Defined as healing/non-healing Healing defined as reduction in wound area of greater than 20% over a 2-week period

only to be done once Arterial leg ulcers show change in flux ABPI of <0.8-0.6

On clinical inspection present as neuropathic

On clinical inspection present as neuroischemic

Leg Ulcer

The geko™ W-2 devices are small disposable, internally powered, neuromuscular stimulators that are applied externally to the leg. The W-2 device has a fixed 27mA current. The devices are self-adhesive and are applied to the outer/posterior aspect of the knee. This positioning enables integral electrodes to apply a stimulus to the lateral popliteal nerve (often additionally termed the common peroneal) which branches from the sciatic nerve. This nerve controls the contraction of several muscles in the lower leg.

gekoTM

Welsh wound Innovation Centre

Speckle Study: In Arterial, Mixed and Diabetic Foot Ulcers

A Single Centre Open Label Study Measuring Microcirculatory Flux Using Speckle Imaging Device, in Patients With Arterial, Mixed and Diabetic Foot Ulcers Using gekoTM Neuromuscular Electrostimulation (NMES)

Measurements of microcirculatory flux in the lower limb of the different subgroups with geko device on.

measurements of Temperature over same time period as speckle device using the Exergen DermaTemp model DT1001.

Firstkind Ltd

The BM aspirate will be diluted at 6:1 ratio with phosphate buffer saline with 2 ml EDTA (30 ml BM aspirate+ 5 ml PBS/EDTA buffer).MNCs will be separated under aseptic conditions using a Ficoll. Hypaque desity gradient by centrifugation at 1800 rpm for 20 min then the MNCs will be plated in 40 ml(αMEM), serum free media; mesencult(MSCs culture),penicillin (100 U/ml),streptomycin(10 mg/ml),0.5 ml amphotericin B(all from Gibco BRL) and 10 ng/ml basic fibroblast growth factor (b-FGF)(R&D system, Minneapolis, MN) and will be incubated at 370 c in a humidified atmosphere containing 5% CO2 .after one day ,nonadherent cells will be cultured in the presence of Mesenchymal media for 3 weeks changed every week. After reaching 80% confluence the MSCs will be placed in 10 ml saline and infused IV.

This study was conducted on 10 patients with Diabetic peripheral neuropathy (DPN), 4 females and 6 males

Mesenchymal Stem Cells Transfusion in DPN Patients

Sex: Female, Male

Region of Enrollment

measurement of b-FGF and v-EGF MEASURED BY ELISA before (at zero), and after at (7 days, 90) days after stem cell transfusion to measure the effect of stem cell and its role in nerve regeneration

measurement of b-FGF and v- EGF MEASURED BY ELISA before (at zero), and after at (7 days, 90) days after stem cell transfusion to measure the effect of stem cell and its role in nerve regeneration

Measurement of b-FGF and v- EGF MEASURED BY ELISA

Measurement of b-FGF, v-EGF MEASURED BY ELISA

Measuring nerve conduction velocities(NCV) in m/sec upper and lower limbs nerves(sensory and motor) lower limb nerves : tibial , common peroneal(CP) as motor and sural nerve as sensory upper limb nerves: ulnar nerve as motor and sensory and compare at base line(zero day) and 90 days after stem cells transfusion

nerve conduction velocities of nerves examined measured in Upper limbs and Lower limbs nerves,motor and sensory
lower limb motor nerves: tibial and common peroneal lower limb sensory nerve : sural nerve
upper limb motor nerve: ulnar nerve upper limb sensory nerve: ulnar nerve
data measured at zero (before stem cell transfusion) and 90 days after stem cell transfusion

Nerve Conduction Velocities of Nerves

Change of Nerve Conduction Velocities of Nerves Affected Measured by Nerve Conduction Study.

Measuring nerve conduction latency in msec of upper and lower limbs nerves(sensory and motor) lower limb nerves : tibial , common peroneal(CP) as motor and sural nerve as sensory upper limb nerves: ulnar nerve as motor and sensory and compare at base line and 90 days after stem cells transfusion

nerve conduction latency of nerves examined measured in Upper limbs and Lower limbs nerves,motor and sensory lower limb motor nerves: tibial and common peroneal lower limb sensory nerve : sural nerve upper limb motor nerve: ulnar nerve upper limb sensory nerve: ulnar nerve data measured at zero (before stem cell transfusion) and 90 days after stem cell transfusion

Nerve Conduction Latency of Nerves

Change of Nerve Conduction Latency of Nerves Affected Measured by Nerve Conduction Study

