Lyophilized Amniotic Membrane Patch Primary Procedure in Myopic Traction Maculopathy with Macular Detachment, finds study

Maculopathy secondary to pathologic myopia (PM) is
increasingly causing visual impairment and blindness worldwide. PM is an ocular
disorder characterized by a spherical equivalent (SE) of more than – 6.0
diopters (D) or by an axial length (AL) of more than 26.5 millimeters (mm). PM
is associated with myopic maculopathy (MM) or myopic tractional maculopathy
(MTM), a disorder that encompasses a spectrum of retinal abnormalities in
patients with high myopia, including macular foveoschisis and macular hole.
Myopic foveoschisis consists of the progressive separation of the layers of the
retina, which are connected by Müller cells. However, when foveoschisis
progresses, it can lead to a macular hole.

Maculopathy secondary to pathologic myopia (PM) is
increasingly causing visual impairment and blindness worldwide. PM is
associated with tractional maculopathy that ranges from macular foveoschisis to
macular hole. These disorders are treated with different options that offer
variable results, reflecting the need for new techniques that address myopic
maculopathy with consistent outcomes.

This diversity of treatments with variable results reflects
the need for new techniques that address myopic maculopathy with consistent
results. In addition, good preoperative visual acuity and the absence of
preoperative foveal detachment are significant predictors of good visual
prognosis, which is why surgical intervention before the development of macular
complications may improve visual outcomes. However, this is not the reality in
the clinical setting, where patients present with advanced cases, foveal
detachment, and poor visual acuity. It has been reported that the human
amniotic membrane (HAM) is safe for intraocular use and to promote retinal
healing; other authors proposed the use of a thin layer of lyophilized amniotic
membrane (LAM) as a patch (LAMPatch) to temporarily block retinal breaks,
reporting good tolerance on the retinal surface. Based on this, Ramirez-Estudillo
et al presented a novel technique using the lyophilized amniotic membrane as an
adjuvant in pars plana vitrectomy in patients with FD, MH, and MHRD.

Since human amniotic membrane (HAM) has been reported to be
safe for intraocular use and to promote retinal healing, it was incorporated as
an adjuvant in pars plana vitrectomy in patients with different tractional
disorders related to myopia. This work presents a prospective, consecutive case
series of seven patients with high myopia who underwent a 25-gauge vitrectomy
with ILM peeling and HAM transplantation.

Tractional myopic degeneration with foveoschisis and
concurrent tangential traction represents a significant challenge since the
standard of care, PPV plus limitorhexis, fails to maintain the retina attached
to the posterior pole. For this purpose, several scleral buckling options have
been developed, as previously mentioned, but at least in our country, these
options are not readily accessible. For example, amniotic membrane can be found
in three presentations: fresh, cryopreserved and freeze-dried. The fresh
variety is difficult to obtain, and as a human-derived tissue, entails
infectious risks and its regulatory and logistics management are complex. These
disadvantages gave rise to the cryopreserved membrane, which is widely
available and is the one that has been broadly used in ophthalmology, including
as a plug transplanted into the subretinal space. Due to the above, LAMPatch is
a valuable option. It reduces tangential traction by using an amniotic membrane
graft approved and used for other types of ocular surgeries, especially of the
anterior segment. The utility of this graft is that it works as a patch that
maintains the adherence of the posterior pole to the choroid and sclera;
specifically, it serves as a scaffold to increase the adhesion surface without
which tangential traction would again pull the retina, causing retinal
detachment.

It is relevant to mention that in addition to this
advantage, this technique is not more complicated than conventional vitrectomy
plus limitorhexis since it only adds one step: the amniotic membrane placement.
However, amniotic membrane handling requires a learning curve since it is essential
to keep the media dry to avoid folding. Specifically, the vitreous cavity must
be completely free of fluid to insert the amniotic membrane so that it does not
fold, and the surgeon can unfold it over the desired anatomical location.
Finally, although the anatomical results in our case series are like those
observed after PPV plus limitorhexis, the great differentiator of this
technique is that the permanence of tissue at six months is very stable, unlike
the recurrence of traction with conventional surgery. This functional success
translates into a gain and maintenance of visual acuity superior to vitrectomy
plus limitorhexis; up to now, the results authors report from the 6-month
follow-up are excellent both anatomically and functionally.

