular teratoma: a distinct and unrecognized secondary somatic malignancy.

We report an interesting case of testicular germ cell tumor with distinct seminomatous and teratomatous components. A rare development of secondary somatic malignancy in the form of hepatocellular carcinoma was observed. Immunohistochemically, hepatocellular cancer was positive for cytokeratin, hepatocyte paraffin-1 (HepPar-1), α-fetoprotein, glypican-3 (GPC-3), octamer-binding transcription factor 3/4 (Oct3/4), and Ki-67. In addition, adenocarcinoma and rhabdomyoblastic differentiation were also evident. Placental alkaline phosphatase (PLAP), Sal-like 4, and Oct3/4 were positive in seminoma. To the best of our knowledge, we have not found any such report of secondary development of hepatocellular carcinoma in a testicular teratoma. We believe that it is a rare, distinct phenomenon in germ cell tumors and deserves recognition.

Allogenic umbilical cord tissue for temporomandibular joint injuries.

The temporomandibular joint (TMJ) is crucial for functions of daily living such as mastication and articulation. Common TMJ issues include osteoarthritis, internal derangement, and myofascial pain dysfunction. Conservative methods such as physical therapy and medications are used, with surgical options such as arthroscopy and replacement for severe cases. Emerging regenerative medicine explores non-surgical treatments using human stem cells from umbilical cord derivatives, showing potential for tissue regeneration in TMJ disorders. A systematic search was conducted across PubMed, Embase, Scopus, and Web of Science databases, adhering to PRISMA guidelines, aiming to identify relevant articles published in English until August 2023. The search used specific terms to target in vitro, preclinical, and clinical studies on umbilical cord (UC)-derived tissue and mesenchymal stem cells (MSCs) for treating TMJ disorders. The search was extended to three clinical trial registries for on-going investigations related to UC tissue and MSCs for TMJ disorder management. The studies included in this article report the safety and efficacy profiles of allogenically acquired, umbilical cord-derived tissues and associated mesenchymal stem cells for temporomandibular joint ailments, future adequately powered, randomized controlled trials are warranted to conclusively justify the clinical use of this biologic therapy.

Comparison of Histological Changes in Tissue Specimens Kept in Tap Water, River Water and Seawater for Different Intervals of Time.

BACKGROUND: Forensic pathologists find it difficult to ascertain the actual reason for death and the actual mode of death in drowning cases. It is commonly acknowledged that not all people whose dead bodies are found in water perished from drowning. The medico-legal inquiry includes an important component that examines dead bodies collected from the water. The corpse's time in the water continues to be the main concern. This aids in determining the time of death, which is crucial to any medico-legal investigation. The traditional histological analysis of hematoxylin and eosin (H&E)-stained oral soft tissue can be crucial in the assessment of this feature. Hence, this study was done to compare histological changes in the tissue specimens kept in tap water, river water, and seawater for different intervals of time. MATERIALS AND METHODS: One hundred eighty specimens were obtained from 180 dead bodies and divided randomly into three categories. Category A consisted of 60 specimens submerged in tap water, Category B of 60 specimens submersed in river water, and Category C consisted of 60 specimens submerged in seawater. The specimens underwent routine histological processing and H&E staining. The microscopic evaluation of specimens was carried out at two hours and on the first, second, third, fourth, and fifth days of submersion. Details were recorded regarding the structural changes, cellular changes, connective tissue changes, changes in the basement membrane, and intensity of H&E staining. Once the process of routine histological processing and H&E staining was completed for each study specimen, an evaluation of microscopic changes in the tissue was made. RESULTS: The present study revealed that seawater preserved tissue best and for a longer period than river water and tap water. River water preserved tissue better than tap water. In pathologic tissue, details were preserved for much longer. It was noted that in squamous cell carcinoma, connective tissue was destroyed earlier than epithelium, in contrast to normal tissue where epithelium was destroyed before connective tissue. CONCLUSION: This study indicates that the medium of submersion in drowning victims affects the histopathological features. The time of death is an important aspect of forensic investigation. Considering this, all cases of drowning should be very carefully evaluated, and the medium taken into consideration while determining the time of death, as tissue degrades faster in freshwater than in seawater.

Allogenic Umbilical Cord Tissue for Rotator Cuff Injuries.

Highly prone to injury, the rotator cuff greatly contributes to the stability and mobility of the shoulder. Clinicians prioritize conservative treatment, resorting to surgery only when necessary, although they are hindered by inherent limitations. Biological therapies, including perinatal tissue, such as umbilical cord (UC) tissue, hold promise for treating rotator cuff injuries (RCIs) in the field of regenerative medicine. This article qualitatively presents the in vitro, preclinical, clinical, and ongoing scientific literature exploring the application of UC tissue and associated mesenchymal stem cells in the context of RCIs. Employing the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines, a systematic review was conducted. These studies have presented substantial evidence indicating that UC tissue and UC-derived mesenchymal stem cells are safe and potentially efficacious for managing RCIs, though more adequately powered randomized controlled trials are warranted to further establish efficacy and justify clinical use.

