Preclinical and clinical evidence for using perinatal tissue allografts in nerve sparing robot assisted radical prostatectomy to hasten recovery of functional outcomes: a literature review.

INTRODUCTION: Localized prostate cancer (PCa) is one of the most common malignancies in the United States. Despite continued refinement of robot assisted radical prostatectomy (RARP) surgical methods, post-surgical erectile dysfunction and urinary incontinence remain significant challenges due to iatrogenic injury of local nervous tissue. Thus, the development of therapeutic strategies, including the use of biologic adjuncts to protect and/or enhance recovery and function of nerves following RARP is of growing interest. Perinatal tissue allografts have been investigated as one such biologic adjunct to nerve sparing RARP. However, knowledge regarding their clinical efficacy in hastening return of potency and continence as well as the potential underpinning biological mechanisms involved remains understudied. Thus, the objective of this literature review was to summarize published basic science and clinical studies supporting and evaluating the use of perinatal allografts for nerve repair and their clinical efficacy as adjuncts to RARP, respectively. METHODS: The literature as of May 2024 was reviewed non-systematically using PubMed, EMBASE, Scopus, and Web of Science databases. The search terms utilized were "robotic prostatectomy", "prostate cancer", "nerve sparing", "perinatal tissue", "allograft", "potency", and "continence" alone or in combination. All articles were reviewed and judged for scientific merit by authors RP and JM, only peer-reviewed studies were considered. RESULTS: Eight studies of perinatal tissue allograph use in RARP were deemed worthy of inclusion in this nonsystematic review. CONCLUSIONS: Incontinence and impotence remain significant comorbidities despite continued advancement in surgical technique. However, basic science research has demonstrated potential neurotrophic, anti-fibrotic, and anti-inflammatory properties of perinatal tissue allografts, and clinical studies have shown that patients who receive an intra-operative prostatic perinatal membrane wrap have faster return to potency and continence.

Interleukin 6 and interleukin 17A serum levels and gene- polymorphisms in the development of early allograft rejection in living donor liver transplant recipients.

The aim of this study is to evaluate the role of serum level of Interleukin 6(IL-6) and Interleukin 17 (IL-17) in liver transplantation outcome for living recipients, Analyze the relation between the gene polymorphism and the occurrence of rejection after liver transplantation and Study the relation between the gene polymorphism and the occurrence of different infectious complications. The study was conducted in March 2023 and included 60 healthy volunteers from the National Liver Institute (NLI) blood bank at Menoufia University and 120 live donation liver recipient patients at NLI. During one month of liver transplantation, the cytokine levels (IL-17, IL-6 proteins, IL-6 G-174C, and IL-17 A rs2275913 gene polymorphism) and CD4 levels for 60 patients of 120 live donation liver recipient patients whom early reject transplanted tissue and the same parameters were measured after 6 months follow up for non-reject group. The main finding of this study was that the post-transplant rejection group and the post-transplant non-rejection and control groups differed significantly in the genotype frequency (CC, CG, and GG) or alleles of IL-6 G-174C (p = 0.011). On the other hand IL-17A rs2275913 gene polymorphism and its alleles (p = 0.71) showed no statistically significant difference. We also observed that serum IL-17 levels, with 100% specificity and 100% sensitivity threshold, will be more sensitive and specific than serum IL-6 and CD4 count in differentiating post-transplant rejection from non-rejection patients. The results showed that there was no significant relationship between the genotypes and serum levels of interleukins and the type and degree of rejection. Proinflammatory cytokines might be useful indicators for distinguishing and early identifying unfavorable outcomes after transplantation, allowing for prompt and effective treatment intervention. To evaluate these findings, prospective clinical trials are required.

Outcome comparison of the most commonly employed wound coverage techniques in patients with massive burns ≥50% TBSA - A systematic review and meta-analysis.

