BackgroundBio-products from stem/progenitor cells, such as extracellular vesicles, are likely a new promising approach for reprogramming resident cells in both acute and chronic kidney disease. Forty CKD patients stage III and IV (eGFR 15–60 mg/ml) have been divided into two groups; twenty patients as treatment group “A” and twenty patients as a matching placebo group “B”. Two doses of MSC-derived extracellular vesicles had been administered to patients of group “A”. Blood urea, serum creatinine, urinary albumin creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) have been used to assess kidney functions and TNF-α, TGF-β1 and IL-10 have been used to assess the amelioration of the inflammatory immune activity.ResultsParticipants in group A exhibited significant improvement of eGFR, serum creatinine level, blood urea and UACR. Patients of the treatment group “A” also exhibited significant increase in plasma levels of TGF-β1, and IL-10 and significant decrease in plasma levels of TNF-α. Participants of the control group B did not show significant improvement in any of the previously mentioned parameters at any time point of the study period. ConclusionAdministration of cell-free cord-blood mesenchymal stem cells derived extracellular vesicles (CF-CB-MSCs-EVs) is safe and can ameliorate the inflammatory immune reaction and improve the overall kidney function in grade III-IV CKD patients.

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BACKGROUND Spinal dural arteriovenous fistula (SDAVF) is a rare disorder with an unknown etiology. Often, the clinical presentation and imaging findings are misleading, causing this condition to be mistaken for other entities, such as demyelinating or degenerative spinal lesions. OBSERVATIONS The authors report a challenging case of SDAVF in which the patient’s symptoms were initially thought to be attributable to a herniated disc based on his imaging studies at another institution. He sought the authors for a second opinion, which yielded a confirmed diagnosis of SDAVF. Due to his rapidly progressive neurological manifestations, he underwent a surgical division of the fistula using intraoperative video angiography via indocyanine green injections. His symptoms progressively improved over a 3-month period. He regained full sphincter control by 4 months, which gave him a better recovery than seen in other patients with SDAVFs, who do not generally fully regain sphincter control. LESSONS SDAVF is a critical spinal vascular pathology that should not be overlooked in the differential diagnosis of any patient presenting with signs of progressive myelopathy. Despite its associated vague initial clinical symptoms, SDAVF typically, but not always, demonstrates a characteristic imaging appearance on magnetic resonance (MR) imaging studies; therefore, MR angiography is still required for definitive diagnosis. Surgical treatment for SDAVF is almost always definitive and curative.

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Flying over the clouds or driving through the crowd, to work in an auto-managed and scalable environment or to get overwhelmed with the management as well as the development techniques and costly resources. That is a common problem facing most small to medium sized organizations. Cloud computing has been a breakthrough recently helping in the emergence of new resources, management, and services sharing between users and providers. With the consideration of the quality of services as a crucial factor for evaluating any service, the decision of adopting the new cloud techniques or remain in premise is one of the problems that faces the decision makers. The work proposed in this paper concentrates on surveying and studying the cloud among different professionals' perspectives and researches to be able to determine the most important and common aspects that affect the decision of cloud adoption. Furthermore, it considers in action the quality of services that are proposed to be the most effective while deciding. The factors determined are classified and used to set the infrastructure of building a full framework to facilitate the user's adoption decision. An evaluation model is proposed as well to measure the efficiency of the framework within real life.

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Availability of sufficient and accurate spatial data concerning land resources is a pillar for sustainable agricultural development. The current work was aimed at using remote sensing (RS) and geostatistical analysis tools within geographic information system (GIS) to map land capability and crop suitability for an area in the Qattara Depressing, Western Desert of Egypt, located east of the Qattara Depression between latitude 30° 10' 4" to 30° 20' 57" N and longitude 28° 32' 26" to 28° 52' 10" E, covering 630 km 2 (63000 ha). Thirty-seven soil profiles were dug to 150 cm. Soil samples were collected from different horizons and analyzed for their main properties. Applied System for Land Evaluation (ASLE) software was used to assess land capability and land suitability. Landforms include sand sheets, sand dunes, depressions, sabkha and water bodies. The 74.69% of the soils are"poor" (C4), 0.47% are"good" (C2), 11.68% are"fair" (C3), 11.12% are"very poor" (C5), and 0.47% are"non-agricultural" (C6). Soil texture, salinity and alkalinity are the main limiting factors. Classes for suitability (considering 22 crops) are highly suitable (S1), suitable (S2), moderately suitable (S3), marginally suitable (S4), currently not-suitable (N1), and potentially not-suitable (N2) for 22 crops. The most recommended crops are date palm and tomatoes. The studied soils require precise management practices to be promising for agricultural expansion.

Diabetes Mellitus is by definition an end-stage organ failure. Type 1 diabetes mellitus (T1DM) is an autoimmune disease. Auto-inflammatory infiltrate appears to characterize the insulitis associated with T2DM. Recently, in 2013, Eva Corpos and colleagues described a comprehensive composition of peri-islet capsules and their basement membrane (BM). Virtanen I, Otonkoski T and Irving-Rodgers H.F. have reported similar descriptions few years earlier which have not been taken seriously as they deserve. Bluestone JA, Virtanen I and Irving-Rodgers H.F. and other colleagues reported that accumulation of the lymphocytes around the islets without invasion of the BM is the first step in disease induction (non-destructive insulitis phase). Invasion of the BM byleucocytic infiltration (destructive insulitis phase) occurs over a period of several years offering a good window for therapeutic intervention. Clinical symptoms appear only when 70% -90% of β-cell mass are destroyed. This data emphasize the importance of identification and classification of such pathologic features by performing a biopsy of the pancreas with histoimmunochemistry analysis at the pre-hyperglycemic stage in a high risk genetically predisposed autoimmune suspected patient which may at least in part help to achieve new therapeutic approaches and help in halting the progression to end stage pancreatic disease (ESPD) known as diabetes mellitus. In this review we are going to emphasize the predictive role biopsy of the pancreas can build up a solid gold standard tool in diagnosis, stage and therapeutically follow up autoimmune diabetes mellitus.