A case series of the use of amniotic membrane (AM) for treating chronic nonhealing wounds. It presents five cases of polymorbid patients with a total of nine chronic nonhealing wounds. The patient group consisted of four men and one woman with various comorbidities, aged 45-72 years. The mean initial wound size was 15.8 cm2, and the mean time from the onset of the wound to the first application of AM was 122 weeks. The wounds were caused by chronic venous insufficiency and/or peripheral arterial disease. Wounds were treated in a standardized protocol. AM was applied weekly in the first month and then every two weeks. Photo documentation of the wound and microbiological colonization was carried out at each visit. In three out of five patients, the AM treatment effectively promoted healing up to complete wound closure. In two cases, the wounds stayed unhealed despite numerous AM applications. Pain relief was noted in all patients. The success of the treatment was closely tied to patient factors, such as adherence to the prescribed treatment regimen and individual patient characteristics. In some cases, treatment failure was observed, possibly due to underlying comorbidities, wound parameters, or poor patient compliance. AM treatment has the potential to become a viable treatment option for these nonhealing wounds. However, the effectiveness of the treatment may be influenced by various patient factors and the underlying cause of the wound. Therefore, it is crucial to have an individualized treatment plan that considers these particular factors.
- MeSH
- amnion * MeSH
- hojení ran * MeSH
- kryoprezervace metody MeSH
- lidé MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Klíčová slova
- Amnioderm,
- MeSH
- amnion MeSH
- biologické krytí MeSH
- dermatologické látky terapeutické užití MeSH
- diabetická noha * farmakoterapie terapie MeSH
- hojení ran * MeSH
- komorbidita MeSH
- poranění nohy (od hlezna dolů) MeSH
- senioři MeSH
- Check Tag
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
During pregnancy, two fetomaternal interfaces, the placenta-decidua basalis and the fetal membrane-decidua parietals, allow for fetal growth and maturation and fetal-maternal crosstalk, and protect the fetus from infectious and inflammatory signaling that could lead to adverse pregnancy outcomes. While the placenta has been studied extensively, the fetal membranes have been understudied, even though they play critical roles in pregnancy maintenance and the initiation of term or preterm parturition. Fetal membrane dysfunction has been associated with spontaneous preterm birth (PTB, < 37 weeks gestation) and preterm prelabor rupture of the membranes (PPROM), which is a disease of the fetal membranes. However, it is unknown how the individual layers of the fetal membrane decidual interface (the amnion epithelium [AEC], the amnion mesenchyme [AMC], the chorion [CTC], and the decidua [DEC]) contribute to these pregnancy outcomes. In this study, we used a single-cell transcriptomics approach to unravel the transcriptomics network at spatial levels to discern the contributions of each layer of the fetal membranes and the adjoining maternal decidua during the following conditions: scheduled caesarian section (term not in labor [TNIL]; n = 4), vaginal term in labor (TIL; n = 3), preterm labor with and without rupture of membranes (PPROM; n = 3; and PTB; n = 3). The data included 18,815 genes from 13 patients (including TIL, PTB, PPROM, and TNIL) expressed across the four layers. After quality control, there were 11,921 genes and 44 samples. The data were processed by two pipelines: one by hierarchical clustering the combined cases and the other to evaluate heterogeneity within the cases. Our visual analytical approach revealed spatially recognized differentially expressed genes that aligned with four gene clusters. Cluster 1 genes were present predominantly in DECs and Cluster 3 centered around CTC genes in all labor phenotypes. Cluster 2 genes were predominantly found in AECs in PPROM and PTB, while Cluster 4 contained AMC and CTC genes identified in term labor cases. We identified the top 10 differentially expressed genes and their connected pathways (kinase activation, NF-κB, inflammation, cytoskeletal remodeling, and hormone regulation) per cluster in each tissue layer. An in-depth understanding of the involvement of each system and cell layer may help provide targeted and tailored interventions to reduce the risk of PTB.