Minimally invasive ureterolysis and intraperitonealization of ureter for idiopathic retroperitoneal fibrosis; single center analysis of an erratic disease.

INTRODUCTION: Idiopathic retroperitoneal fibrosis is a known cause of obstructive uropathy. Ureterolysis is done when medical management fails or the presentation is at an advanced stage. Conventionally ureterolysis without omental wrap has been considered incomplete. Our Institute has experience of laparoscopic or robotic ureterolysis with intraperitonealization of the ureter alone and no other adjunctive procedure. This study retrospectively assesses the result of the procedure with patients presenting with varying severity of disease. METHODS: From 2008, all patients who underwent laparoscopic or robotic ureterolysis were analyzed retrospectively for pre-operative management, operative findings, and post operative outcomes. RESULTS: We operated and released nine renal units in seven patients. Two of the nine cases were performed robotically completely and the rest was performed by laparoscopic approach. Median follow up was 60 months. All patients documented resolution of symptoms. The mean post-operative creatinine at 1 year was significantly decreased to 1.47 ± 0.49 mg/dl in comparison to preoperative creatinine (p < 0.05). The postoperative mean ESR decreased significantly from a preoperative value of 58.2 ± 19.41 mm to 15.8 ± 17.23. The nuclear scan revealed unobstructed drainage and radiological imaging revealed resolution of hydronephrosis and fibrosis in all. The mean GFR on the nuclear scan after 3 and 12 months of surgery was 36.3 ± 4.33 and 40 ± 3.77, respectively. Thus, there was significant increase noted in GFR at 3 and 12 months in comparison to preoperative GFR (p < 0.05). CONCLUSION: Laparoscopic/robotic ureterolysis with intraperitonealization alone is secure and durable procedure for idiopathic retroperitoneal fibrosis needing surgical release.

Artificial Intelligence and Machine Learning in Rotator Cuff Tears.

Rotator cuff tears (RCTs) negatively impacts patient well-being. Artificial intelligence (AI) is emerging as a promising tool in medical decision-making. Within AI, deep learning allows to autonomously solve complex tasks. This review assesses the current and potential applications of AI in the management of RCT, focusing on diagnostic utility, challenges, and future perspectives. AI demonstrates promise in RCT diagnosis, aiding clinicians in interpreting complex imaging data. Deep learning frameworks, particularly convoluted neural networks architectures, exhibit remarkable diagnostic accuracy in detecting RCTs on magnetic resonance imaging. Advanced segmentation algorithms improve anatomic visualization and surgical planning. AI-assisted radiograph interpretation proves effective in ruling out full-thickness tears. Machine learning models predict RCT diagnosis and postoperative outcomes, enhancing personalized patient care. Challenges include small data sets and classification complexities, especially for partial thickness tears. Current applications of AI in RCT management are promising yet experimental. The potential of AI to revolutionize personalized, efficient, and accurate care for RCT patients is evident. The integration of AI with clinical expertise holds potential to redefine treatment strategies and optimize patient outcomes. Further research, larger data sets, and collaborative efforts are essential to unlock the transformative impact of AI in orthopedic surgery and RCT management.

Salivary metabolite signatures of oral cancer and leukoplakia through gas chromatography-mass spectrometry.

Background: Saliva contains a large array of metabolites, many of which can be informative for the detection of diseases. Gas chromatography-mass spectrometry (GC-MS) is a system that has long been used for metabolite profiling owing to its sensitivity, specificity, reproducibility and synchronized analysis; it has relatively broad coverage of compound classes including sugars, sugar alcohols, glycosides and lipophilic compounds. Aim and Objectives: The present study was conducted to explore the use of GC-MS in assessing variation in salivary metabolites and to recognize the metabolites which can be used as disease diagnostic tools and metabolite markers for detection of oral squamous cell carcinoma. Materials and Methods: The present study included clinically and histopathologically confirmed oral squamous cell carcinoma (OSCC) and oral leukoplakia patients (OLK) and the control group. Patients were divided into three groups: OSCC (n = 30), OLK (n = 30) and healthy individuals as controls (n = 30). Patients were refrained from eating, drinking, smoking or oral hygiene procedures for at least 1.5 h before the collection. Saliva was collected between 9.00 and 10.00 am. Samples were stored at -80°C. Filtered samples were used for GC-MS. Results: Fifteen compounds differed significantly between control, OLK and OSCC. These metabolites were decanedioic acid, 2-methyloctacosane, eicosane, octane, 3,5-dimethyl, pentadecane, hentriacontane, 5, 5-diethylpentadecane, nonadecane, oxalic acid, 6-phenylundecanea, l-proline, 2-furancarboxamide, 2-isopropyl-5-methyl-1-heptanol, pentanoic acid, Docosane. Conclusion: The findings of the study suggest the application of salivary metabolomics as a promising tool in the identification of tumor-specific biomarkers in early diagnosis and prediction of OSCC and oral leukoplakia. In future, standardizing the protocol for salivary analysis and overcoming some of the limitations will be helpful to establish salivary metabolomics as a reliable, the highly sensitive and specific method for clinical use as an independent diagnostic aid.