INTRODUCTION: Early wound coverage is one of the most essential factors influencing the survival of extensively burned patients, especially those with a total body surface area (TBSA) burned greater than 50 %. In patients with limited donor sites available for autografting, techniques such as the Meek micrograft procedure or cultured epidermal allografts (CEA) have proven to be viable alternatives. In this systematic review and meta-analysis, we analyzed the outcomes of different wound coverage techniques in patients with massive burn injuries ≥ 50 % TBSA in the past 17 years. METHODS: The EMBASE, PUBMED, Google Scholar and MEDLINE databases were searched from inception to December 2022 for studies investigating major burn reconstruction (>50 % TBSA) with the use of one of: a) autografts, b) allografts, c) cell-based therapies, and d) Meek micrografting. The review was conducted in accordance with the PRISMA guidelines. The outcomes evaluated were mortality, length of hospital stay, graft take and number of operations performed. RESULTS: Following a two-stage review process, 30 studies with 1369 patients were identified for analysis. Methods of coverage comprised the original autografting, and the newer Meek micrografting, CEA autografting, and allografting. Pooled mean age of the entire cohort was 32.5 years ( ± SE 3.6) with mean burn size of 66.1 % ( ± 2.5). After pooling the data, advantages in terms of mortality rate, length of stay, graft take and number of required surgeries were seen for the Meek and CEA groups. Mortality was highest in patients treated with autografts (50 %) and lowest with cell-based therapy (11 %). Length of stay was longest with cell-based therapy (91 ± 16 days) and shortest with Meek micrografting (50 ± 24 days). Graft take was highest with autografts (96 ± 2 %) and lowest with cell-based therapy (72 ± 9 %). Average number of operations was highest with cell-based therapy (9 ± 4) and lowest with Meek micrografting (4 ± 2). CONCLUSIONS: Comparison of the four techniques highlighted differences in terms of all outcomes assessed, and each technique was associated with different advantages. Interestingly autografting, the option with the highest graft take rate, was also associated with the highest mortality. This study not only serves to provide the first comparison of the most commonly used techniques in major burn reconstruction, but also highlights the need for prospective studies that directly compare the efficacy of the different techniques to ultimately establish whether a true superior option exists.

Outcomes After Osteochondral Allograft Transplantation of the Medial Femoral Condyle in Patients With Varus and Nonvarus Alignment.

BACKGROUND: Fresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized. PURPOSE: To evaluate how varus malalignment affects graft survival and patient-reported outcomes after isolated OCA transplantation of the medial femoral condyle (MFC). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 70 patients (74 knees) who underwent primary OCA transplantation of the MFC between 2005 and 2019 were identified from a prospectively collected single-surgeon cartilage registry with a minimum 2-year follow-up. Coronal-plane alignment was evaluated utilizing standing hip-to-ankle radiographs. OCA failure, defined as removal of the graft or conversion to arthroplasty, and reoperations were recorded. Patient-reported outcomes were obtained preoperatively and postoperatively using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, modified Merle d'Aubigné-Postel score, and overall patient satisfaction score. RESULTS: The mean mechanical tibiofemoral angle for patients with varus alignment was 3.9° of varus (range, 1.1° to 8.9°) and for patients with nonvarus alignment it was 0.02° of valgus (range, 3.6° varus to 4.6° valgus). Graft survivorship was 95.3% in the varus group and 95.8% in the nonvarus group (P = .918) at 5 years postoperatively. Reoperations after OCA transplantation occurred in 14.0% of the varus group and 22.6% of the nonvarus group (P = .336). The mean International Knee Documentation Committee total score improved from 45.2 preoperatively to 74.8 at latest follow-up in the varus group and from 40.5 preoperatively to 72.3 at latest follow-up in the nonvarus group. Patient satisfaction was >85%. CONCLUSION: Patients undergoing isolated OCA transplantation of the MFC had high rates (>90%) of graft survivorship and significant improvements in pain and function. Patients with mild preexisting varus malalignment were found to have no difference in the failure rate or clinical outcomes compared with patients with nonvarus alignment.

