Pouya Mafi

Sources of Adult Mesenchymal Stem Cells Applicable for Musculoskeletal Applications - A Systematic Review of the Literature

Mesenchymal stem cells (MSCs) were first discovered by Friedenstein and his colleagues in 1976 from bone marrow. The unique property of these cells was their potential to develop into fibroblastic colony forming cells. Since Friedenstein’s discovery of these cells the interest in adult MSCs has been progressively growing. Nowadays MSCs are defined as undeveloped biological cells capable of proliferation, self renewal and regenerating tissues. All these properties of MSCs have been discovered in the past 35 years. MSCs can play a crucial role in tissue engineering, organogenesis, gene therapy, transplants as well as tissue injuries. These cells were mainly extracted from bone marrow but there have been additional sources for MSCs discovered in the laboratories including: muscle, dermis, trabecular bone, adipose tissue, periosteum, pericyte, blood, synovial membrane and so forth. The discovery of the alternative sources of MSCs helps widen the application of these cells in different areas of medicine. By way of illustration, they can be used in various therapeutic purposes such as tissue regeneration and repair in musculoskeletal diseases including osteonecrosis of femoral head, stimulating growth in children with osteogenesis imperfecta, disc regeneration, osteoarthritis and duchenne muscular dystrophy. In order to fully comprehend the characteristics and potential of MSCs future studies in this field are essential.

Evaluation of biological protein-based collagen scaffolds in cartilage and musculoskeletal tissue engineering--a systematic review of the literature.

The term tissue engineering is the technology that combines cells, engineering and biological/synthetic material in order to repair, replace or regenerate biological tissues such as bone, muscle, tendons and cartilage. The major human applications of tissue engineering are: skin, bone, cartilage, corneas, blood vessels, left mainstem bronchus and urinary structures. In this systematic review several criteria were identified as the most desirable characteristics of an ideal scaffold. These state that an ideal scaffolds needs to be biodegradable, possess mechanical strength, be highly porous, biocompatible, non-cytotoxic, non antigentic, stuitable for cell attachment, proliferation and differentiation, flexible and elastic, three dimensional, osteoconductive and support the transport of nutrients and metabolic waste. Subsequently, studies reporting on the various advantages and disadvantages of using collagen based scaffolds in musculoskeletal and cartilage tissue engineering were identified. The purpose of this review is to 1) provide a list of ideal characteristics of a scaffold as identified in the literature 2) identify different types of biological protein-based collagen scaffolds used in musculoskeletal and cartilage tissue engineering 3) assess how many of the criteria each scaffold type meets 4) weigh different scaffolds against each other according to their relative properties and shortcomings. The rationale behind this approach is that the ideal scaffold material has not yet been identified. Hence, this review will define how many of the identified ideal characteristics are fulfilled by natural collagen-based scaffolds and address the shortcomings of its use as found in the literature.

A Systematic Review of Dynamometry and its Role in Hand Trauma Assessment

The dynamometer was developed by American neurologists and came into general use in the late 19th century. It is still used in various ways as a diagnostic and prognostic tool in clinical settings. In this systematic review we assessed in detail the different uses of dynamometry, its reliability, different dynamometers used and the influence of rater experience by bringing together and evaluating all published literature in this field. It was found that dynamometry is applied in a wide range of medical conditions. Furthermore, the great majority of studies reported acceptable to high reliability of dynamometry. Jamar mechanical dynamometer was used most often in the studies reviewed. There were mixed results concerning the effect of rater experience. The factors influencing the results of dynamometry were identified as age, gender, body weight, grip strength, BMI, non/dominant hand, assessing upper/lower limbs, rater and patient’s strength and the distance from the joint where the dynamometer is placed. This review provides an understanding of the relevance and significance of dynamometry which should serve as a starting point to guide its use in hand trauma assessment. On the basis of our findings, we suggest that hand dynamometry has a great potential, and could be used more often in clinical practice.The dynamometer was developed by American neurologists and came into general use in the late 19th century. It is still used in various ways as a diagnostic and prognostic tool in clinical settings. In this systematic review we assessed in detail the different uses of dynamometry, its reliability, different dynamometers used and the influence of rater experience by bringing together and evaluating all published literature in this field. It was found that dynamometry is applied in a wide range of medical conditions. Furthermore, the great majority of studies reported acceptable to high reliability of dynamometry. Jamar mechanical dynamometer was used most often in the studies reviewed. There were mixed results concerning the effect of rater experience. The factors influencing the results of dynamometry were identified as age, gender, body weight, grip strength, BMI, non/dominant hand, assessing upper/lower limbs, rater and patients strength and the distance from the joint where the dynamometer is placed. This review provides an understanding of the relevance and significance of dynamometry which should serve as a starting point to guide its use in hand trauma assessment. On the basis of our findings, we suggest that hand dynamometry has a great potential, and could be used more often in clinical practice.

