This literature review finds that umbilical cord tissue, specifically Wharton's jelly, offers the greatest number of harvestable mesenchymal stem cells. The review analyzed 161 studies reporting mesenchymal stem cell yields from various tissue sources, including adipose tissue, bone marrow, umbilical cord tissue, and placental tissue. It found that yields from umbilical cord tissue ranged from 10,000 to 4,700,000 cells per milliliter, far exceeding yields from other sources. Adipose tissue provided the next highest yields, ranging from 4,737 to 1,550,000 cells per milliliter. Bone marrow yields ranged more widely from 1 to 317,400 cells per millil
Mammalian MSC from Selected Species: Features and Applications
Christiane Uder, Sandra Br€uckner, Sandra Winkler, Hans-Michael Tautenhahn,†‡ Bruno Christ†*
Mesenchymal stromal/stem cells (MSC) are promising candidates for cellular therapy of different diseases in humans and in animals. Following the guidelines of the International Society for Cell Therapy, human MSC may be identified by expression of a specific panel of cell surface markers (CD1051, CD731, CD901, CD34-, CD14-, or CD11b-, CD79- or CD19-, HLA-DR-). In addition, multiple differentiation potential into at least the osteogenic, adipogenic, and chondrogenic lineage is a main criterion for MSC definition. Human MSC and MSC of a variety of mammals isolated from different tissues meet these criteria. In addition to the abovementioned, they express many more cell surface markers. Yet, these are not uniquely expressed by MSC. The gross phenotypic appearance like marker expression and differentiation potential is similar albeit not identical for MSC from different tissues and species. Similarly, MSC may feature different biological characteristics depending on the tissue source and the isolation and culture procedures. Their versatile biological qualities comprising immunomodulatory, anti-inflammatory, and proregenerative capacities rely largely on the migratory and secretory capabilities of MSC. They are attracted to sites of tissue lesion and secrete factors to promote self-repair of the injured tissue. This is a big perspective for clinical MSC applications in both veterinary and human medicine. Phase I/II clinical trials have been initiated to assess safety and feasibility of MSC therapies in acute and chronic disease settings. Yet, since the mode of MSC action in a specific disease environment is still unknown at large, it is mandatory to unravel the response of MSC from a given source onto a specific disease environment in suitable animal models prior to clinical applications.
International Journal of Stem Cell Research and Transplantation (IJST) is an international, Open Access, peer-reviewed journal, which mainly focuses, on the advancements made in the field of cell biology, specifically in the field of Stem Cells.
International Journal of Stem Cell Research and Transplantation (IJST) ISSN:2328-3548, is a free, Open Access, Peer-reviewed, exclusive online journal covering areas of Stem cell research, translational work and Clinical studies in the specialty of Stem Cells and Transplantation including allied specialties relevant to the core subject, which is dedicated in publishing high quality manuscripts.
International Journal of Stem Cell Research and Transplantation (IJST) is a peer-reviewed journal, and is dedicated to providing information with respect to the latest advancements that are being upgraded in our everyday life with respect to the application of Stem cells.
Reprogramming to pluripotency is possible from adult cells of different tissues and species through the ectopic expression of defined factors. The generated induced Pluripotent Stem Cells (iPSCs) are relevant for various purposes, including disease modeling, drug or toxicity screening and autologous cell therapy. Over the last few years, increased efforts are being made to improve the reprogramming techniques, the efficiency and quality of the generated iPSCs, as well as to identify the best cell source to be reprogrammed. Cells derived from fetal tissues, such as amniotic fluid, placenta and umbilical cord, offer distinct advantages in terms of reprogramming compared to adult somatic cells. Importantly, fetal cells are more primitive, easily achievable in sufficient numbers and are devoid of any ethical concern. They show great plasticity, high proliferation rate, low immunogenity and absence of teratoma formation. Therefore, they can be reprogrammed much faster and more efficiently than adult cells. Here, we provide a comprehensive overview of the advantages of reprogramming fetal sources in comparison to other commonly used cell types.
Role of cancer stem cells in cancer therapyniper hyd
Cancer is one of the leading cause of death, till to date there is no perfect treatment due to its stem cell relapse which is not responding to conventional therapies like chemo, radio, surgery. so we should target the cancer stem cell with novel targets like nano, and immunotherapies.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Novel Way to Isolate Adipose Derive Mesenchymal Stem Cells & Its Future Clini...IOSR Journals
Abstract: Adipose-derived stem cells (ADSCs), were isolated from discarded human fat tissue, obtained from csection with our recently modified methods, in Stem Cell & Regenerative Medicine Lab, VSBT. Here we develop
two methods to isolate Adipose derived mesenchymal stem cells with enzyme digestion and use of
phosphatidylcholine and deoxycholate. Surface protein expression was analyzed by flow cytometry to
characterize the cell phenotype. The multi-lineage potential of ADSCs was testified by differentiating cells with
adipogenic inducer. ADSCs can be cultured in vitro for up to one month without passage. Also, the flow
cytometry analysis showed that ADSCs expressed high levels of stem cell related surface marker CD105.