Surgical Outcomes of a Human Umbilical Cord Allograft Over the Ahmed Glaucoma Valve Plate for Refractory Glaucoma.

OBJECTIVES: To report the surgical outcomes of sterile dehydrated human umbilical cord allograft over the Ahmed glaucoma valve (AGV) plate for refractory glaucoma. METHODS: Thirty-four eyes of 34 patients with refractory glaucoma who underwent AGV with umbilical cord allograft (AmnioPlast THICK™; Life Cell International Private Limited, Mumbai, India) placed over the AGV plate between September 2021 and 2022 at a tertiary eye care centre were included (group1) and compared with 30 eyes of 30 patients undergoing AGV without amnioblasts (group 2). The intraocular pressure (IOP) at day one, one month, six months, and final IOP; the necessity for medications; or additional surgeries for IOP control were extracted from the hospital database. Success was defined as achieving an IOP below 22 mm Hg with or without glaucoma medications. IOP spikes after surgery were identified as a rise in pressure beyond 22 mm Hg at any point beyond six weeks post-surgery following an initial reduction of pressure exceeding 30% from the baseline pre-surgical IOP. RESULTS: A notable reduction in intraocular pressure (37 ± 7.9 mm Hg preoperative versus 14 ± 3.7 mm Hg at the final follow-up and 28 ± 3.6 mm Hg versus 18 ± 6.7 mm Hg in group 1 and 2, respectively) was observed in all eyes, with successful outcomes observed in 23 out of 34 eyes (67%). Ten eyes experienced a pressure spike, occurring at a median time of 12 months (range: 6-18 months), predominantly beyond six months post-surgery in group 1, while group 2 had similar pressure spikes in 21 of 30 eyes at a median time of two months (range: 1-5 months). No eyes necessitated supplementary glaucoma procedures, concluding with a final IOP of 14 ± 3.7 mm Hg at 1.9 ± 0.8 years. Vision loss occurred in only one of the 11 eyes that failed owing to non-glaucoma-related causes in group 1. CONCLUSIONS: The human umbilical cord allograft plate over the AGV plate may help in postponing the onset of intraocular pressure spikes beyond traditionally defined timelines. This helps in reducing and delaying the hypertensive phase occurring due to fibrosis.

Percutaneous isometric reconstruction of medial collateral and posterior oblique ligaments offers similar outcomes to open techniques with reduced complication rates at a medium-term follow-up: A retrospective comparative study.

BACKGROUND: Knee Injuries involving the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) can cause severe instability. The open surgical technique involves larger incisions. A percutaneous technique may offer similar outcomes with reduced morbidity and a shorter recovery time. The purpose of this study was to compare the clinical and functional outcomes of percutaneous and open reconstruction using isometric allografts. METHODS: A retrospective comparative analysis was conducted on 21 patients between 2010 and 2021. Eleven patients underwent open surgery, while 10 underwent percutaneous surgery. The subjective IKDC, Lysholm, and Tegner scores, and valgus laxity were evaluated. Complications were also recorded. RESULTS: Both the groups demonstrated significant improvements in functional scores and a reduction in valgus laxity postoperatively, with no significant differences. The mean improvements were 32.3 for the IKDC score and 37.9 for the Lysholm score. The average reduction in the Tegner score was 1.1 points. Postoperative radiographic measurements of medial joint opening were < 2 mm in all patients. The percutaneous group had fewer complications, with arthrofibrosis being significantly less frequent (0 vs. 4 in the open group). The mean follow-up was 3.5 years. CONCLUSION: Percutaneous reconstruction of the medial side of the knee with an isometric technique is a safe and effective procedure that provides results similar to those of open reconstruction. The advantages of percutaneous reconstruction include smaller incisions, less pain and scarring, shorter recovery time, and lower risk of complications. Allografts are preferred over autografts to avoid donor site morbidity and weakening of the medial stabilizers.

