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Background: Existing clinical studies supported the potential efficacy of mesenchymal stromal cells as well as derived exosomes in the treatment of COVID-19. We aimed to explore the safety and efficiency of aerosol inhalation of the exosomes derived from human adipose-derived MSCs (haMSC-Exos) in patients with COVID-19. Methods: The MEXCOVID trial is a phase 2a single-arm, open-labelled, interventional trial and patients were enrolled in Jinyintan Hospital, Wuhan, China. Eligible 7 patients were assigned to receive the daily dose of haMSCs-Exos (2.0 × 108 nano vesicles) for consecutively 5 days. The primary outcomes included the incidence of prespecified inhalation-associated events and serious adverse events. We also observed the demographic data, clinical characteristics, laboratory results including lymphocyte count, levels of D-dimer and IL-6 as well as chest imaging. Results: Seven severe COVID-19 related pneumonia patients (4 males and 3 females) were enrolled and received nebulized haMSC-Exos. The median age was 57 year (interquartile range (IQR), 43 year to 70 year). The median time from onset of symptoms to hospital admission and administration of nebulized haMSC-Exos was 30 days (IQR, 15 days to 40 days) and 54 d (IQR, 34 d to 69 d), respectively. All COVID-19 patients tolerated the haMSC-Exos nebulization well, with no evidence of prespecified adverse events or clinical instability during the nebulization or during the immediate post-nebulization period. All patients presented a slight increase of serum lymphocyte counts (median as 1.61 × 109/L vs. 1.78 × 109/L). Different degrees of resolution of pulmonary lesions after aerosol inhalation of haMSC-Exos were observed among all patients, more obviously in 4 of 7 patients. Conclusions: Our trial shows that a consecutive 5 days inhalation dose of clinical grade haMSC-Exos up to a total amount of 2.0 × 109 nano vesicles was feasible and well tolerated in seven COVID-19 patients, with no evidence of prespecified adverse events, immediate clinical instability, or dose-relevant toxicity at any of the doses tested. This safety profile is seemingly followed by CT imaging improvement within 7 days. Further trials will have to confirm the long-term safety or efficacy in larger population. Trial Registration: MEXCOVID, NCT04276987. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the short-term in vivo dynamic motion characteristics of the lower lumbar spine (L3–S1) after unilateral pedicle screw fixation (UPSF) or bilateral pedicle screw fixation (BPSF) combined with TLIF for treatment of L4–5 lumbar degenerative disc diseases (DDD). Methods: Twenty-eight patients were recruited (13 UPSF, 15 BPSF). Each patient was CT-scanned to construct 3D models of the L3–S1 vertebrae. The dual fluoroscopic imaging system (DFIS) was then used to image the lumbar spine while the patient performed seven functional activities (upright standing, maximum extension, flexion, left–right twist, and left–right bend). The in vivo vertebral positions were reproduced using the 3D vertebral models and DFIS images. The ranges of motion (ROMs) of L3–4, L4–5, and L5–S1 segments were analyzed. Results: At the index L4–5 segment, the primary ROM of left–right twist of the UPSF group (2.11 ± 0.52°) was significantly larger (p = 0.000) than the BPSF group (0.73 ± 0.32°). At the proximal adjacent L3–4 segment, the primary ROMs of left–right twist, and left–right bend of the UPSF group (2.16 ± 0.73°, 2.28 ± 1.03°) were significantly less (p = 0.003, 0.023) than the BPSF group (3.17 ± 0.88, 3.12 ± 1.04°), respectively. However, at distal adjacent L5–S1 segment, no significant difference was found between the two groups during all activities. Conclusions: The ROM in left–right twisting of UPSF group was significantly larger compared with BPSF group at the index level in the short term. The UPSF has less impact on the cranial adjacent level (L3–4) in left–right twisting and bending activities compared to the BPSF. The data implied that the UPSE and BPSF combined with TLIF would result in different biomechanics in the index and cranial adjacent segment biomechanics. Long-term follow-up studies are necessary to compare the clinical outcomes of the two surgeries. [ABSTRACT FROM AUTHOR]

Background: Low-grade myofibroblastic sarcoma (LGMS) is a rare type of tumor. Previous research has paid much attention to reporting pathological analyses of LGMS. However, only few systematic clinical and/or radiological studies have been conducted. Methods: This study recruited 14 cases (8 males and 6 females) of LGMS. X-ray or computer tomography (CT) scan were performed on 11 cases. MRI was performed on 5 cases. Results: X-Ray and CT scan: Five cases developed LGMS in bones, including 3 cases in the distal femur, 1 in the right shoulder blade, and another 1 in the right inferior ramus. Massive infiltrative and vermiform bone destruction with poorly-circumscribed lesion margins and partial soft tissue masses were observed. The other 9 cases were developed in soft tissues. Out of them, 4 cases presented slightly irregular hyper- or lower-density masses with poorly-circumscribed margins. 2 cases presented massive calcification and ossification. Significant enhancement was observed in 1 case, while no obvious enhancement was seen in the other 2 cases. MRI: MR images of 5 cases revealed homogeneous iso- or hyper-signal intensity on T1WI and homogeneous or heterogeneous hyper-signal intensity on T2WI. Enhanced MRI revealed homogeneous enhancement in 2 cases and rim enhancement in 1 case. Conclusions: Our findings show that LGMS is characterized by invasiveness, metastases and calcification. Different radiological tools should be employed to make an accurate diagnosis. [ABSTRACT FROM AUTHOR]