- MeSH
- amnion metabolismus cytologie MeSH
- chorion metabolismus MeSH
- decidua * metabolismus MeSH
- dospělí MeSH
- extraembryonální obaly * metabolismus MeSH
- lidé MeSH
- porod v termínu genetika MeSH
- předčasný odtok plodové vody genetika metabolismus MeSH
- předčasný porod * genetika MeSH
- stanovení celkové genové exprese MeSH
- těhotenství MeSH
- transkriptom * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- amnion patologie MeSH
- antibakteriální látky aplikace a dávkování MeSH
- chorioamnionitida * diagnóza epidemiologie farmakoterapie terapie MeSH
- lidé MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- Klíčová slova
- Amnioderm,
- MeSH
- amnion MeSH
- biologické krytí MeSH
- dermatologické látky terapeutické užití MeSH
- diabetická noha * terapie MeSH
- hojení ran * MeSH
- komorbidita MeSH
- lidé MeSH
- péče o kůži metody MeSH
- poranění nohy (od hlezna dolů) terapie MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
Preterm, prelabor rupture of the human fetal membranes (pPROM) is involved in 40% of spontaneous preterm births worldwide. Cellular-level disturbances and inflammation are effectors of membrane degradation, weakening, and rupture. Maternal risk factors induce oxidative stress (OS), senescence, and senescence-associated inflammation of the fetal membranes as reported mechanisms related to pPROM. Inflammation can also arise in fetal membrane cells (amnion/chorion) due to OS-induced autophagy and epithelial-mesenchymal transition (EMT). Autophagy, EMT, and their correlation in pPROM, along with OS-induced autophagy-related changes in amnion and chorion cells in vitro, were investigated. Immunocytochemistry staining of cytokeratin-18 (epithelial marker)/vimentin (mesenchymal marker) and proautophagy-inducing factor LC3B were performed in fetal membranes from pPROM, term not in labor, and term labor. Ultrastructural changes associated with autophagy were verified by transmission electron microscopy of the fetal membranes and in cells exposed to cigarette smoke extract (an OS inducer). EMT and LC3B staining was compared in the chorion from pPROM versus term not in labor. Transmission electron microscopy confirmed autophagosome formation in pPROM amnion and chorion. In cell culture, autophagosomes were formed in the amnion with OS treatment, while autophagosomes were accumulated in both cell types with autophagy inhibition. This study documents the association between pPROMs and amniochorion autophagy and EMT, and supports a role for OS in inducing dysfunctional cells that increase inflammation, predisposing membranes to rupture.
Chemické poleptania sú zrak ohrozujúce poranenia, vyžadujúce okamžitú liečbu. Hlavným cieľom počiatočnej terapie je intenzívny a výdatný výplach spojovkového vaku, za účelom neutralizácie a eliminácie pôsobiacej chemikálie. Ďalšie terapeutické postupy, či už konzervatívne, alebo chirurgické, závisia od klinického nálezu. Cieľ: V kazuistike popisujeme priebeh a liečbu pacientky s poleptaním oboch očí zásaditou látkou. Kazuistika: V práci uvádzame kazuistiku 35-ročnej ženy, s chemickým poleptaním oboch očí alkalickým činidlom. Do troch týždňov nastala úplná reepitelizácia oboch rohoviek. Vzhľadom k tomu sme predpokladali uspokojivú prognózu hojenia, avšak na ľavom oku došlo s odstupom času k lýze rohovky. Stav sa podarilo zvládnuť, ale následne došlo na ľavom oku zrejme v súvislosti s infekciou COVID-19 k závažnej keratouveitíde s hypopyonom a lýzou rohovky, čo v konečnom dôsledku viedlo k eviscerácii postihnutého oka. Výsledky a záver: V kazuistike popisujeme management ľahkého poleptania na pravom oku a komplikovaného stredne ťažkého poleptania ľavého oka zásaditou chemikáliou. Obe oči boli do troch týždňov kompletne prehojené, no nález na ľavom oku sa skomplikoval, čo dospelo v konečnom dôsledku až k eviscerácii postihnutého oka. Ochorenie COVID-19 mohlo prispieť k zhoršeniu nálezu na rohovke alebo mohlo ísť iba o koincidenciu dvoch ochorení a keratouveitída mala závažný priebeh z dôvodu predchádzajúceho ťažkého priebehu hojenia a mnohých komplikácií po chemickom poleptaní oka.
Chemical burns are sight-threatening injuries that require immediate management. The main goal of the initial treatment is prompt and copious irrigation to neutralize and eliminate the chemical, followed by various therapeutic options (conservative and surgical) according to the individual patient’s postinjury findings. Purpose: In this case report, we describe the course and treatment of a patient with chemical alkali burns of both eyes. This study reports the outcomes of an ocular alkali burn patient who became infected with COVID-19 and where severe keratouveitis with corneal graft melting and hypopyon occurred, ultimately resulting in evisceration of the eye. Observations: We report the case of a 35-year-old woman, after an alkali burn of both eyes. Complete re-epithelialization of both corneas occurred within three weeks. Due to this observation, we assumed a satisfactory healing prognosis. However, corneal lysis occurred in the left eye over time. The condition was managed, but subsequently severe keratouveitis with hypopyon and corneal lysis occurred in the left eye, apparently in connection with the COVID-19 infection, which ultimately led to the evisceration of the affected eye. Conclusions and Importance: In the case report, we describe the management of a mild chemical alkali burn of the right eye and a complicated moderate burn of the left eye with an alkaline chemical. Both eyes were completely healed within three weeks. However, the findings on the left eye became complicated, which ultimately led to the evisceration of the affected eye. The disease of COVID-19 could have contributed to the deterioration of the findings on the cornea, or it could have just been a coincidence of two diseases, with the keratouveitis having a serious course due to the previous difficult course of healing and many complications after the chemical burn.