A single institution's surgical care model for pediatric burns with ≤ 10% body surface area involvement.

Small burn injuries are extremely prevalent in the pediatric population and continue to pose a challenge for clinicians. Despite their high incidence, a standardized algorithm for treating small burns does not currently exist, and care is often influenced by clinical judgement and resource availability. The aim of this study was to explore the utility of a two-stage grafting technique, involving allograft and autograft, for treating small burns (≤ 10% total body surface area) in pediatric patients. A retrospective review of patients aged 0-18 years who had a small burn and underwent a two-stage grafting procedure between 09-01-2018 and 09-01-2022 was conducted. One hundred and seventy-five patients with 220 wounds met the inclusion criteria for this study. The mean time from presentation to allograft surgery was 11.4 days (SD 5.2) followed by autograft surgery approximately one week later. Most patients were discharged within 24 hours following allograft surgery (87.4%) and autograft surgery (81.1%). Mean autograft take was 97.7% (SD 11.8) with only four patients experiencing significant graft loss requiring subsequent re-grafting. These positive outcomes demonstrate that the two-stage technique can be successfully utilized for treating smaller pediatric burns. Moreover, these findings help to address the significant knowledge gap regarding the optimal approach to treating small burn wounds. Further research is warranted to learn more about cosmetic outcomes following two-stage grafting and determine how it compares to other techniques for treating small burns.

Perfusate hemoglobin during normothermic liver machine perfusion as biomarker of early allograft dysfunction: A pilot study.

BACKGROUND: Normothermic machine perfusion (NMP) aims to reduce ischemia-reperfusion injury in donor livers and its clinical manifestation, early allograft dysfunction (EAD) by maintaining perfusion and oxygenation. However, there is limited data on which NMP perfusate biomarkers might be associated with such EAD and the role of perfusate hemoglobin has not been assessed. METHODS: We performed a pilot retrospective analysis of adult donor livers undergoing NMP between 2020 and 2022 at our center. NMP was commenced at the recipient hospital after initial static cold storage. All NMP circuits were primed in the same manner according to the manufacturer's instructions. Livers were stratified by initial perfusate hemoglobin below (≤5.2 mmol/L) or above (>5.2 mmol/L) the median. The association between hemoglobin levels and EAD or recipient peak transaminase levels was assessed. RESULTS: Among 23 livers, eight were considered unsuitable for transplantation, leaving 15 livers for assessment. Higher initial hemoglobin was associated with a lower risk of EAD (0% vs. 55.6%, p = 0.04). Perfusate hemoglobin decreased after NMP initiation (p = 0.003) and negatively correlated with recipient peak transaminase levels (ALT: ρ = -0.72, p = 0.002; AST: ρ = -0.79, p < 0.001). Consistently, higher hemoglobin livers also demonstrated lower perfusate liver enzymes. CONCLUSIONS: Perfusate hemoglobin levels decreased during NMP, and lower perfusate hemoglobin levels were associated with a higher incidence of EAD and higher levels of liver injury markers. Maintaining higher hemoglobin levels during NMP may help reduce ischemia-reperfusion injury and prevent or attenuate EAD. Larger prospective studies are needed to validate the findings of this pilot study.

Real-World Clinical Experience With an Allograft Adipose Matrix for Replacing Volume Loss in Face, Hands, and Body.

INTRODUCTION: Real-world experience using an allograft adipose matrix (AAM) (Renuva) is presented as a series of seven cases demonstrating successful use of the matrix by nine expert cosmetic physicians across the United States. AAM is donated tissue that is aseptically processed without terminal irradiation into a transplantable adipose matrix that functions as a natural, versatile, and nonimmunogenic cushioning and volume-restoring tissue. When injected, the adipose matrix is replaced with the body's own fat cells and provides the cellular scaffold required for volume restoration and retention. METHODS: Nine expert dermatologists were selected to share and discuss real-world patient cases using AAM. The experts discussed a variety of cases and selected 7 cases that demonstrated successful, novel use of AAM to present in this manuscript. RESULTS: Experts agreed that the novel AAM is an easy-to-use, effective, and safe alternative to traditional fillers and fat grafting. CONCLUSION: The use of the AAM is recommended for the face, hands, and other adipose tissue-containing parts of the body. The presented real-world cases provide guidance on how to identify ideal candidates to ensure optimal volume restoration results.