Lyophilized amniotic membrane as an additional step after
vitrectomy with limitorhexis, provides structural and clinical stabilization by
OCT at the 6-month follow-up in a series of cases with FD, MH, and MHRD.
Although longer-term structural and functional follow-up is required, study
results laid the groundwork for a prospective, randomized, controlled clinical
study

Source: Ramirez-Estudillo et al; Clinical Ophthalmology
2024:18 2473–2480

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Some adverse pregnancy outcomes may increase risk of heart disease later in life, unravels study

Pregnancy-related hypertension has already been proven to lead to a number of negative health outcomes later in life, including more bothersome menopause symptoms like hot flashes, the risk of dementia, kidney problems, and stroke. A new study suggests it can also lead to cardiovascular disease during menopause. Results of the study will be presented at the 2024 Annual Meeting of The Menopause Society in Chicago September 10-14.

In the new study involving nearly 400 women with a mean age of 81.6 years, researchers sought to assess the association between a self-reported history of preeclampsia or eclampsia, gestational hypertension, and gestational diabetes with cardiovascular outcomes in postmenopausal women.

What they found is that a self-reported history of gestational hypertension was associated with cardiovascular disease. Women with preeclampsia or all three adverse pregnancy outcomes also had a numerically higher prevalence of heart disease, but it did not meet the standards of statistical significance. No association was found between gestational diabetes and heart disease.

“Future research based on a larger sample size is needed to better understand the role adverse pregnancy outcomes may have in cardiovascular disease development and risk stratification,” says Marie Tan, lead author from Drexel University College of Medicine in Philadelphia.

More detailed results will be discussed at the 2024 Annual Meeting of The Menopause Society as part of the presentation entitled “The association between adverse pregnancy outcomes and cardiovascular disease in menopausal women: results from a cross-sectional analysis.”

“Cardiovascular disease is the number one cause of mortality in women and it’s important to study any new risk factors” says Dr. Stephanie Faubion, medical director for The Menopause Society. “Although future research is still needed, studies like this are important and remind us to thoroughly discuss a patient’s health history, including any complications or adverse outcomes during pregnancy.”

Reference:

Some adverse pregnancy outcomes may increase risk of heart disease later in life, The Menopause Society, Meeting: 2024 Annual Meeting of The Menopause Society.

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Micronized Amnion/Chorion Bilayer Injections benefits Refractory Interstitial Cystitis/Bladder Pain Syndrome patients: Study

A recent groundbreaking study revealed that an
amnion/chorion (AC) bilayer product could treat interstitial cystitis/bladder
pain syndrome (IC/BPS) which normally does not respond to traditional treatments
as per the results published in the journal International Urology &
Nephrology.

Intravesical application of the birth tissue like amnion and
chorion inside the bladder can reduce inflammation, reduce the development of
excessive collagen formation, and help in the regeneration of healthy bladder
tissue. Research in the past has shown that micronized (finely ground) amnion
monolayer injections given to the bladder tissue have given temporary relief
for IC/BPS patients who haven’t responded to traditional treatments. Hence, researchers
from Wayne State University School of Medicine, Detroit, MI, USA conducted a
study to evaluate the therapeutic responses and adverse events of micronized
amnion/chorion bilayer (AC) in patients with refractory IC/BPS and followed up
for 6 months.

About 15 IC/BPS patients, who did not respond to conventional
treatments were included in the study. Each participant received about 100 mg
of reconstituted micronized AC injections directly into the detrusor muscle
layer by the cystoscopy method. The procedure was carried out under general
anesthesia by using a 23-gauge needle. About twenty 0.5 mL injections were given
across the lateral and posterior walls of the bladder avoiding certain areas of
the bladder like the dome and trigone. The outcomes involved measuring Changes
in interstitial cystitis symptom index (ICSI), Interstitial cystitis problem
index (ICPI), Bladder pain/ interstitial cystitis symptom score (BPIC-SS), and
Overactive Bladder Assessment Tool (OAB), from baseline to 6 months
post-injection. A retrospective assessment of these changes was done and the
safety of the injections was also analyzed.