ADSCs have strong proliferation ability, maintain their phenotypes, and have stronger multi-differentiation
potential. The molecular basis of ADSC differentiation was studied using bioinformatics tools with an aim to
identify the key proteins involved in differentiation, such that they could be used as potential targets for drug
development for the treatment of obesity. The key proteins involved were found to be PPARG and C/EBPα. The
structures of the proteins were retrieved from MMDB (Molecular Modelling Database) and PDB (Protein Data
Bank) respectively. Key Words: Adipose-derived stem cells, Mesenchymal stem cells, Enzyme digestion, Phosphatidylcholine, Deoxycholate, PPARG, C/EBPα, etc.
Mammalian MSC from Selected Species: Features and Applications
Christiane Uder, Sandra Br€uckner, Sandra Winkler, Hans-Michael Tautenhahn,†‡ Bruno Christ†*
Mesenchymal stromal/stem cells (MSC) are promising candidates for cellular therapy of different diseases in humans and in animals. Following the guidelines of the International Society for Cell Therapy, human MSC may be identified by expression of a specific panel of cell surface markers (CD1051, CD731, CD901, CD34-, CD14-, or CD11b-, CD79- or CD19-, HLA-DR-). In addition, multiple differentiation potential into at least the osteogenic, adipogenic, and chondrogenic lineage is a main criterion for MSC definition. Human MSC and MSC of a variety of mammals isolated from different tissues meet these criteria. In addition to the abovementioned, they express many more cell surface markers. Yet, these are not uniquely expressed by MSC. The gross phenotypic appearance like marker expression and differentiation potential is similar albeit not identical for MSC from different tissues and species. Similarly, MSC may feature different biological characteristics depending on the tissue source and the isolation and culture procedures. Their versatile biological qualities comprising immunomodulatory, anti-inflammatory, and proregenerative capacities rely largely on the migratory and secretory capabilities of MSC. They are attracted to sites of tissue lesion and secrete factors to promote self-repair of the injured tissue. This is a big perspective for clinical MSC applications in both veterinary and human medicine. Phase I/II clinical trials have been initiated to assess safety and feasibility of MSC therapies in acute and chronic disease settings. Yet, since the mode of MSC action in a specific disease environment is still unknown at large, it is mandatory to unravel the response of MSC from a given source onto a specific disease environment in suitable animal models prior to clinical applications.
International Journal of Stem Cell Research and Transplantation (IJST) is an international, Open Access, peer-reviewed journal, which mainly focuses, on the advancements made in the field of cell biology, specifically in the field of Stem Cells.
International Journal of Stem Cell Research and Transplantation (IJST) ISSN:2328-3548, is a free, Open Access, Peer-reviewed, exclusive online journal covering areas of Stem cell research, translational work and Clinical studies in the specialty of Stem Cells and Transplantation including allied specialties relevant to the core subject, which is dedicated in publishing high quality manuscripts.
International Journal of Stem Cell Research and Transplantation (IJST) is a peer-reviewed journal, and is dedicated to providing information with respect to the latest advancements that are being upgraded in our everyday life with respect to the application of Stem cells.
Reprogramming to pluripotency is possible from adult cells of different tissues and species through the ectopic expression of defined factors. The generated induced Pluripotent Stem Cells (iPSCs) are relevant for various purposes, including disease modeling, drug or toxicity screening and autologous cell therapy. Over the last few years, increased efforts are being made to improve the reprogramming techniques, the efficiency and quality of the generated iPSCs, as well as to identify the best cell source to be reprogrammed. Cells derived from fetal tissues, such as amniotic fluid, placenta and umbilical cord, offer distinct advantages in terms of reprogramming compared to adult somatic cells. Importantly, fetal cells are more primitive, easily achievable in sufficient numbers and are devoid of any ethical concern. They show great plasticity, high proliferation rate, low immunogenity and absence of teratoma formation. Therefore, they can be reprogrammed much faster and more efficiently than adult cells. Here, we provide a comprehensive overview of the advantages of reprogramming fetal sources in comparison to other commonly used cell types.
Role of cancer stem cells in cancer therapyniper hyd
Cancer is one of the leading cause of death, till to date there is no perfect treatment due to its stem cell relapse which is not responding to conventional therapies like chemo, radio, surgery. so we should target the cancer stem cell with novel targets like nano, and immunotherapies.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Novel Way to Isolate Adipose Derive Mesenchymal Stem Cells & Its Future Clini...IOSR Journals
Abstract: Adipose-derived stem cells (ADSCs), were isolated from discarded human fat tissue, obtained from csection with our recently modified methods, in Stem Cell & Regenerative Medicine Lab, VSBT. Here we develop
two methods to isolate Adipose derived mesenchymal stem cells with enzyme digestion and use of
phosphatidylcholine and deoxycholate. Surface protein expression was analyzed by flow cytometry to
characterize the cell phenotype. The multi-lineage potential of ADSCs was testified by differentiating cells with
adipogenic inducer. ADSCs can be cultured in vitro for up to one month without passage. Also, the flow
cytometry analysis showed that ADSCs expressed high levels of stem cell related surface marker CD105.
ADSCs have strong proliferation ability, maintain their phenotypes, and have stronger multi-differentiation
potential. The molecular basis of ADSC differentiation was studied using bioinformatics tools with an aim to
identify the key proteins involved in differentiation, such that they could be used as potential targets for drug
development for the treatment of obesity. The key proteins involved were found to be PPARG and C/EBPα. The
structures of the proteins were retrieved from MMDB (Molecular Modelling Database) and PDB (Protein Data
Bank) respectively. Key Words: Adipose-derived stem cells, Mesenchymal stem cells, Enzyme digestion, Phosphatidylcholine, Deoxycholate, PPARG, C/EBPα, etc.