The heterobivalent (SSTR2/albumin) radioligand [67Cu]Cu-NODAGA-cLAB4-TATE enables efficient somatostatin receptor radionuclide theranostics.

Somatostatin type 2 receptor (SSTR2) radionuclide therapy using ß- particle-emitting radioligands has entered clinical practice for the treatment of neuroendocrine neoplasms (NENs). Despite the initial success of [177Lu]Lu­DOTA-TATE, theranostic SSTR2 radioligands require improved pharmacokinetics and enhanced compatibility with alternative radionuclides. Consequently, this study evaluates the pharmacokinetic effects of the albumin-binding domain cLAB4 on theranostic performance of copper­67-labeled NODAGA-TATE variants in an SSTR2-positive mouse pheochromocytoma (MPC) model. Methods: Binding, uptake, and release of radioligands as well as growth-inhibiting effects were characterized in cells grown as monolayers and spheroids. Tissue pharmacokinetics, absorbed tumor doses, and projected human organ doses were determined from quantitative SPECT imaging in a subcutaneous tumor allograft mouse model. Treatment effects on tumor growth, leukocyte numbers, and renal albumin excretion were assessed. Results: Both copper­64- and copper­67-labeled versions of NODAGA-TATE and NODAGA-cLAB4­TATE showed similar SSTR2 binding affinity, but faster release from tumor cells compared to the clinical reference [177Lu]Lu­DOTA-TATE. The bifunctional SSTR2/albumin-binding radioligand [67Cu]Cu­NODAGA-cLAB4­TATE showed both an improved uptake and prolonged residence time in tumors resulting in equivalent treatment efficacy to [177Lu]Lu­DOTA-TATE. Absorbed doses were well tolerated in terms of leukocyte counts and kidney function. Conclusion: This preclinical study demonstrates therapeutic efficacy of [67Cu]Cu­NODAGA-cLAB4­TATE in SSTR2-positive tumors. As an intrinsic radionuclide theranostic agent, the radioligand provides stable radiocopper complexes and high sensitivity in SPECT imaging for prospective determination and monitoring of therapeutic doses in vivo. Beyond that, copper­64- and copper­61-labeled versions offer possibilities for pre- and post-therapeutic PET. Therefore, NODAGA-cLAB4-TATE has the potential to advance clinical use of radiocopper in SSTR2-targeted cancer theranostics.

Total Talus Allograft Transplantation With Subtalar Arthrodesis for Missing Talus: A Report of a Rare Case.

Post-traumatic missing talus is a rare and severe injury that often results in poor functional outcomes, with no consensus on the optimal treatment approach as strategies vary based on injury severity. We present the case of a 44-year-old male who sustained a missing talus following a high-energy motorcycle accident. After initial wound management and application of an external fixator, the patient underwent size-matched, fresh-frozen talus allograft transplantation combined with subtalar fusion. Postoperative radiography and CT confirmed successful transplantation with solid subtalar fusion, although progressive osteonecrosis was noted in the medial shoulder region of the talus. At the two-year follow-up, the patient exhibited limited ankle and hindfoot motion but was able to bear weight and walk without assistance, reporting no pain in his feet and achieving a final American Orthopaedic Foot & Ankle Society hindfoot score of 72. This case underscores the potential of total talar allograft transplantation with subtalar arthrodesis in treating severe talar bone loss or missing talus, although long-term follow-up is necessary to assess the clinical implications of medial talar collapse and the possible need for revision surgery.

