Pei-Jiun Tsai

Transplantation of insulin-producing cells from umbilical cord mesenchymal stem cells for the treatment of streptozotocin-induced diabetic rats

BackgroundAlthough diabetes mellitus (DM) can be treated with islet transplantation, a scarcity of donors limits the utility of this technique. This study investigated whether human mesenchymal stem cells (MSCs) from umbilical cord could be induced efficiently to differentiate into insulin-producing cells. Secondly, we evaluated the effect of portal vein transplantation of these differentiated cells in the treatment of streptozotocin-induced diabetes in rats.MethodsMSCs from human umbilical cord were induced in three stages to differentiate into insulin-producing cells and evaluated by immunocytochemistry, reverse transcriptase, and real-time PCR, and ELISA. Differentiated cells were transplanted into the liver of diabetic rats using a Port-A catheter via the portal vein. Blood glucose levels were monitored weekly.ResultsHuman nuclei and C-peptide were detected in the rat liver by immunohistochemistry. Pancreatic β-cell development-related genes were expressed in the differentiated cells. C-peptide release was increased after glucose challenge in vitro. Furthermore, after transplantation of differentiated cells into the diabetic rats, blood sugar level decreased. Insulin-producing cells containing human C-peptide and human nuclei were located in the liver.ConclusionThus, a Port-A catheter can be used to transplant differentiated insulin-producing cells from human MSCs into the portal vein to alleviate hyperglycemia among diabetic rats.

Spectral and morphological classification of different chronic and acute Taiwanese gallstones via FTIR, SEM and ESEM-EDX microanalyses

BACKGROUND Gallstone disease is one of the leading upper gastrointestinal surgical problems in different countries. AIMS To analyze the chronic gallstones and acute gallbladder sludge retrieved from 36 Taiwanese patients. METHODS FTIR microspectroscopy was used to classify the types of gallstones, and an ESEM-EDX microanalysis was first applied to determine the microstructural features and elemental compositions of the various gallstones. Bacteria presented on the surface of gallstones were also detected by SEM. RESULTS Four types of gallstones were obtained from these 36 Taiwanese patients: calcium bilirubinate (CaBR) stones (30.6%), cholesterol stones (19.4%), mixed stones including 6 subtypes (47.2%), and acute gallbladder sludge (2.8%) made of CaBR and protein/insoluble biomaterials. Bacteria imprints and bacterial discharges or bacterial biofilms were also found on the surface of gallstones and acute sludge under a SEM observation. ESEM-EDX results revealed that calcium was found to be the main constituent of all of the types of stones except cholesterol stones, and aluminum was also presented in most of the stones and sludge samples. Chloride was only detected in the acute gallbladder sludge. CONCLUSION FTIR spectra, morphological features, and elemental compositions of the acute gallbladder sludge were different from those of the chronic gallstones.

Pseudoaneurysm of the Iliac Artery Secondary to Aspergillus Infection After Kidney Transplantation

Infectious complications are the top causes of morbidity and mortality in patients who undergo renal transplantation. We report a patient who received a cadaveric renal transplant in Mainland China. One year post-transplantation, the patient had right buttock pain with radiation to the leg. Swelling and tenderness over the right groin was also found. Magnetic resonance imaging revealed a multilobulated cystic lesion, about 8 x 7 cm, at the right iliac fossa and presacral region extending to the posterior aspect of the graft kidney and up to the right psoas muscle. Drainage of the intra-abdominal abscess was performed. The abscess culture showed presence of Aspergillus spp. The patient had received steroids, tacrolimus and mycophenolate mofetil, which could be a risk factor for fungal infection. The cause of Aspergillus infection in our patient remains unclear. It may have been due to immune system insufficiency of the patient rendering the patient prone to infection. Pseudoaneurysm formation of the internal iliac artery following Aspergillus infection after kidney transplantation is rarely reported. Although it is a dilemma, once a severe situation such as pseudoaneurysm with aspergillosis presents, graft removal is suggested.

Diagnostic and therapeutic dilemmas in periampullary lesions.

BACKGROUND/AIMS Periampullary lesions often present diagnostic and therapeutic dilemmas. This study is to clarify the justification of pancreaticoduodenectomy for the resectable periampullary lesion without histological confirmation of malignancy. METHODOLOGY Clinical data for periampullary lesions with presumed malignancy were retrieved from our prospectively-collected computer database. The surgical risks and test performance characteristics in diagnosis were determined. RESULTS There were 636 patients undergoing pancreaticoduodenectomy, including 572 with malignancy and 64 (10.1% false positive rate) with benign lesions. No resection was attempted for 32 patients, but 8 (25% false negative rate) eventually turned out to be malignant. Our data showed a sensitivity of 98.6% (572/580), a specificity of 27% (24/88) and an accuracy of 89.2% (596/668) in detecting periampullary malignancy. The surgical risks after pancreaticoduodenectomy were significantly lower in the benign group, with 28.1% morbidity (vs. 43.7% in the malignant group), no pancreatic leakage (vs. 11.5% in malignant group) and no surgical mortality (vs. 7.3% in the malignant group). CONCLUSIONS Pancreaticoduodenectomy is justified for a periampullary lesion without histological confirmation whenever malignancy is suspected. Moreover, a nihilistic approach could be associated with a significant false negative rate (25%) if left unresected and might preclude a patient with periampullary malignancy from cure.