Post-traumatic Osteomyelitis of the Rib-point of Care In children, Presenting with chest Wall Pain.

Introduction: The rib osteomyelitis is a very rare entity and it hardly accounts for 1% of all cases of osteomyelitis. In this case report, we are presenting a case of acute osteomyelitis of rib in a very young child, with a previous history of mediocre trauma over the chest wall. Case Report: It is a case report of a young boy, who had sustained the blunt injury over the chest wall. The X-ray was unremarkable. After sometime, he presented to the hospital with the pain over the chest wall. Now, the X-ray showed the signs of rib osteomyelitis. Conclusion: In children, the clinical presentation of rib osteomyelitis is very non-specific. Sometimes, the injury while playing, which is very usual in this age group may create the confusion. Hence, it may need high index of suspicion by the physician to include is as a possible diagnosis.

Covid Assossiated Invasive Fungal Sinusitis.

Acute invasive fungal sinusitis is an aggressive infection affecting immunocomprosmised patients and carries a high mortality. Patients with Covid-pneumonia are at an increased risk of developing invasive pulmonary fungal infections probably due to their reduced immunological competence. Here, we review three cases of Covid-associated invasive fungal sinusitis.

Tracheostomy in Covid-19 Patients: Surgical Concerns and Considerations.

Tracheostomy in Covid-19 patients is an aerosol generating procedure putting health care workers at great risk. Retrospective study of tracheostomy in ten Covid-19 patients with ARDS using modifications of the surgical techniques revealed its efficacy in limiting the risks of spread to health care workers and improving surgical outcome.

Allogenic Perinatal Tissue for Musculoskeletal Regenerative Medicine Applications: A Systematic Review.

Producing tremendous amounts of stress and financial burden on the global patient population and healthcare systems around the world, most current modalities of treatment for musculoskeletal ailments often do not address the etiopathogenetic causes of these disorders. Regenerative medicine for musculoskeletal disorders relies on orthobiologics derived from either allogenic or autologous sources. Multiple drawbacks are associated with autologous sources, including donor-site morbidity, a dearth of studies, and variability in both patient reported and clinical/functional outcomes. On the other hand, allogenic sources address several of these concerns, and continue to be a suitable source of mesenchymal stem cells (MSCs). This review qualitatively reports both the preclinical and clinical outcomes of publications studying the applications of umbilical cord (-derived Wharton's jelly), amniotic suspension allograft, amniotic membrane, and amniotic fluid in musculoskeletal medicine. A systematic review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines on studies published between January 2010 and October 2022 that used allogeneic perinatal tissues. Further randomized controlled clinical studies are necessary to properly evaluate the safety and efficacy of these tissues in orthopedic surgery.

Allogenic perinatal tissue for musculoskeletal regenerative medicine applications: a systematic review protocol.

BACKGROUND: Musculoskeletal ailments impact the lives of millions of people, and at times necessitate surgery followed by physiotherapy, drug treatments, or immobilization. Regenerative musculoskeletal medicine has undergone enormous progress over the last few decades. Sources of tissues used for regenerative medicine purposes can be grouped into autologous or allogenic. Although autologous sources are promising, there is a wide range of limitations with the treatment, including the lack of randomized controlled studies for orthopaedic conditions, donor site morbidity, and highly variable outcomes for patients. Allogenic sources bypass some of these shortcomings and are a promising source for orthopaedic regenerative medicine applications. METHODS: A systematic search will be performed using PubMed, Elsevier, ScienceDirect, and Google Scholar databases for articles published in English before May 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and guidelines will be used. Studies will be eligible if they apply to acute and chronic orthopaedic musculoskeletal complications or animal or human disease models. Publications must include the use of MSCs and/or tissue obtained from amniotic/chorionic membrane, amniotic fluid, umbilical cord, and/or umbilical cord-derived Wharton's jelly as an intervention. Placebos, noninjury models, acute injury models, non-injury models, and gold standard treatments will be compared. The study selection will be performed by two independent reviewers using a dedicated reference management software. Data synthesis and meta-analysis will be performed separately for preclinical and clinical studies. DISCUSSION: The results will be published in relevant peer-reviewed scientific journals. Investigators will present results at national or international conferences. TRIAL REGISTRATION: The Protocol will be registered on PROSPERO international prospective register of systematic reviews prior to commencement.