Prospective Assessment of Outcomes After Femoral Condyle Osteochondral Allograft Transplantation With Concurrent Meniscus Allograft Transplantation.

Background: Osteochondral allograft transplantation (OCAT) and meniscus allograft transplantation (MAT) have each become more commonly implemented for the treatment of young to middle-aged patients with complex knee pathology. Evidence regarding tibiofemoral OCAT in the setting of concurrent MAT is limited. Purpose/Hypothesis: The purpose of this study was to characterize outcomes for femoral condyle OCAT with concurrent MAT (OCAT+MAT) in the ipsilateral compartment of patients after evidence-based shifts in practice. It was hypothesized that OCAT+MAT would be associated with successful outcomes characterized by statistically significant and clinically meaningful improvements in patient-reported outcome measures (PROMs) of knee pain and function in >80% of patients for at least 2 years after transplantation. Study Design: Case series; Level of evidence, 4. Methods: With institutional review board approval and documented informed consent, patients who underwent primary OCAT+MAT between 2016 and 2020 and enrolled in a lifelong registry for prospective collection of outcomes after OCAT were included. Patients with minimum 2-year follow-up data regarding complications, failures, adherence, and PROMs were analyzed. Patients who required OCAT and/or MAT revision or conversion to arthroplasty were defined as experiencing treatment failures. Results: A total of 23 consecutive patients (mean age, 37.1 years; mean body mass index, 28 kg/m2; 14 men) met the inclusion criteria, with a mean follow-up of 51 months (range, 24-86 months). The initial treatment success rate was 78% based on 5 initial treatment failures, and the overall success rate was 83% based on a successful revision OCAT. All failures occurred in the medial compartment. Older patient age (42.2 vs 32.1 years; P = .046) and nonadherence to postoperative restriction and rehabilitation protocols (P = .033; odds ratio, 14) were significant risk factors for treatment failure. All measured PROMs achieved significant improvements (P < .001) and minimum clinically important differences at a minimum of 2 years postoperatively. Conclusion: OCAT+MAT was associated with successful short- to mid-term outcomes in 83% of cases. Evidence-based shifts in practice were implemented before the enrollment of this patient cohort. Older patients and those who were not adherent to postoperative restriction and rehabilitation protocols had a significantly higher risk for treatment failure and subsequent conversion to arthroplasty.

The potential of autologous regulatory T cell (Treg) therapy to prevent Cardiac Allograft Vasculopathy (CAV) in paediatric heart transplant recipients.

Paediatric heart transplant is an established treatment for end stage heart failure in children, however patients have to commit to lifelong medical surveillance and adhere to daily immunosuppressants to minimise the risk of rejection. Compliance with immunosuppressants can be burdensome with their toxic side effects and need for frequent blood monitoring especially in children. Though the incidence of early rejection episodes has significantly improved overtime, the long-term allograft health and survival is determined by Cardiac Allograft Vasculopathy (CAV) which affects a vast number of post-transplant patients. Once CAV has set in, there is no medical or surgical treatment to reverse it and graft survival is significantly compromised across all age groups. Current treatment strategies include novel immunosuppressant agents and drugs to lower blood lipid levels to address the underlying immunological pathophysiology and to manage traditional cardiac risk factors. Translational researchers are seeking novel immunological approaches that can lead to permanent acceptance of the allograft such as using regulatory T cell (Tregs) immunotherapy. Clinical trials in the setting of graft versus host disease, autoimmunity and kidney and liver transplantation using Tregs have shown the feasibility and safety of this strategy. This review will summarise current knowledge of the latest clinical therapies for CAV and pre-clinical evidence in support of Treg therapy for CAV. We will also discuss the different Treg sources and the considerations of translating this into a feasible immunotherapy in clinical practice in the paediatric population.

A Multi-Center International Analysis of Lung Transplantation Outcomes in Patients With COVID-19.

