Injection of cryopreserved amniotic membrane and umbilical cord particulate for pressure injuries: a retrospective case series.

INTRODUCTION: PI poses a significant burden to society. Cryopreserved AMUC has potential benefits in managing complex wounds owing to its anti-inflammatory, anti-scarring, and proregenerative properties. AMUC grafts are commonly in sheets, but also come as morselized powders that can be sprinkled or injected. The authors initially used AMUC injection in chronic PIs in March 2017. MATERIALS AND METHODS: This is a single-center, retrospective review of patients with nonhealing PIs treated with AMUC particulate between March 2017 and November 2018. Incidence of wound healing (zero wound volume with complete reepithelialization) was measured at 12, 24, 36, and 52 weeks. RESULTS: Review included 26 PIs (21 patients); of which, 85% were stage 4 PIs, per the NPIAP staging system. After AMUC injection, 14 PIs (54%) achieved complete wound closure at a median of 12.4 weeks (range, 5-52 weeks). Complete wound closure was observed in 7 patients (27%) at 12 weeks, 10 patients (38%) at 24 weeks, 13 patients (50%) at 36 weeks, and 14 patients (54%) at 52 weeks. One patient with vascular issues required amputation; however, no treatment-related adverse events or complications were observed. CONCLUSIONS: These preliminary results suggest that injection of AMUC particulate may be a safe and promising treatment in promoting wound closure of difficult-to-treat PIs.

Proteomic profiling of tear fluid as a promising non-invasive screening test for colon cancer.

BACKGROUND: Current screening options for colorectal cancer (CRC) are either invasive (colonoscopy) or have lower sensitivity to identify pre-malignant lesions (fecal immunochemical test). We proposed to identify protein profiles in tears of patients with both pre-malignant polyps and CRC; these profiles could have potential as a noninvasive screening test. METHOD: Colonoscopy patients were divided into "high risk" group (CRC and tubular adenomatous polyp) and "low risk" (normal and hyperplastic polyps). Tear fluids from patients were analyzed by Liquid Chromatography Mass Spectrometry/Mass Spectrometry. The data were analyzed for protein expression, protein-protein interaction and gene set enrichment. RESULTS: The results showed 80 proteins (18 up-regulated and 62 down-regulated) significantly differentiated in "high-risk" compared to "low-risk"; Twenty-eight of these show protein-protein interactions, 9 of which were associated with pathways demonstrated to be altered in CRC patients. CONCLUSION: Our pilot data, though limited, demonstrated tear protein profiling could distinguish the groups of patients with and without colon lesions.

Association of tobacco and alcohol use with earlier development of colorectal pathology: should screening guidelines be modified to include these risk factors?

BACKGROUND: Current guidelines for colorectal cancer (CRC) screening recommend initial screening at 50 years of age for normal-risk patients. Alcohol and tobacco use can be associated with an earlier onset of CRC and possibly polyps. METHODS: We reviewed all colonoscopies performed at our institution from January to December 2007. Patient data were collected on age, sex, tobacco and alcohol history, and the presence of colon lesions. RESULTS: Our data included 663 patients (643 men and 20 women) with a mean age of 60.7 years (range 23-89 years); 68.5% were current/former tobacco users, 53.7% were current/former alcohol users, 37.6% had used both, and 21.7% had used neither. Colonoscopy findings were as follows 64% of patients had no lesions, 30.6% had tubular polyps, 3.5% had villous polyps, and 2% had cancer. The current use of tobacco, alcohol, or both was associated with the early development of colon pathology (ie, 66.9 years, 61.1 years, and 59.2 years [P < .05], respectively). In nonusers, the mean age was 67.7 years. CONCLUSIONS: Our work confirms that the use of alcohol and tobacco is associated with an earlier onset of colon pathology. Consideration should be given to modifying screening guidelines to include these habits as "high-risk" factors.

Skin graft take rates, granulation, and epithelialization: dependence on myeloid cell hypoxia-inducible factor 1alpha.

OBJECTIVE: To compare the "take" rates of skin grafts between myeloid-selective hypoxia-inducible factor (HIF) 1alpha knockout (KO) and wild-type (WT) mice. Production of the alpha subunit of HIF-1alpha is increased in healing wounds, which stimulates expression of vascular endothelial growth factor (VEGF) to promote angiogenesis. Therefore, the take rate of skin grafts may be closely associated with the presence or absence of HIF-1alpha production in the recipient bed. DESIGN: The percentage of healthy graft areas obtained by planimetry and scores for epithelialization and granulation tissue formation obtained by histopathologic analysis were compared in 12 KO and 12 WT mice following skin grafting. RESULTS: The graft take rate was significantly impaired in the KO group (P = .009), whereas epithelialization (P = .46) or granulation (P = .41) tissue formation scores did not reveal any significant differences. CONCLUSION: Hypoxia-inducible factor 1alpha in myeloid cells may be an important molecule for revascularization of avascular tissues such as skin grafts, probably owing to its stimulating effect on angiogenesis.

Long-term glucose control and risk of perioperative complications.

BACKGROUND: The impact of long-term preoperative glucose control on short-term surgical complications is unclear. We investigated whether preoperative hemoglobin A1c (HA(1c)) levels correlated with the risk of postoperative complications. METHODS: A database of 38,989 patients undergoing major surgical procedures from October 1996 to May 2007 was reviewed. Of these patients, 2,960 were diagnosed diabetic with a HA(1c) level within 30 days before their operation. National Surgical Quality Improvement Program (NSQIP) definitions were used in determining postoperative complications. RESULTS: Of 36,039 nondiabetic patients, 5,095 experienced 1 or more complications (14.1%). In 2,960 diabetic patients, 780 diabetic patients had 1 or more complications (26.4%) (P

Association of tobacco and alcohol use with earlier development of colorectal cancer: should we modify screening guidelines?

BACKGROUND: Current guidelines recommend initial colorectal cancer screening at age 50 years for average-risk patients. Alcohol and tobacco use can be associated with earlier onset of colorectal cancer. We hypothesized an earlier age at diagnosis and/or more advanced stage in patients with these habits. METHODS: We queried our tumor registry for colorectal cancer diagnosed between January 1997 and December 2006. Data were analyzed to evaluate effects of alcohol and tobacco use. RESULTS: Of 335 colorectal cancer patients, 81% used tobacco, 51% used alcohol, 45% used both, and 14% used neither. Current tobacco and alcohol use were associated with younger ages at onset of colorectal cancer. Thirteen of 332 patients were diagnosed with colorectal cancer before age 50 years. All had exposure to alcohol and tobacco. Fifty-four percent (7/13) of these patients presented at stage 3/4 compared with 34% of the overall population. CONCLUSIONS: Modification of screening guidelines to include these habits as "high-risk" factors may be indicated.