Findings:

  • About 15 total refractory IC/BPS patients who
    did not respond to conventional treatments were included in the study.
  • The participants were of an average age of
    41.1 ± 14.5 years.
  • All the participants received intra-detrusor
    injections of 100 mg of micronized AC.
  • A significant improvement in IC/BPS symptom
    scores was seen in all patients about a month after injections.
  • Sustained clinical response was noted in all the
    participants at 6 months post-injection.
  • No product-related adverse events were observed.

Thus, the researchers concluded that using an amnion/chorion
(AC) bilayer product could be a better treatment option for individuals with
interstitial cystitis/bladder pain syndrome (IC/BPS). They also found that the
symptom relief was long-term of up to 6 months. This study also showed a
beneficial alternative for individuals who did not respond to other therapies.
The researchers also suggested further studies involving larger groups of
populations to confirm the effectiveness of the treatment.

Further reading: O’Hollaren, K., Considine, J., Radoiu,
C. et al. Amniotic bladder therapy: study of micronized
amnion/chorion for the treatment of interstitial cystitis/bladder pain syndrome
(IC/BPS) at 6 months. Int Urol Nephrol (2024). Doi: https://doi.org/10.1007/s11255-024-04251-x

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Collagen Drink Improves Skin Health in Young and Middle-Aged Women: Study

A collagen drink combining collagen peptides (CP) and elastin peptides (EP) demonstrated significant improvements in skin health among young and middle-aged women according to a recent study. The findings of this study were published in the Journal of Dermatologic Science and Cosmetic Technology.

This research explored the effects of an orally administered collagen drink on the skin health of women aged between 25 and 50 years. While previous studies have shown the individual benefits of CP and EP in vitro and in vivo, this trial was focused on evaluating the combined effects of these peptides in the context of skin health.

The participants in the study were divided into two groups where one received the collagen drink daily for 8 weeks and the other group received a placebo. The primary outcomes measured were the skin hydration, elasticity, transepidermal water loss (TEWL), collagen content in the dermis, pore size, wrinkle length, skin smoothness, and overall skin roughness. Also, mass spectrometry was employed to assess the bioavailability of collagen peptides by measuring specific collagen efficacy components in the blood.

The results were strong, with the collagen drink group showing significant improvements in multiple skin health indicators when compared to the placebo group. There was a remarkable increase (39.19%) in skin hydration among the participants who consumed the collagen drink, this indicates its effectiveness in maintaining moisture levels in the skin. The Transepidermal Water Loss group also experienced a 33.45% reduction which suggested a strengthened skin barrier that reduces moisture loss. Skin Elasticity improved by 25.37%, demonstrating the ability of the drink to restore the skin’s natural firmness and resilience. A 21.64% increase in dermal collagen content was observed which reflected the potential of the drink to promote collagen synthesis within the skin.

The study found a 7.94% decrease in pore size and an 18.09% reduction in wrinkle length by highlighting the drink’s anti-aging benefits. The participants reported a 2.85% improvement in skin smoothness and a 15.32% decrease in skin roughness, which further contributed to the overall youthful appearance of the skin. The study also revealed a significant reduction in overall pore volume by 60%, as well as decreases in skin luminosity (15.20%) and smoothness index (22.55%), suggesting a notable enhancement in skin texture. Overall, these findings suggest that regular consumption of a CP and EP-enriched collagen drink could be a valuable addition to the skincare regimen of individuals looking to maintain or iprove their skin health as they age.

Source:

Lu, S., Zhang, S., Wang, Y., Ni, J., Zhao, T., & Xiao, G. (2024). Anti-skin aging effects and bioavailability of collagen tripeptide and elastin peptide formulations in young and middle-aged women. In Journal of Dermatologic Science and Cosmetic Technology (Vol. 1, Issue 2, p. 100019). Elsevier BV. https://doi.org/10.1016/j.jdsct.2024.100019

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Dupilumab may reduce COPD exacerbations in patients regardless of emphysema status: Study

A new study published in the journal of Respiratory Medicine showed that patients with type 2 inflammation and chronic obstructive pulmonary disease (COPD), with or without investigator-reported emphysema, showed comparable levels of dupilumab effectiveness. Significantly diminished lung function and a higher chance of exacerbations which are defined by increasing cough or dyspnea, an increase in the volume or purulence of sputum, or a combination of these symptoms that is frequently linked to chronic obstructive pulmonary disease. Despite the use of inhaled drugs, exacerbations are also linked to a higher risk of mortality from any cause, a faster deterioration in lung function, and an increased risk of recurrent exacerbations.