Femoral Head Bone vs Acetabular Subchondral Bone: Selecting the Optimal Anat...remedypublications2
Mesenchymal Stromal Cells (MSC) have a great importance for the field of regenerative
medicine. However, there is high variability in existing protocols for MSC
in vitro
expansion, which
can lead to low reproducibility of pre-clinical studies and, even more critically, the reduced safety
of patients undergoing clinical trials. Although bone marrow is one of the most important sources
for the isolation and
in vitro
culture of MSC, the preferred anatomical location for obtaining bone
marrow is often unclear, and this information is relevant for the interpretation of results obtained
from preclinical and clinical trials.
describe two recent scientific research studies and it therapies inv.pdffeelingcomputors
describe two recent scientific research studies and it therapies involving stem cells. Explain what
the researches did(how the study was performed).the result and conclusion
Solution
Therapies for wound healing:
Wound healing is a dynamic process bleeding and coagulation, acute inflammation, cell
migration, proliferation, differentiation, angiogenesis, re-epithelialization, and synthesis and
remodeling of the extracellular matrix. Many local and systemic factors can impair wound
healing process resulting in prolonged and non-healing chronic wounds which affects the quality
of patients’life. Stem cell-based therapy represents a promising therapeutic approach for wound
healing. Stem cells have been shown to mobilize and find home for ischemic and wounded
tissues where they secrete chemokines and growth factors to promote angiogenesis and
extracellular matrix remodeling.
In wounds, It has been reported that Mesenchymal stem cells are recruited to wound skin at the
time of wound healing and have the capacity to differentiate into multiple skin cell types
including keratinocytes, endothelial cells and pericytes. Furthermore, circulating MSC
recruitment was induced by a specific chemokine (SLC/CCL21)/chemokine receptor (CCR7)
interaction both in vitro and in vivo. Intradermal injection of SLC/CCL21 significantly
accelerated wound closure by increasing rates of MSC accumulation, especially the formation of
endothelial transdifferentiated cells (Sasaki et al., 2008) . MSCs are good candidate which can be
transdifferentiated into endothelial cells and epithelial- fibroblast cells for wound repair therapy
and understanding there signaling mechanism can further help in regenerative medicine.
Mesenchymal stem cells (MSC), referred as mesenchymal stromal cells , colony forming unit-
fibroblasts and mesenchymal progenitor cells , were first identified by Friedenstein as
subpopulation of bone marrow cells. Other than hemopoietic stem cells and differentiated
lineages, bone marrow contains a subset of nonhemopoietic cells, mesenchymal stem cells
(MSCs) that account for roughly 0.01–0.001% of the bone marrow derived cell population .
These are a rare population of non-hematopoietic stromal cells, present in the bone marrow and
most connective tissues of the body.They have capability to proliferate in vitro in uncommitted
state and retain their multilineage differentiation potency which make them attractive candidates
for biological cell-based tissue repair approaches. These cells have ability to differentiate into
three mesenchymal lineages: adipogenic , osteogenic, chondrogenic and can be induced to
commit to various other phenotypes like neurogenic, hepatocytes,myogenic, tenocytes,
cardiomyocytes, fibroblast and endothelial cells. In vivo studies have also shown that MSCs can
differentiate into tissue-specific cells in response to cues provided by different organs . In
addition to pluripotency, MSCs are known to have immunosuppressive effects involving vari.
Better cell cultures lower your research costs!-A common Neuromics' theme is harnessing the power of cells. The raw cost of the cells are often the biggest consideration. We encourage our customers to focus on true costs. These include the # number of cells (how many times can they be passaged?), culture viability (how long do the cells live) and bioactivity (how closely do cultures mimic in vivo behavior?). I would like to present a publication and presentation confirms our competitiveadvantage when analyzing true costs.
Rotator cuff repair using a stem cell approachZakary Bondy
This presentation communicates current methods for rotator cuff repair mainly focusing on mesenchymal and tendon-derived stem cells. It looks to expand on future research in this field by communicating a future experiment to expand on current knowledge of tendon-derived stem cells.
EXTRACTION AND CLASSIFICATION OF BLEBS IN HUMAN EMBRYONIC STEM CELLdbpublications
A main objective of this paper is
to extract bleb from the human
embryonic stem cells. Blebbing is an
important biological indicator in
determining the health of human
embryonic stem cells (hESC). Especially,
areas of a bleb sequence in a video are
often used to distinguish two cells
blebbing behaviours in HESC; dynamic
and apoptotic blessings. Here analyses
active contour segmentation method for
bleb extraction in hESC videos and
introduces a bio-inspired score function
to improve the performance in bleb
extraction. The full bleb formation
consists of bulb expansion and retraction.
Blebs change their size and image
properties dynamically in both processes
and between frames. Therefore, adaptive
parameters are needed for each
segmentation method. A score function
derived from the change of bleb area and
orientation between consecutive frames with cuckoo optimization is proposed
which provides adaptive parameters for
bleb extraction in videos and classified
using artificial neural networks (ANN).