A Systemic Review of Adult Mesenchymal Stem Cell Sources and their Multilineage Differentiation Potential Relevant to Musculoskeletal Tissue Repair and Regeneration

BACKGROUND Adult mesenchymal stem cells (MSCs) were first isolated from bone marrow by Friedenstein in 1976. These cells were clonogenic, non-haematopoietic, and able to replicate extensively in vitro. The fields of regenerative medicine and tissue engineering have grown dramatically since their inception. In the decades since, MSCs have been identified from mesoderm-, endoderm- and ectoderm-derived tissues. In light of our ageing population, the need for effective cell-based therapies for tissue repair and regeneration is ever-expanding. OBJECTIVES The purpose of this systematic review was to summarise evidence from the most recent studies outlining different sources of adult MSCs and their suitability in musculoskeletal applications. METHODS Online published articles were searched for using the PubMed/MEDLINE and Ovid databases, and relevant articles fulfilling the pre-defined eligibility criteria were analysed. RESULTS To date, MSCs have been isolated from a number of adult tissues, including trabecular bone, adipose tissue, bone marrow, synovium, dermis, periodontal ligament, dental pulp, bursa and the umbilical cord. Bone marrow MSCs are currently considered the gold standard, with which newly discovered sources are compared on the basis of their renewal capabilities and multipotency. Furthermore, MSCs have been successful in the regeneration of osteonecrosis, osteoarthritis, bony defects, fracture remodeling and so on. CONCLUSION Unfortunately, significant hurdles remain and will need to be overcome before tissue engineering using MSCs becomes routine in clinical practice. Thus, further research and understanding are required into the safe and effective sourcing and application of mesenchymal stem cells in musculoskeletal applications.

Orthopaedic approaches to proximal humeral fractures following trauma.

Proximal humeral fractures have been a topic of discussion in medical literature dating back as far as 3rd century BC. Today, these fractures are the most common type of humeral fractures and account for about 5-6% of all fractures in adults with the incidence rising rapidly with age. In broad terms the management of proximal humeral fractures can be divided into two categories: conservative versus surgical intervention. The aim of treatment is to stabilize the fracture, aid better union and reduce pain during the healing process. Failure to achieve this can result in impairment of function, and significantly weaken the muscles inserting onto the proximal humerus. With the rising incidence of proximal humeral fractures, especially among the elderly, the short and long term burden for patients as well as the wider society is increasing. Furthermore, there is a lack of consistency in the definitive treatment and management of displaced fractures. This systematic review of literature compares the surgical treatment of proximal humeral fractures with their conservative management, by evaluating the available randomised controlled trials on this topic.

Pilon fracture: a case report of a 45-year-old dental technician.

