Phase-changing citrate macromolecule combats oxidative pancreatic islet damage, enables islet engraftment and function in the omentum.

Clinical outcomes for total-pancreatectomy followed by intraportal islet autotransplantation (TP-IAT) to treat chronic pancreatitis (CP) are suboptimal due to pancreas inflammation, oxidative stress during islet isolation, and harsh engraftment conditions in the liver's vasculature. We describe a thermoresponsive, antioxidant macromolecule poly(polyethylene glycol citrate-co-N-isopropylacrylamide) (PPCN) to protect islet redox status and function and to enable extrahepatic omentum islet engraftment. PPCN solution transitions from a liquid to a hydrogel at body temperature. Islets entrapped in PPCN and exposed to oxidative stress remain functional and support long-term euglycemia, in contrast to islets entrapped in a plasma-thrombin biologic scaffold. In the nonhuman primate (NHP) omentum, PPCN is well-tolerated and mostly resorbed without fibrosis at 3 months after implantation. In NHPs, autologous omentum islet transplantation using PPCN restores normoglycemia with minimal exogenous insulin requirements for >100 days. This preclinical study supports TP-IAT with PPCN in patients with CP and highlights antioxidant properties as a mechanism for islet function preservation.

Streptococcus cristatus: An uncommon cause for a common hospital admission.

Common organisms associated with community-acquired pneumonia include Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Pneumonia can rarely be caused by an organism such as Streptococcus cristatus, as in our case. This organism belongs to the Mitis group within the Streptococcus genus and typically coexists with humans in the oral cavity. We present a case of Streptococcus cristatus bacteremia and community acquired pneumonia in a previously healthy 40-year-old male, for whom infective endocarditis has been ruled out, and who was successfully treated with ceftriaxone. While most reported cases of Streptococcus cristatus involve infective endocarditis, our case is the first identified instance of community acquired pneumonia caused by Streptococcus cristatus. This case highlights that pneumonia with Streptococcus cristatus, typically considered a commensal in the oral mucosa microbiota of humans, is possible, as seen in our case. Unlike previous cases in the literature, our patient did not have infective endocarditis, which is the common presentation of this bacterium. Instead, he solely presented with pneumonia, marking the first reported case in the literature of Streptococcus cristatus causing pneumonia.

Effects of Propranolol in Accelerating Wound Healing and Attenuation of Hypermetabolism in Adult Burn Patients.

OBJECTIVE: To compare the mean duration of wound healing and attenuation of muscle wasting in adult burn patients treated with propranolol and control group. STUDY DESIGN: A randomised controlled trial. PLACE AND DURATION OF STUDY: Allied Burn and Reconstructive Surgery Center, Faisalabad from March to August 2018. METHODOLOGY: Seventy adult burn patients with 20-40% burn of the total body surface area (TBSA) were included in the study and divided into two groups; propranolol group and control group. Propranolol was administered at dose of 0.5-3 mg/Kg body weight per day along with standard burn care treatment during the entire period of treatment. RESULTS: Faster healing of the superficial burns was noticed in the patients of propranolol group. In superficial burns lesser time was needed for adequate healing; 13.20 ±1.90 days versus 20.34 ±2.32 days (p <0.001). At the same time, lesser time was required for deep burn patients treated with propranolol to be ready for skin grafting; 23.87 ±2.36 versus 33.64 ±3.15 days; p <0.001) comparing control group. Mean mid-arm circumference was 27.57 ±1.62 cm in study group and 24.46 ±1.77 cm in control group (p<0.0001) which was statistically significant. This result showed that hypermetabolic response of burn in terms of muscle wasting was clearly modulated by betablocker therapy. CONCLUSION: Propranolol administration in adult burn patients appears to be beneficial in reducing morbidity, mortality and hospital stay by enhancing earlier wound healing and attenuating the catabolic muscle wasting in response to stress caused by burn.