Stem-cell therapy in medicine–how far we came and what we can expect?Apollo Hospitals
The name ‘stem-cell’ is making the news in recent times both for good and not. The current articles tries to give a snap shot of the scientific and clinical picture of stem-cells in medicine as of today and discuss what it have to offer in the to the mankind. The article discusses the characters and types of stem-cells, their current indication in therapeutics (both established and upcoming), as well as their use in research. It also gives a brief overview of the current laws guiding its use in clinical practice and the various cultural beliefs associated with the use of same.
Adipose Tissue and Mesenchymal Stem Cells: State of the Art and Lipogems® Technology Development
Carlo Tremolada1 & Valeria Colombo1 & Carlo Ventura2
Abstract Inthepastfewyears,interestinadiposetissueasan ideal source of mesenchymal stem cells (MSCs) has increased. These cells are multipotent and may differentiate in vitro into several cellular lineages, such as adipocytes, chondrocytes, osteoblasts, and myoblasts. In addition, they secrete many bioactive molecules and thus are considered Bmini-drugstores.^ MSCs are being used increasingly for many clinical applications, such as orthopedic, plastic, and reconstructive surgery. Adipose-derived MSCs are routinely obtained enzymatically from fat lipoaspirate as SVF and/or may undergo prolonged ex vivo expansion, with significant senescence and a decrease in multipotency, leading to unsatisfactory clinicalresults.Moreover, these techniquesare hampered by complex regulatory issues. Therefore, an innovative technique (Lipogems®; Lipogems International SpA, Milan, Italy) was developed to obtain microfragmented adipose tissue with an intact stromal vascular niche and MSCs with a high regenerative capacity. The Lipogems® technology, patented in 2010 and clinically available since 2013, is an easyto-use system designed to harvest, process, and inject refined fat tissue and is characterized by optimal handling ability and a great regenerative potential based on adipose-derived MSCs. In this novel technology, the adipose tissue is washed, emulsified, and rinsed and adipose cluster dimensions gradually are reduced to about 0.3 to 0.8 mm. In the resulting
Lipogems® product, pericytes are retained within an intact stromal vascular niche and are ready to interact with the recipient tissue after transplantation, thereby becoming MSCs and starting the regenerative process. Lipogems® has been used in more than 7000 patients worldwide in aesthetic medicineandsurgery,aswellasinorthopedicandgeneralsurgery, with remarkable and promising results and seemingly no drawbacks. Now, several clinical trials are under way to supporttheinitialencouragingoutcomes.Lipogems®technology is emerging as a valid intraoperative system to obtain an optimal final product that may be used immediately for regenerative purposes.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. Systematic Review
Umbilical Cord Tissue Offers the Greatest Number of
Harvestable Mesenchymal Stem Cells for Research
and Clinical Application: A Literature Review of
Different Harvest Sites
C. Thomas Vangsness Jr., M.D., Hal Sternberg, M.D., and Liam Harris, B.S.
Purpose: Recent years have seen dramatic increases in the techniques used to harvest and isolate human mesenchymal
stem cells. As the potential therapeutic aspects of these cells further develop, informative data on the differences in yields
between tissue harvest sites and methods will become increasingly valuable. We collected and compared data on cell yields
from multiple tissue harvest sites to provide insight into the varying levels of mesenchymal stem cells by tissue and offer
primary and alternative tissue types for harvest and clinical application. Methods: The PubMed and Medline databases
were searched for articles relating to the harvest, isolation, and quantification of human mesenchymal stem cells. Selected
articles were analyzed for relevant data, which were categorized according to tissue site and, if possible, standardized to
facilitate comparison between sites. Results: Human mesenchymal stem cell levels in tissue varied widely according to
tissue site and harvest method. Yields for adipose tissue ranged from 4,737 cells/mL of tissue to 1,550,000 cells/mL of tissue.
Yields for bone marrow ranged from 1 to 30 cells/mL to 317,400 cells/mL. Yields for umbilical cord tissue ranged from
10,000 cells/mL to 4,700,000 cells/cm of umbilical cord. Secondary tissue harvest sites such as placental tissue and synovium
yielded results ranging from 1,000 cells/mL to 30,000 cells/mL. Conclusions: Variations in allogeneic mesenchymal stem
cell harvest levels from human tissues reflect the evolving nature of the field, patient demographic characteristics, and dif-
ferences in harvest and isolation techniques. At present, Wharton’s jelly tissue yields the highest concentration of allogeneic
mesenchymal stem cells whereas adipose tissue yields the highest levels of autologous mesenchymal stem cells per milliliter of
tissue. Clinical Relevance: This comparison of stem cell levels from the literature offers a primer and guide for harvesting
mesenchymal stem cells. Larger mesenchymal stem cell yields are more desirable for research and clinical application.
See commentary on page 1844
Recent advances in stem cell technology have
begun to realize the therapeutic regenerative po-
tential of mesenchymal stem cells (MSCs).1,2
As new
experiments are performed in various fields of medicine,
more and more physicians may be able to improve disease
outcomes through the use of MSCs. In orthopaedic sur-
gery, MSCs may present a unique opportunity to decrease
recovery time3
and reduce morbidity rates4
among
patients. Disorders such as osteoarthritis,5-7
ligament and
tendon repair,8-10
and bone union11
may all benefit from
the therapeutic application of MSCs in humans. As evi-
dence of the benefits of these procedures grows, more
surgeons will look to provide cellular treatments to their
patients. At present, there are 502 active human clinical
trials involving the therapeutic use of MSCs,12
a number
that is only expected to increase.