INTRODUCTION: Lung transplantation has become increasingly utilized in patients with COVID-19. While several single-center and UNOS database studies have been published on lung transplants (LTs) for end-stage lung disease (ESLD) from Coronavirus disease 2019 (COVID-19), there is a lack of multi-center and international data. METHODS: This is a multicenter analysis from 11 high-volume lung transplant centers in the United States and Europe. Data were collected through the Multi-Institutional ECLS Registry and stratified by ESLD due to COVID-19 versus other etiologies. Demographics and clinical variables were compared using Chi-square test and Fisher's exact test. Survival was assessed by Kaplan-Meier curves and compared by log-rank test with propensity score matching. RESULTS: Of 1606 lung transplant recipients, 46 (2.9%) were transplanted for ESLD from COVID-19 compared to 1560 (97.1%) without a history of COVID-19. Among COVID-19 patients, 30 (65.2%) had COVID-19-associated ARDS and 16 (34.8%) had post-COVID-19 fibrosis. COVID-19 patients had higher lung allocation scores (78.0 vs. 44.4, p < 0.0001), had severely limited functional status (37.0% vs. 2.9%, p < 0.0001), had higher preoperative ECMO usage (65.2% vs. 5.4%, p < 0.0001), and spent less time on the waitlist (32 vs. 137 days, p < 0.0001). A 30-day survival was comparable between COVID-19 and non-COVID-19 patients before (100% vs. 98.7%, p = 0.39) and after propensity matching (p = 0.15). CONCLUSIONS: Patients who received LTs due to COVID-19 had short-term survival comparable to that of patients without COVID-19. Our findings support the idea that lung transplantation should be considered for select patients with ESLD due to COVID-19.

Structural allograft versus Polyetheretherketone cage in Anterior Cervical Discectomy and Fusion: A Meta-analysis.

BACKGROUND: Polyetheretherketone (PEEK) cages and structural allografts (SAs) are commonly used in Anterior Cervical Discectomy and Fusion (ACDF), yet their postoperative results remain uncertain. This meta-analysis was conducted to determine whether there were any differences in outcomes between patients who received these two grafts in ACDF. METHODS: We comprehensively searched electronic databases up to August 2023. Observational studies or randomized controlled trials reported postoperative outcomes, including fusion, subsidence, reoperation rates, and patient-reported outcomes through the Neck Disability Index (NDI), the Visual Analog Scale (VAS) for neck and arm pain, and the Japanese Orthopedic Association (JOA)/modified JOA score following primary ACDF using SA or PEEK cage. The results are presented in odds ratios (ORs) or mean differences with corresponding 95% confidence intervals (CIs). RESULTS: Eleven studies were included, with 1213 patients (788 receiving SAs and 425 receiving PEEK cages). Patients having SA had significantly higher fusion (OR: 1.84, 95% CI: 1.27-2.67, p = 0.001) and lower subsidence (OR: 0.50, 95%CI: 0.30-0.86, p = 0.01) rates when compared with the PEEK cage. There was no difference in revision rate between SA or PEEK cage (p = 0.88). Two grafts demonstrated similar clinical improvements in NDI (p = 0.31), VAS for the neck (p = 0.77) and arm pain (p = 0.22), and JOA/mJOA score (p = 0.99). CONCLUSION: SA demonstrates better fusion and lower subsidence rates than the PEEK cage in ACDF. Nevertheless, these two cages resulted in equally successful postoperative clinical performances.

Perspective: metabolomics has the potential to change the landscape of kidney transplantation diagnostics.

Kidney transplantation is the most efficient renal replacement therapy. Current diagnostics for monitoring graft health are either invasive or lack precision. Metabolomics is an emerging discipline focused on the analysis of the small molecules involved in metabolism. Given the kidneys' central role in metabolic homeostasis and previous observations of altered metabolites correlating with restricted kidney graft function, metabolomics is highly promising for the discovery of novel biomarkers and the development of novel diagnostics. In this perspective, we summarize the known metabolic roles for the kidney, discuss biomarkers of graft health and immune status emerging from metabolomics research, and provide our perspective on how these and future findings can be integrated in clinical practice to enable precision diagnostics.