Although COPD has long been thought to include an enhanced innate immune response, there is emerging evidence that some people with the condition have type 2 inflammation. The interleukin-4 and interleukin-13 pathways raise fractional exhaled nitric oxide (FeNO) levels and, more generally, enhance eosinophil and type 2 inflammatory cell infiltrations in the lung. In the phase 3 BOREAS study, patients with type 2 inflammation and chronic obstructive pulmonary disease experienced fewer exacerbations and better lung function when treated with dupilumab, a completely human monoclonal antibody that targets the common receptor component for interleukin-4 and interleukin-13. Thus, this study was carried out by Surya Bhatt and colleagues to evaluate clinical outcomes in BOREAS patients according to their emphysema status.

Every two weeks for 52 weeks, patients with COPD with type 2 inflammation (screening blood eosinophils ≥300 cells/μL) receiving maximum inhaled treatment were randomized to receive either a placebo or an additional 300 mg of dupilumab. This study evaluated the change in prebronchodilator forced expiratory volume in 1 second (FEV1) from baseline to Week 12 in patients with and without investigator-reported emphysema, as well as the annualized rates of moderate/severe COPD exacerbations during a 52-week period.

A total of 306 out of 939 patients (32.6%) had investigator-reported emphysema at baseline. In individuals with and without emphysema, dupilumab decreased exacerbation rates by 29% and 31%, respectively, when compared to a placebo. With patients with and without emphysema, the prebronchodilator FEV1 least squares mean difference from baseline to Week 12 with dupilumab vs. placebo was 0.07 L and 0.09 L, respectively. The annualized rate of exacerbations and the decrease in prebronchodilator FEV1 did not show any treatment by emphysema interaction impact. Overall, dupilumab efficacy was similar in individuals with type 2 inflammation and COPD, whether or not they had investigator-reported emphysema.

Reference:

Bhatt, S. P., Rabe, K. F., Hanania, N. A., Vogelmeier, C. F., Bafadhel, M., Christenson, S. A., Papi, A., Singh, D., Laws, E., Dakin, P., Maloney, J., Lu, X., Bauer, D., Bansal, A., Robinson, L. B., & Abdulai, R. M. (2024). Dupilumab reduces exacerbations and improves lung function in patients with chronic obstructive pulmonary disease and emphysema: Phase 3 randomized trial (BOREAS). In Respiratory Medicine (p. 107846). Elsevier BV. https://doi.org/10.1016/j.rmed.2024.107846

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Traditional Mayan practices have long promoted unique levels of family harmony. But what effect is globalization having?

A new paper in the journal Child Development shows how some aspects of family interaction among Indigenous people in Guatemala have fundamentally shifted with rapid globalization, yet families have still maintained a unique level of harmony in their interactions.

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New microfluidic device shows tumor shape predicts cancer aggressiveness

Researchers at the University of Toronto’s Faculty of Applied Science & Engineering have designed a new microfluidic platform that allows for unprecedented control and manipulation of tumor shapes—a largely unexplored area with great potential to advance cancer research.

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New study shows how salmonella tricks gut defenses to cause infection

A new UC Davis Health study has uncovered how Salmonella bacteria, a major cause of food poisoning, can invade the gut even when protective bacteria are present. The research, published in the Proceedings of the National Academy of Sciences, explains how the pathogen tricks the gut environment to escape the body’s natural defenses.

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Global pandemic accord: Where the talks stand

The 12th round of negotiations towards a global accord on handling future pandemics ended Friday without a final agreement, with rich and poor nations still wrangling over how to make it work.

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Excessive social media use tied to substance experimentation in US pre-teens

As teens continue to spend more time on screens and social media, a new study finds that among 11-12-year-olds, excessive time online is associated with early experimentation with substances like alcohol, nicotine, and cannabis.

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