With these innovations have come new de-
velopments for the harvesting and characterization of
MSCs. Advances over the past several years have yiel-
ded promising avenues for collecting MSCs for potential
surgical applications. As the technology for these ap-
plications develops, a direct comparison of the qualities,
tissue harvest sites, and yields for different sources of
MSCs will become valuable to treating surgeons.
To this end, we reviewed the established literature
on MSC sources from different tissue harvest sites for
human MSCs. The purpose of this study was to provide a
From Keck School of Medicine, University of Southern California (C.T.V.,
L.H.), Los Angeles; and Biotime (H.S.), Alameda, California, U.S.A.
The authors report that they have no conflicts of interest in the authorship
and publication of this article.
Received July 18, 2014; accepted March 12, 2015.
Address correspondence to C. Thomas Vangsness Jr., M.D., Keck School of
Medicine, University of Southern California, 1520 San Pablo St., #3800, Los
Angeles, CA, U.S.A. E-mail: vangsnes@usc.edu
Ó 2015 by the Arthroscopy Association of North America
0749-8063/14622/$36.00
http://dx.doi.org/10.1016/j.arthro.2015.03.014
1836 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 31, No 9 (September), 2015: pp 1836-1843
2. consensus of opinion for the best site and tissue type for
MSC harvest through review of established literature.
We hypothesized that, despite wide variations in
yields between anatomic sites and harvest techniques,
placental tissue yields the greatest, most easily accessible
quantity of MSCs for research or clinical application.
Methods
Search
For this study, the PubMed and Medline databases
were used to conduct a comprehensive search of jour-
nal articles related to the qualities, classes, and harvest
of human MSCs (Fig 1). The search terms used were as
follows: placental stem cell, adipose stem cell, bone
marrow mesenchymal stem cell, umbilical cord
mesenchymal stem cell, amniotic stem cell, chorionic
stem cell, mesenchymal stem cell isolation, mesen-
chymal stem cell harvest, progenitor cell harvest, and
mesenchymal stem cell quantification. These searched
terms yielded 25,063 results. Among these results, ar-
ticles without the keywords “human” and “harvest”
were excluded, yielding 1,075 articles. These articles
were evaluated for quality and relevance to this study,
after which 161 articles were selected for more detailed
analysis. The bibliographies of these 161 articles were
also searched for relevant publications, ultimately
yielding 29 articles for review. In addition, the
ClinicalTrials.gov database was reviewed for relevant
clinical trials involving the use of human MSCs.
Eligibility Criteria and Data Extraction
This search was limited to articles published in the
English language up to December 31, 2014. Relevant
articles for this survey were studied, and their bibliog-
raphies were searched and evaluated for relevant data
concerning MSC harvest. Articles were analyzed for
information on different classes of MSCs, cell surface
markers, and tissue harvest sites, as well as quantifica-
tion of cells at these specific harvest sites, with relevant
articles selected for this review based on inclusion of
MSC harvest data. These data were organized by
different harvest sites and tissue types to be presented
in a clear and direct format.
Results
The results of this literature review yielded 4 major
tissue sources of MSCs as defined by tissue localization,
as well as multiple subclasses. These broad classes were
placental tissue derived, adipose derived, bone marrow
derived, and umbilical cord derived. The synovial
membrane, peripheral blood, umbilical cord blood,
periosteum, muscle, and trabecular bone have been
studied as sources of MSCs, but comparative data are
much less common. The results of this review are
summarized in Table 1.
Adipose
Adipose tissue harvest by reviewed studies relied
primarily on a lipoaspiration technique to isolate
Fig 1. Comparative histological slides of various Human
mesenchymal stem cell populations from various tissues. (A)
Adipose tissue mesenchymal stem cell shown in inverted
phase microscopy (magnification unknown; reprinted with
permission56
). (B) Bone marrow mesenchymal stem cells.
(Â10 magnification; reprinted with permission57
). (C) Umbil-
ical cord tissue mesenchymal stem cells shown in inverted
phase (Â200 magnification; reprinted with permission58
). (D)
Synovial tissue mesenchymal stem cells shown in alizarin red S
stain (Â200 magnification; reprinted with permission59
).