Pilon fractures are complex and difficult-to-treat fractures of the lower extremity that account for about 1% of all lower extremity fractures and up to 10% of tibial fractures. The injury is caused by high energy axial load either from motor vehicle accidents or a fall from height. The treatment of these fractures has caused controversy among surgeons due to mixed outcomes. Here we report a case of pilon fracture in a 45 year old male patient who has sustained the injury as a result of a fall from a height of approximately 12 feet. We describe why it is absolutely crucial that the patient is treated with external fixation initially and evaluate its merits and drawbacks as well as ways to minimize the complications associated with external fixation of open intra-articular distal tibial fractures.

The Use of Growth Factors and Mesenchymal Stem Cells in Orthopaedics: In particular, their use in Fractures and Non-Unions: A Systematic Review

AIM The aim was to look at current evidence for treating non-unions or delayed fracture healing in regard to novel methods applying mesenchymal stem cells (MSCs) and growth factors (GF). METHODS Pre-clinical and clinical trials focusing on the use of Mesenchymal Stem Cells and Growth Factors for fracture healing were included in this review. Published articles were identified using specific search terms in Medline, Cochrane Library, PubMed, Scopus and Web of Science. RESULTS Of the 580 articles found, 82 met my selection criteria and were included, with 39 papers involving trials on the effects of GFs and MSCs on non-unions or bone repair. These included 11 articles on MSCs, 10 on Bone Morphogenetic Proteins, 2 on Vascular-Endothelial GF, 5 on Insulin like-GF, 4 on Transforming-GF-β, 4 on Platelet-Rich Plasma, 1 on Platelet Derived-GF and 2 on Fibroblast-GF, with the other articles included qualitatively. Overall results were positive with the addition of MSCs, Bone Morphogenetic Proteins, VEGF, IGF and TGF-β in aiding fracture healing compared to controls, with mixed results for other factors. CONCLUSION Overall this review shows promising results regarding the use of MSCs and various Growth factors in the treatment of fractures and non-unions, as well as synergistic effects observed when combined together. However more research is indicated as these methods are still in the early stages of development.

The use of robotic assisted surgery; the current and future challenges

Received: June 28, 2015 Revised: September 17, 2016 Accepted: September 17, 2016 Abstract: Background: Living with robots has always been regarded as a science fiction theme, however due to rapid advances in technology it is becoming more of a reality. The use of robots in surgery dates back to more than 25 years, and has previously been of great assistance to humans in the fields of Aeronautics and Armed forces. An evolutionary step was made after collaboration between the National Aeronautics and Space Administration (NASA), and the Stanford Research Institute in the field of robotic-assisted surgery. Thereafter, more surgical specialties incorporated this technology in surgical procedures. The objective of this article is to review different applications, challenges, and the future of robotic surgery.

The Use of Growth Factors and Mesenchymal Stem Cells in Orthopaedics.

Abstract Aim The aim was to look at current evidence for treating non-unions or delayed fracture healing in regard to novel methods applying mesenchymal stem cells (MSCs) and growth factors (GF). Methods Pre-clinical and clinical trials focusing on the use of Mesenchymal Stem Cells and Growth Factors for fracture healing were included in this review. Published articles were identified using specific search terms in Medline, Cochrane Library, PubMed, Scopus and Web of Science. Results Of the 580 articles found, 82 met my selection criteria and were included, with 39 papers involving trials on the effects of GFs and MSCs on non-unions or bone repair. These included 11 articles on MSCs, 10 on Bone Morphogenetic Proteins, 2 on Vascular-Endothelial GF, 5 on Insulin like-GF, 4 on Transforming-GF-β, 4 on Platelet-Rich Plasma, 1 on Platelet Derived-GF and 2 on Fibroblast-GF, with the other articles included qualitatively. Overall results were positive with the addition of MSCs, Bone Morphogenetic Proteins, VEGF, IGF and TGF-β in aiding fracture healing compared to controls, with mixed results for other factors. Conclusion Overall this review shows promising results regarding the use of MSCs and various Growth factors in the treatment of fractures and non-unions, as well as synergistic effects observed when combined together. However more research is indicated as these methods are still in the early stages of development.