- Klíčová slova
- lýza rohovky,
- MeSH
- amnion transplantace MeSH
- chemické popálení * diagnóza etiologie komplikace terapie MeSH
- COVID-19 komplikace virologie MeSH
- dospělí MeSH
- eviscerace oka MeSH
- hydroxid sodný škodlivé účinky MeSH
- keratokonjunktivitida etiologie MeSH
- keratoplastika perforující MeSH
- lidé MeSH
- poranění oka * diagnóza etiologie komplikace terapie MeSH
- rohovka chirurgie patofyziologie patologie MeSH
- transplantace rohovky MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
This study aimed to evaluate the efficacy of cryopreserved amniotic membrane (AM) grafts in chronic wound healing, including the mean percentage of wound closure per one AM application, and to determine whether the healing efficiency differs between AM grafts obtained from different placentas. A retrospective study analyzing inter-placental differences in healing capacity and mean wound closure after the application of 96 AM grafts prepared from nine placentas. Only the placentas from which the AM grafts were applied to patients suffering from long-lasting non-healing wounds successfully healed by AM treatment were included. The data from the rapidly progressing wound-closure phase (p-phase) were analyzed. The mean efficiency for each placenta, expressed as an average of wound area reduction (%) seven days after the AM application (baseline, 100%), was calculated from at least 10 applications. No statistical difference between the nine placentas' efficiency was found in the progressive phase of wound healing. The 7-day average wound reduction in particular placentas varied from 5.70 to 20.99% (median from 1.07 to 17.75) of the baseline. The mean percentage of wound surface reduction of all analyzed defects one week after the application of cryopreserved AM graft was 12.17 ± 20.12% (average ± SD). No significant difference in healing capacity was observed between the nine placentas. The data suggest that if there are intra- and inter-placental differences in AM sheets' healing efficacy, they are overridden by the actual health status of the subject or even the status of its individual wounds.
- MeSH
- amnion * transplantace MeSH
- hojení ran MeSH
- kryoprezervace MeSH
- lidé MeSH
- placenta * MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Peripheral lesion of the facial nerve leads to ipsilateral palsy of facial muscles. Weakening of the orbicularis oculi muscle results in inability to close the eyelids, i.e., lagophtalmos. As a result of lagophtalmos, the lower parts of the eye surface dry and cause a formation of exposure keratopathy of variable severity. Chronic corneal changes lead to development of vascularized corneal scar, which permanently deteriorates the visual acuity. Immediately after the diagnosis of peripheral facial nerve palsy by the neurologist, frequent application of ophthalmic lubricants and an early ophthalmological examination are recommended. The treatment of eye complications depends on the character of corneal involvement and extent of lagophtalmos, considering the possibility of its spontaneous restitution. The therapy is surgical in serious cases, aimed at adjusting the position of the eyelids, and in case of a non-healing corneal ulcer, the amniotic membrane transplant is indicated.
Periferní léze nervus facialis vede ke stejnostranné paréze mimických svalů. Oslabení musculus orbicularis oculi má za následek nedovírání oční štěrbiny, tedy lagoftalmus. V důsledku lagoftalmu osychají dolní části povrchu oka, což se projeví rozvojem různě závažné expoziční keratopatie. Chronické změny rohovky způsobují její jizvení doprovázené vaskularizací a vedou k trvalému zhoršení zrakové ostrosti. Bezprostředně po stanovení diagnózy neurologem je doporučena frekventní aplikace lubrikancií do spojivkového vaku a časné oftalmologické vyšetření. Léčba očních komplikací závisí na charakteru postižení rohovky a rozsahu lagoftalmu s přihlédnutím k možnosti jeho spontánní restituce. Terapie závažnějších stavů je chirurgická, zaměřena na úpravu polohy a postavení víček a v případě nehojícího se vředu rohovky je řešením transplantace amniové membrány.
- MeSH
- amnion MeSH
- anastomóza chirurgická škodlivé účinky MeSH
- Bellova paréza * chirurgie etiologie komplikace patologie terapie MeSH
- blefaroplastika metody škodlivé účinky MeSH
- lagoftalmus chirurgie etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nervus facialis patologie MeSH
- oční symptomy MeSH
- oftalmologické chirurgické výkony metody škodlivé účinky MeSH
- vestibulární schwannom chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