HARVESTABLE MESENCHYMAL STEM CELLS 1837
3. Table 1. Reported Mesenchymal Stem Cell Yields From Various Harvest Sites
Authors Tissue Type Tissue Site Reported Level
Converted Level: Cells per
Milliliter of Tissue
Raposio et al.44
Adipose Unknown 5.0 Â 105
cells/80 mL adipose tissue 6,250 cells/mL
Minonzio et al.45
Adipose Unknown 587,753 cells/75.3 g adipose tissue 7,395 cells/mL
Oedayrajsingh-
Varma et al.46
Adipose Abdomen, hip, thigh 6.3 Æ 1.8% of harvested adipose SVF
(mean Æ SEM)
18,334-61,398 cells/mL
von Heimburg
et al.47
Adipose Unknown 80,000 to 350,000 cells/g adipose
tissue
75,800-331,625 cells/mL
Policha et al.48
Adipose Abdomen 259,345 Æ 15,441 cells/g adipose
tissue (mean Æ SEM)
245,729 Æ 14,630 cells/mL
Gruber et al.49
Adipose Abdomen 471,000 cells/mL of adipose tissue 471,000 cells/mL
Aust et al.50
Adipose Abdomen 404,000 Æ 206,000 cells/mL
lipoaspirate (mean Æ SD)
404,000 cells/mL
Mitchell et al.29
Adipose Unknown 308,849 nucleated cells/mL of
lipoaspirate
19,303 cells/mL
Yoshimura et al.14
Adipose Unknown 1.31 Æ 0.5 Â 109
and 1.55 Æ 0.79 Â
109
/L adipose tissue
(mean Æ SEM)
1,310,000 cells/mL and
1,550,000 cells/mL
Zhu et al.36
Adipose Unknown 500,000 cells/1.5 mL of adipose tissue 333,333 cells/mL
Yu et al.51
Adipose Unknown 375 Æ 142 Â 103
/mL of lipoaspirate
(mean Æ SD)
375,000 cells/mL
Strem et al.13
Adipose Unknown 5,000/g of adipose tissue 4,737.5 cells/mL
De Ugarte et al.16
Adipose Unknown 2 Â 105
/g of adipose 189,500 cells/mL
De Ugarte et al.16
Bone marrow Hip 3 Â 105
/g 317,400 cells/mL
Wexler et al.33
Bone marrow Unknown 1 in 3.4 Â 104
nucleated cells
Hernigou et al.32
Bone marrow Anterior iliac crest 612 Æ 134 cells/mL of bone marrow
(mean Æ SD)
612 cells/mL
Hernigou et al.52
Bone marrow Iliac crest 84 to 7,581 cells/mL 84 to 7,581 cells/mL
Pierini et al.34
Bone marrow Posterior iliac crest 269.3 Æ 185.1/106
mononuclear cells
(mean Æ SD)
3,606.94 cells/mL
Pierini et al.34
Bone marrow Anterior iliac crest 166 Æ 133.8/106
mononuclear cells
(mean Æ SD)
1,942.72 cells/mL
de Girolamo et al.6
Bone marrow Iliac crest 0.04% of cells
de Girolamo et al.6
Bone marrow Subchondral knee 0.02% of cells
Sakaguchi et al.15
Bone marrow Tibia 1:105
to 1:106
nucleated cells 1-30 cells/mL
Sakaguchi et al.21
Trabecular bone Tibia Approximately 1:103
to 1:105
nucleated cells
1,000-100,000 cells/g
Sakaguchi et al.21
Periosteum Tibia Approximately 1:102
nucleated cells 30,000 cells/g
Sakaguchi et al.21
Synovium Medial knee Approximately 1:102
nucleated cells 30,000 cells/g
Sakaguchi et al.21
Muscle Semitendinosus
muscle
Approximately 1:102
nucleated cells 20,000 cells/g
Bongso and
Fong18
UC Wharton’s jelly 4.7 Â 106
/cm of UC
Tsagias et al.53
UC Wharton’s Jelly 0.65 Â 106
/cm of cord
Chatzistamatiou
et al.54
UC Wharton’s Jelly 1.75 Â 105
Æ 0.94 Â 105
À 3.02 Â
105
Æ 0.66 Â 105
cells/cm
(mean Æ SD)
Karahuseyinoglu
et al.17
UC Wharton’s jelly 10 Â 103
/cm of UC
Weiss et al.35
UC Wharton’s jelly 1.5 Â 104
/cm UC
Fu et al.55
UC Wharton’s jelly 50 Â 103
/cm of UC
Lu et al.21
UC Cord blood Approximately 1:103
to 1:104
nucleated cells
Kim et al.18
UC Wharton’s Jelly 6.4 Æ 3.2 Â 104
/g wet tissue
(mean Æ SEM)
1,000 cells/mL
Kim et al.19
Placental tissue Chorion 4.5 Æ 2.7 Â 104
/g of wet tissue
Zvaifler et al.20
Blood Peripheral Approximately 1:103
to 1:104
nucleated cells
1-40 cells/mL
NOTE. Values were reported in mL when reported in mL in the literature, or when accepted densities were available for conversion to mL.
Values reported in grams of cm of tissue which could not be converted were reported in their original units.
SVF, stromal vascular fraction; UC, umbilical cord.
1838 C. T. VANGSNESS ET AL.
4. adipose tissue, and unprocessed lipoaspirate and simple
adipose tissue were evaluated as equivalent substances.
Levels for adipose-derived MSCs ranged from 4,737.5
MSCs/mL of lipoaspirate13
to 1,550,000 MSCs/mL of
lipoaspirate14
(Table 1, Fig 1).
Bone Marrow
Bone marrow tissue harvest was primarily conducted
through repeated aspirations through large-bore nee-
dles, ranging from 15- to 18-gauge sizes.15
Levels for
bone marrowederived MSCs ranged from 1 to 30
MSCs/mL15
to 317,400 cells/mL16
(Table 1, Fig 1).