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Revolutionizing tracheal reconstruction: innovations in vascularized composite allograft transplantation.

Tracheal defects, particularly those extending over long segments, present substantial challenges in reconstructive surgery due to complications in vascularization and integration with host tissues. Traditional methods, such as extended tracheostomies and alloplastic stents, often result in significant morbidity due to mucus plugging and mechanical erosion. Recent advances in vascularized composite allograft (VCA) transplantation have opened new avenues for effective tracheal reconstruction. This article reviews the evolution of tracheal reconstruction techniques, focusing on the shift from non-vascularized approaches to innovative revascularization methods that enhance graft integration and functionality. Key advancements include indirect revascularization techniques and the integration of regenerative medicine, which have shown promise in overcoming historical barriers to successful tracheal transplantation. Clinical case studies are presented to illustrate the complexities and outcomes of recent tracheal transplantation procedures, highlighting the potential for long-term success through the integration of advanced vascular engineering and immune modulation strategies. Furthermore, the role of chimerism in reducing graft rejection and the implications for future tracheal transplantation and tissue engineering efforts are discussed. This review underscores the transformative potential of VCA in tracheal reconstruction, paving the way for more reliable and effective treatments for extensive tracheal defects.

Ultrasound super-resolution imaging for the assessment of renal allograft dysfunction: A pilot study.

Background: The purpose of this study was to examine the feasibility and practical application of ultrasound (US) super-resolution imaging (SRI) in evaluating microvasculature and measuring renal allograft function. Methods: Sixteen consecutive patients who received kidney transplants were prospectively enrolled. The patients were assigned as: normal allograft function (n = 6), and allograft malfunction (n = 10). Localizing each potential contrast signal resulted in super-resolution images (SRI). SRI was utilized to assess micro-vessel density (MVD) and microvascular flow rate, whereas contrast-enhanced (CE) US images were statistically processed to get the time to peak (TTP) and peak intensity. Logistic regression was utilized to evaluate their relationship. Results: US SRI may be utilized effectively on allografts to show microvasculature with significantly higher resolution than typical color Doppler flow and CEUS pictures. In the multivariate analysis, MVD and TTP were significant US markers of renal allograft failure (p = 0.031 and p = 0.045). The combination of MVD and TTP produced an AUC of 0.783 (p < 0.05) for allograft dysfunction. Conclusions: SRI can accurately portray the microvasculature of renal allografts, while MVD and TTP are appropriate US markers for assessing renal allograft failure.

Pericardium decellularization in a one-day, two-step protocol.

Scaffolds used in tissue engineering can be obtained from synthetic or natural materials, always focusing the effort on mimicking the extracellular matrix of human native tissue. In this study, a decellularization process is used to obtain an acellular, biocompatible non-cytotoxic human pericardium graft as a bio-substitute. An enzymatic and hypertonic method was used to decellularize the pericardium. Histological analyses were performed to determine the absence of cells and ensure the integrity of the extracellular matrix (ECM). In order to measure the effect of the decellularization process on the tissue's biological and mechanical properties, residual genetic content and ECM biomolecules (collagen, elastin, and glycosaminoglycan) were quantified and the tissue's tensile strength was tested. Preservation of the biomolecules, a residual genetic content below 50 ng/mg dry tissue, and maintenance of the histological structure provided evidence for the efficacy of the decellularization process, while preserving the ECM. Moreover, the acellular tissue retains its mechanical properties, as shown by the biomechanical tests. Our group has shown that the acellular pericardial matrix obtained through the super-fast decellularization protocol developed recently retains the desired biomechanical and structural properties, suggesting that it is suitable for a broad range of clinical indications.