Measuring nerve conduction amplitudes in uv of upper and lower limbs nerves(sensory and motor).
lower limb nerves : tibial , common peroneal(CP) as motor and sural nerve as sensory .
upper limb nerves: ulnar nerve as motor and sensory. and compare at base line and 90 days after stem cells transfusion

nerve conduction amplitudes of nerves examined measured in Upper limbs and Lower limbs nerves,motor and sensory lower limb motor nerves: tibial and common peroneal, lower limb sensory nerve : sural nerve.
upper limb motor nerve: ulnar nerve motor , upper limb sensory nerve: ulnar nerve sensory data measured at zero (before stem cell transfusion) and 90 days after stem cell transfusion

Nerve Conduction Amplitudes of Nerves

Change of Nerve Conduction Amplitude of Nerves Affected Measured by Nerve Conduction Study.

fasting, 2 hours postprandial blood sugar measurement before at base line (zero day) and after (90 days) stem cells transfusion as a follow up and comparing the values.

Plasma biochemical blood measurements will be determined by standard laboratory procedures in the central lab at clinical pathology department, Kasr Alaini hospital) Fasting blood glucose level, 2 hours postprandial.

Blood Tests Measured Before and After Stem Cell Transfusion

Change of Levels of Fasting Blood Sugar and 2 Hours Post Prandial at Base Line ( Zero Day ) and After (90 Days) After Stem Cells Transfusion

Blood tests before and after stem cells(90 days) transfusion and comparing the values in percent % which is reflecting the patient blood sugar control in the previous 3 months

as a cumulative effect of patient control we measured HA1C at zero level and 90 days after stem cell transfusion in %

HA1C Measurment Before and Afterr Stem Cell

Change of Levels of Glycated Haemoglobin( HA1C) After Stem Cells Transfusion Measured in Percent %

collection: bone marrow biopsy from iliac crest. Separation of cells:The bone marrow aspirate will be diluted at a ratio of 6:1 with phosphate buffer saline (PBS) with 2 ml EDTA (30 ml BM aspirate+ 5 ml PBS/EDTA buffer). The MNCs will be separated under aseptic conditions using a Ficoll. Hypaque desity gradient by centrifugation at 1800 rpm for 20 min then the MNCs will be plated in 40 ml alpha-modi-field Eagle's medium (αMEM), serum free media; mesencult(Mesenchymal stem cell culture),penicillin (100 U/ml),streptomycin(10 mg/ml),0.5 ml amphotericin B(all from Gibco BRL) and 10 ng/ml basic fibroblast growth factor (b-FGF) (R&D system, Minneapolis, MN) and will be incubated at 37 c in a humidified atmosphere containing 5% CO2.after one day,non adherent cells will be cultured in the presence of Mesenchymal media for 3 weeks changed every 1 week. After reaching 80% confluence the MSCs will be placed in 10 ml saline and will be infused intravenously. on 2 sessions to the same patient

Mesenchymal Stem Cells Transfusion in Diabetic Neuropathy

Overall Study

Dina Mohammed Riad Ebrahim Abdelmagid

Diabetic Peripheral Neuropathy

collection of stem cells by bone marrow biopsy from iliac crest, then culture for 1 month , then IV transfusion on 2 sessions to the same patient

mesenchymal stem cells

Effect Of Mesenchymal Stem Cells Transfusion on the Diabetic Peripheral Neuropathy Patients .

Effect Of Mesenchymal Stem Cells Transfusion on the Peripheral Neuropathy in Diabetic Patients Measured by Nerve Conduction.

dina mohammed riad

Assistant Lecturer of Internal Medicine,faculty of medicine,Kasr Al Ainy hospital

Cairo University

Placebo one dose in the evening of surgery and post op day #1.

Gabapentin 400mg orally at 9pm on the evening of surgery and first day post operatively

Degenerative Joint Disease of Hip and Knee.

Placebo

400mg orally at 9pm day of surgery and the first evening post operatively.

Gapabentin

University Hospital

Effect of Gabapentin on Orthopedic Pain

The Effect of Gabapentin on Postoperative Pain: a Randomized, Double Blind, Placebo Controlled Trial

Total opioid consumption and lowest/highest pain score in 8 hour segments.

diabetic neuropathies/hypoxia

Speckle Study: In Arterial, Mixed and Diabetic Foot Ulcers

Effect Of Mesenchymal Stem Cells Transfusion on the Diabetic Peripheral Neuropathy Patients .

Effect of Gabapentin on Orthopedic Pain

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