Umbilical Cord and Placental Tissue
Placental tissuee and umbilical cordederived MSCs
proved unique in their diverse harvest and tissue-specific
harvest sites. Tissue cell levels for Wharton’s jelly (um-
bilical cord connective tissue) ranged from 10,000 MSCs/
mL of umbilical cord17
to 4,700,000 MSCs/cm of umbil-
ical cord.18
Chorionic tissue cell levels were reported to be
45,000 MSCs/g of wet tissue (Fig 1).19
Peripheral Tissue
Peripheral blood, which was collected through pe-
ripheral blood draw and centrifugation, was reported to
have MSC levels of 1 to 40 cells/mL.20
Muscle tissue
was harvested from the semitendinosus tendon, which
was collected with a tendon stripper.21
Similarly, peri-
osteum tissue was collected from the tibial insertion of
the same harvested semitendinosus tendon.21
Synovial
tissue was harvested during arthroscopic surgery from
the medial joint capsule of the knee using a pituitary
rongeur.21
Discussion
The advancement of stem cell transplant techniques
over recent years has made the practical acquisition of
these cells increasingly worthwhile for the purpose of
reconstructive surgery. Autologous sources represent
the most current, cost-efficient, and least controversial
option to acquire and transplant MSCs in the clinical
setting. Physicians and researchers exploring this
emerging field will require resources concisely
explaining the most efficient sites for MSC harvest, as
well as the levels of cells available in different tissues.
Determining the best and most consistent tissue source
of human MSCs, as well as the cell levels typically
harvested from related sites, offers a valuable resource
for future clinical studies.
Given the diverse array of units used to report cell
harvest levels among selected studies, values were
converted to a standard measurement to allow direct
comparison between studies and tissues. For adipose
values, a common value for the density of adipose
tissue was selected from previous studies as 0.9475
g/mL22
to convert values from grams to milliliters. The
standard density for bone marrow used for conversions
was determined to be 1.058 g/mL.23
Values from
studies that did not include volume or mass data for
bone marrow harvest could not be reported in millili-
ters and, consequently, were reported with MSCs as a
percentage of total nucleated cells. Similar concerns
arose in the reporting of umbilical cord tissue. Values
from studies that did not include mass or volume data
were instead recorded by length of cord and could not
be converted.
Autograft Tissue and Minimal Manipulation
Comparisons of yields between placental and autograft
tissue invite clarification of the practical difference be-
tween autograph and allograph transplantation, as well
as minimally manipulated tissues. Allograft tissue rarely
presents with immune complications after trans-
plantation. The lack of the human leukocyte antigeneA
surface antigen confers an immune-privileged nature to
placental tissue, allowing for comparable use of the 2
tissues without immune-modifying therapy.24
Conse-
quently, for the purposes of clinical use and this review,
allograft placental tissue is comparable with autograft
cells.
According to US Food and Drug Administration (FDA)
regulations, only cellular products classified as “361 tis-
sue” may be exempt from premarket review and regu-
lation. Classification as 361 tissue requires cells to be
“minimally manipulated,” a criterion that excludes
many common techniques used to harvest, isolate, and
purify MSCs today. It should be noted that adipose tissue
currently harvested for MSCs requires multistep pro-
cessing, including enzymatic digestion, purification, and
expansion in culture, which is considered more than
“minimal manipulation,” thereby excluding them from
361 cellular tissue classification by the FDA.25
However,
recent procedural and technologic advances have
demonstrated efficient, non-enzymatic purification of
human MSCs from lipoaspirate.26
Further, recent
studies have shown mechanically purified adipose-
derived MSCs demonstrate greater pluripotent response
compared to enzymatically isolated adipose stem cells.27
Given recent FDA approval for marketing of this system
and subsequent “361 cellular tissue” classification, the
field of adipose-derived stem cells and their clinical
application may greatly expand in the coming years. In
addition, a 2013 update by the FDA Tissue Reference
Group clarified that bone marrow MSCs, when
expanded in culture, did not fall under the classification
of 361 cells.28
Consequently, the advancement of the
field and therapeutic application of MSCs will likely rely
on the ability to harvest cells in quantities suitable for
implantation without digestion and expansion. A
detailed understanding of the anatomic sites and tissue
types yielding the highest levels and concentrations of
cells by volume will prove crucial to these initial steps.
HARVESTABLE MESENCHYMAL STEM CELLS 1839
5. Technologic developments to further purify MSCs from
harvest tissue without the use of expansion in culture
will allow researchers to rapidly expand both the aca-
demic and clinical applications of these cells. Indeed,
novel “non-manipulating” measures to efficiently
extract MSCs from adipose tissue are currently being
explored,29
which will likely allow for the circumven-
tion of 361 regulations for clinical study and application.
Our results indicate significant differences in the
quantity and consistency of stem cell levels between
adipose, bone marrow, and placental tissues. Studies
performing harvest and isolation of MSCs from adipose
tissue consistently showed higher cell yields than
with MSCs from bone marrow and placental tissue.
Furthermore, variations in harvest levels between
different studies of the same tissue indicate notable
differences. The highest reported yield for studies on
adipose tissue showed an over 300-fold increase in cell
harvest over the lowest reported values.13,14
Bone
marrow studies showed an over 1,000-fold increase
between the highest and lowest reported yields.15,16
This large variation must be noted.
Quantification of Cells
Pertinent to the analysis of cell yields from various
tissues is the methods by which yields were quantified.
Cellular quantification techniques proved relatively
homogeneous across both tissue subtype and anatomic
site. The primary method of cell harvest quantification
was a limited-dilution colony-forming unit assay. Tis-
sues were harvested and homogenized by serial
centrifugation and suspension in liquid media accord-
ing to techniques and concentrations specific to each
anatomic site. Purification of MSCs was performed by
serial replacement of cellular growth media and sub-
sequent disposal of nonadherent cells using the innate
cellular adhesion properties of MSCs.30
Rough cell
densities in liquid media were determined using cell
counters and hemocytometers, after which cells were
plated at densities ranging from 103
cells per plate20
to
106
cells per plate.31
After growth of fibroblast colonies,
cells were stained and counted using light microscopy.