Evaluation of Biochemical Recurrence and Correlation with Various Parameters After Robotic-Assisted Radical Prostatectomy: a Single Center Experience.

Introduction: Biochemical recurrence (BCR) is widely used as an early end point to assess treatment success and frequently prompts the initiation of secondary therapy after radical prostatectomy. We conducted an observational, ambispective study to evaluate BCR after robotic-assisted radical prostatectomy (RARP) for clinically localized prostate cancer. We also analyzed correlation of BCR with pre-operative PSA level, D'Amico classification, pathological stage, post-operative GS, and positive surgical margins after RARP. Material and Methods: A total of 90 patients with clinically localized carcinoma prostate (≤ T 2), who underwent RARP between April 2012 and April 2017 at our institute with 3 year of minimum follow-up were included in our study. Patients having locally advanced disease on clinical staging or died of unrelated cause in follow up or lost to follow up were excluded from study. Patients who had persistent detectable PSA (> 0.20 ng/ml) at 6 week with a second confirmatory level of PSA greater than 0.2 ng/ml at 3rd month were excluded from study. Results: The age of the patient ranges from 46 to 79 years with the mean age of 65.36 ± 6.55 years. The mean PSA was 24.36 ± 26.68 ng/ml with range between 1.8 and 126.6 ng/ml. Nine patients (10%) developed BCR at 1-year follow-up and 81 patients were BCR-free. Thus, 1-year BCRFS and BCR rate were 90% and 10%, respectively in our study. Total 17 patients (18.9%) developed BCR during a 2-year period and 73 patients were free of BCR. Thus, 2-year BCRFS and BCR rate were 81.1% and 18.9%, respectively. A total of 29 patients (32.2%) had BCR and 61 patients were free of BCR at 3 years of follow-up. Thus, overall 3-year BCR rate and 3-year BCRFS rate were 32.2% and 67.8%, respectively. There was significant correlation of BCR with pre-operative PSA level, D'Amico classification, pathological stage, post-operative GS, and positive surgical margins. Conclusions: There is relative paucity of data regarding the BCR rate after RARP in the Indian scenario. The BCR rate in our study was similar to previously published Western and limited Indian data on RARP series in localized prostate cancer. There was significant correlation of BCR with PSA, post-operative GS, pathological stage, PSM, and D'Amico classification.

Monkeypox: An Emerging Global Public Health Emergency.

The virus causing monkeypox, a rare zoonotic viral disease, belongs to the Poxviridae family and the Orthopoxvirus genus. On 23 July 2022, the World Health Organization (WHO) declared the monkeypox outbreak as a Public Health Emergency of International Concern (PHEIC). From May to July 2022, a multi-country outbreak of monkeypox was reported in both endemic and non-endemic regions. Major goals of managing monkeypox are to identify the suspected cases, detect generic orthopoxvirus DNA at a state or commercial laboratory, and establish the Centers for Disease Control and Prevention real-time polymerase chain reaction testing. Currently, there are no approved treatments for monkeypox virus infection. However, a variety of antiviral medications originally designed for the treatment of smallpox and other viral infections could be considered. Pre-exposure prophylaxis for laboratory and health care employees and post-exposure prophylaxis for individuals with high-risk or intermediate-risk exposures are to be considered. The CDC Emergency Operations Center is available for advice on the appropriate use of medical countermeasures, and can help in obtaining antiviral drugs and vaccines from the National Strategic Stockpile. This review gives an overview of the global scenario, clinical presentation, and management of monkeypox in the light of a global public health emergency.

Mesenchymal Stromal Cell-Derived Extracellular Vesicles in Wound Healing.

The well-orchestrated process of wound healing may be negatively impacted from interrupted or incomplete tissue regenerative processes. The healing potential is further compromised in patients with diabetes mellitus, chronic venous insufficiency, critical limb ischemia, and immunocompromised conditions, with a high health care burden and expenditure. Stem cell-based therapy has shown promising results in clinical studies. Mesenchymal stem cell-derived exosomes (MSC Exos) may favorably impact intercellular signaling and immunomodulation, promoting neoangiogenesis, collagen synthesis, and neoepithelization. This article gives an outline of the biogenesis and mechanism of extracellular vesicles (EVs), particularly exosomes, in the process of tissue regeneration and discusses the use of preconditioned exosomes, platelet-rich plasma-derived exosomes, and engineered exosomes in three-dimensional bioscaffolds such as hydrogels (collagen and chitosan) to prolong the contact time of exosomes at the recipient site within the target tissue. An appropriate antibiotic therapy based on culture-specific guidance coupled with the knowledge of biopolymers helps to fabricate nanotherapeutic materials loaded with MSC Exos to effectively deliver drugs locally and promote novel approaches for the management of chronic wounds.