Treatment of Obturator Hernia in a Patient Undergoing Peritoneal Dialysis

2. Twardowski ZJ, Nolph KD, Rubin J, Anderson PC. Peritoneal dialysis for psoriasis. An uncontrolled study. Ann Intern Med 1978 Mar; 88(3):349–51. 3. Whittier FC, Evans DH, Anderson PC, Nolph KD. Peritoneal dialysis for psoriasis: a controlled study. Ann Intern Med 1983 Aug; 99(2):165–8. 4. Gotloib L, Fudin R. Use of peritoneal dialysis and mesothelium in non primary renal conditions. Adv Perit Dial 2009; 25:2–5. 5. Hanicki Z, Cichocki T, Klein A, Smoleński O, Sułowicz W, Czabanowska J. Dialysis for psoriasis — preliminary remarks concerning mode of action. Arch Dermatol Res 1981; 271(4):401–5.

Transplantation of Whartonâs JellyMesenchymal Stem Cells to Improve CardiacFunction in Myocardial Infarction Rats

Background: Myocardial infarction (MI) is a fatal disease that is increasing in incidence. The worst sequelae of MI include myocardial fibrosis and deterioration of pumping function that can lead to irreversible heart failure. This study aims to compare the therapeutic effect of undifferentiated versus TGF-β2–stimulated Wharton’s jelly mesenchymal stem cells (WJ-MSCs) in MI rats. Results: Left anterior descending (LAD) artery ligation-induced myocardial infarct rats were used to evaluate changes in left ventricular function and fibrosis following injection of PBS or 1.6 × 106 undifferentiated or TGF-β2–stimulated WJ-MSCs into the border zone myocardium. Electrocardiograph, echocardiogram, serum cardiac Troponin I level, Masson’s Trichrome staining, immunohistochemistry were used to analyze the therapeutic effects. We found that transplantation of both undifferentiated and TGF-β2 stimulated WJ-MSCs decreased serum Cardiac Troponin I levels, improved fractional shortening, ameliorated ejection fraction changes, and decreased the area of myocardial fibrosis. Moreover, some of the transplanted human WJ-MSCs survived in the myocardium. Conclusions: Transplantation of either undifferentiated or TGF-β2 stimulated WJ-MSCs improved left ventricular function after MI and increased survival. The effects were most marked using undifferentiated WJ-MSCs. These results indicate WJMSCs as a potential stem cell source for use in myocardial infarct therapy.

Transplantation of Hepatocytelike Cells Derived from Umbilical Cord Stromal Mesenchymal Stem Cells to Treat Acute Liver Failure Rat

Background: Liver transplantation is the ultimate treatment for liver failure. However, its use is complicated by shortage of donor organs and numerous other problems. Thus, other methods for the treatment of liver failure, including cell therapy, are being considered. We have evaluated the capacity of hepatocyte-like cells differentiated from Wharton’s jelly mesenchymal stem cells (WJ-MSCs) to prevent or ameliorate acute liver failure in a rat model. Methods: WJ-MSCs were isolated from human umbilical cords and induced to differentiate into hepatocyte-like cells by incubation with a combination of liver-tissue culture medium and growth factors. The differentiated cells were evaluated with immunocytochemistry, RT-PCR, ammonia metabolism test, and glycogen storage for characteristics of functioning hepatocytes. The hepatocyte-like cells were transplanted into the portal vein of rats with acute liver failure induced by carbontetrachloride injection. Survival, serum liver function tests, and body weight of the animals were recorded. Livers of the rats 30 days after transplantation were harvested. Results: The differentiated hepatocyte-like cells had morphologic features and functional characteristics of mature hepatocytes: hepatocyte-related genes, conversion of ammonia to urea, albumin synthesis, glycogen storage, and declining values of alpha-fetoprotein. Transplantation of the hepatocyte-like cells into the rats with carbon tetrachloride-induced liver failure prevented death of the animals and prevented rising values of serum alanine transaminase (ALT), aspartate transaminase (AST), and bilirubin. Immunohistochemical study of rat liver tissues 30 days after transplantation revealed that the WJ-MSCs had survived and were producing albumin. Conclusions: WJ-MSCs of the human umbilical cord were could differentiated into hepatocyte-like cells in vitro. Transplantation of hepatocyte-like cells into the portal vein of rats with carbontetrachloride acute liver injury prevented death of the animals and irreversible liver injury. These findings may serve as a reference for future research in cell therapy of liver failure.