Studies conducted by Mitchell et al.,31
Wexler et al.,32
Hernigou et al.,33
Pierini et al.,34
Sakaguchi et al.,21
Weiss et al.,35
and Lu et al.22
all used the limited-
dilution fibroblast colony-forming unit assay. Among
these studies, notable variables included the time
allowed for colony growth, which varied from 7 to 14
days; the number of cells determined to define a “col-
ony,” which ranged from 20 cells per colony31
to 50
cells per colony33
; and the number of serial dilutions
conducted beforehand to purify the cells. Because the
anatomic tissue source of each cell type necessitates
different methods of initial preparation, comparison of
homogenization and serial dilution is impractical, and
this variable should be noted. Alternative quantification
methods used serial dilution and cellular adherence,
followed immediately by cell quantification using cell
counters. This technique was used by Zhu et al.,36
De
Ugarte et al.,16
Yoshimura et al.,14
and Zvaifler et al.20
Finally, de Girolamo et al.6
used flow cytometry to
quantify cellular harvest levels, incubating cells with
commercial anti-CD45 and anti-CD271 antibodies after
serial dilution and purification using cellular adherence.
Differences in quantification are likely to yield signifi-
cant variations in harvest levels. As shown by Cuthbert
et al.,37
Jones et al.,38
and Tormin et al.,39
roughly 1 in
17 CD271-positive cells yield a fibroblast colony during
colony-forming unit assay. Although these potential
differences did not influence our conclusions, in the
future, consideration must be given to the method of
cellular quantification.
Variations in Yields
Differences in yields among tissue sites are likely a
result of 2 principal factors: harvest techniques and
patient demographic characteristics. Adipose tissuee
derived MSC yields have been shown to be only
minimally affected by age differences among patients.40
Given the multistep process of harvesting and isolating
adipose tissueederived MSCs, differences in yields may
be principally a consequence of variations in harvest
techniques. Procedural variations in enzymatic diges-
tion, buffer selection, and centrifugation can all have
significant impacts on MSC yields.41
Despite this,
analysis of our results indicates that in addition to
higher levels of cells, adipose tissue maintains decidedly
greater consistency in stem cell density as compared
with alternative primary harvest sites. We believe this
consistency results from both the more homogeneous
nature of the tissue as compared with bone marrow
and, paradoxically, the more procedurally involved
manner of its harvest. The complex nature of MSC
harvest from adipose tissue necessitates following or
adapting proven procedures. Consequently, large me-
chanical differences in harvesting which lead to varia-
tions in yield, such as marrow aspiration technique,
were largely eliminated. Concurrently, smaller differ-
ences were increased through the introduction of var-
iations in enzyme and buffer concentrations.
Bone marrowederived MSC yields showed signifi-
cant variation likely because of differences in both the
anatomic harvest site and patient demographic char-
acteristics. Studies by Pierini et al.34
and de Girolamo
et al.6
showed up to a 2-fold differences in yields be-
tween various marrow sites in the body. In particular,
Pierini et al. concluded that the posterior iliac crest was
the optimal harvest site for MSCs, above both the
anterior iliac crest and the subchondral knee. Further-
more, evidence has shown that the use of the iliac crest
as a harvest site, a common site in our review, pre-
disposes harvest samples to significant dilution by
1840 C. T. VANGSNESS ET AL.
6. peripheral blood,37
resulting in both depressed values
and increased variation in harvest yields. In addition,
increased age, particularly among women, has been
shown to have a significant impact on bone
marrowederived MSC harvest yields, with numerous
studies having shown bone marrowederived MSC
yields to decrease with age.42,43
Because selected
studies used a diverse range of donor ages, decreased
yields compared with other studies are likely affected by
increasing donor age and should be considered by
physicians planning future MSC harvests. Finally, these
data on harvest numbers of MSCs by anatomic site and
tissue type offer no predictive information about the
cellular activity of the individual MSCs. Differences in
stem cell biology between and among these tissue
sources must be evaluated in the laboratory and clinic
as we proceed with this new field of biology.
Limitations
Limitations to our study primarily concerned issues of
tissue comparability and scope of the initial search. As
mentioned previously, conversion to common units
(milliliters) for direct comparison of tissues was
dependent on the existence of accepted values for tissue
density. Consequently, umbilical cord stromal tissues,
as well as certain reported bone marrow values, could
not be converted to common units for direct
comparison.
Initial development of the search criteria excluded
articles that had not been translated into English. In
addition, articles that were not accessible through the
PubMed or Medline databases were excluded from our
initial search. Although bibliographies of initially
selected articles were evaluated for relevant publica-
tions and data, this limitation must be acknowledged.
Conclusions
Large variations in cell harvest yields remain for each
major tissue site for MSCs as reported in the literature
to date. Reviewed research supports the understanding
that placental tissue provides the highest concentration
of cells whereas adipose tissue offers the highest levels
of autologous cells. Consequently, considerations must
be made regarding the non-autologous nature of um-
bilical cordederived stem cells, as well as the increased
post-harvest processing required for adipose-derived
stem cells, for the purposes of research and clinical
application.
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