The early and effective treatment of wounds is vital to ensure proper wound closure and healing with appropriate functional and cosmetic outcomes. The use of human amnion membranes for wound care has been shown to be safe and effective. However, the difficulty in handling and placing thin sheets of membrane, and the high costs associated with the use of living cellularized tissue has limited the clinical application of amniotic membrane wound healing products. Here, we describe a novel amnion membrane-derived product, processed to result in a cell-free solution, while maintaining high concentrations of cell-derived cytokines and growth factors. The solubilized amnion membrane (SAM) combined with the carrier hyaluronic acid (HA) hydrogel (HA-SAM) is easy to produce, store, and apply to wounds. We demonstrated the efficacy of HA-SAM as a wound treatment using a full-thickness murine wound model. HA-SAM significantly accelerated wound closure through re-epithelialization and prevented wound contraction. HA-SAM-treated wounds had thicker regenerated skin, increased total number of blood vessels, and greater numbers of proliferating keratinocytes within the epidermis. Overall, this study confirms the efficacy of the amnion membrane as a wound treatment/dressing, and overcomes many of the limitations associated with using fresh, cryopreserved, or dehydrated tissue by providing a hydrogel delivery system for SAM. STEM CELLS
Background and Aims: Relative adrenal insufficiency (RAI) in patients with cirrhosis is associated with increased mortality. Although the pathogenesis of RAI remains unclear, disordered cholesterol metabolism may contribute. Methods:We performed a prospective cohort study of 96 non-critically ill subjects with decompensated cirrhosis at a tertiary care centre. Subjects were administered 250 µcg cosyntropin, with RAI defined as an increase in total cortisol <9 µg/dL. Highdensity lipoprotein (HDL) levels and serum cholesterol esterification percentage (%CE), a validated surrogate marker of lecithin-cholesterol acyltransferase (LCAT) activity, were measured to assess the relationship between disordered cholesterol metabolism and the presence of RAI. Subjects were followed until death, liver transplantation or a maximum of 6 months.Results: Subjects with RAI had decreased levels of HDL (18 vs 29 mg/dL, P < .01) and %CE (64% vs 66%, P = .03). Correlation was seen between HDL and %CE (r = 0.7, R 2 = 0.49; P < .01) and each integer decrease in %CE predicted an approximately 2% increase in the probability of RAI. Transplant-free survival was reduced in subjects with RAI at both 6 months (43% vs 71%, P = .01) and 90 days (54% vs 81%, P < .01). Conclusions:Disruption in cholesterol metabolism contributes to the development of RAI in cirrhosis, as decreased LCAT activity leads to reduced HDL trafficking to the adrenal gland.
Introduction: Endoscopic sleeve gastroplasty (ESG) is a promising bariatric intervention designed to emulate sleeve gastrectomy (SG), the most commonly performed bariatric operation. Comparative studies are limited and there is a lack of large-scale population-based data. Additionally, no studies have examined the impact of race on outcomes after ESG. This is the largest study yet to compare short-term safety and efficacy of ESG to SG, and the first to evaluate the impact of race on short-term outcomes after ESG. Methods: We analyzed 600,000 patients who underwent ESG or SG from 2016-2020 across over 800 hospitals in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Patients who underwent ESG were propensity matched to SG patients. We primarily compared occurrences of adverse events (AE), readmissions, reoperations, and reinterventions within 30-days. Secondary outcomes measured at 30 days included total body weight loss (TBWL), outpatient treatments for dehydration, and emergency room (ER) visits. Multivariate regression evaluated the impact of patient characteristics, including race, on AE. Results: 6,054 patients underwent ESG and 597,463 underwent SG. Propensity matching in a 1:5 ratio compared all ESG cases to 30,270 SG cases. ESG had shorter procedural time (62.9 min vs 72.4, p , .05) and length of stay (0.87 days vs 1.45, p, 0.05). AE were low after both procedures (SG: 1.1% vs ESG: 1.4%, p . 0.05). However, patients undergoing ESG had more readmissions (3.8% vs 2.6%), reoperations (1.4% vs 0.8%), and reinterventions (2.8% vs 0.7%) within 30 days (p , 0.05). SG cohort had more outpatient treatments for dehydration (3.3% vs 2.4%, p, 0.05) and ER visits not resulting in admission (5.9% vs 4.9%, p, 0.05). SG also resulted in greater mean %TBWL compared to ESG (5.4% vs 4.0%, p, 0.05). The greatest odds of increasing AE after both ESG and SG were attributed to the presence of renal insufficiency (ESG: OR 10.0, SG: OR 1.95) and therapeutic anticoagulation (ESG: OR 3.73, SG: OR 1.80). Race was not significantly associated with AE after ESG, while black race was associated with higher risk of AE after SG (OR 1.23, 95% CI: 1.13-1.35). (Table ) Conclusion: ESG demonstrates comparable safety to SG with shorter procedure time and LOS. Clinicians may have been more inclined to readmit and intervene in ESG patients as compared to SG patients with similar complaints. Race did not impact short-term AE after ESG. Further prospective comparative studies are needed.[1097] Figure 1. Univariate and Multivariable Logistic Regression Analysis predicting 6-month readmission rate
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.