POPULARITY
20 episodes with allograft
6 episodes with allograft
4 episodes with allograft
4 episodes with allograft
3 episodes with allograft
2 episodes with allograft
2 episodes with allograft
2 episodes with allograft
Welcome to Season 2 of the Orthobullets Podcast.Today's show is Podiums, where we feature expert speakers from live medical events. Today's episode will feature Dr. Eric Wagner and is titled "Revising the Failed Humerus The Case for Allograft Prosthetic Composites."Follow Orthobullets on Social Media:FacebookInstagram TwitterLinkedIn
Chapters 00:00 Introduction to Tendons and Personal Background 03:01 Understanding ACL Injuries and Rehabilitation 05:56 Graft Types: Autograft vs Allograft 08:56 Early Rehabilitation Strategies for ACL Surgery 11:53 Managing Swelling and Pain Post-Surgery 14:58 Progressing Rehabilitation: From Extension to Strength 17:59 Considerations for Graft Selection 21:01 Challenges with Quad Tendon Grafts 23:52 Hamstring and Patellar Grafts: Pros and Cons 32:06 Understanding Anterior Knee Pain and Rehabilitation 34:40 Strength Training in ACL Recovery 37:49 Introducing Plyometrics in Rehabilitation 39:28 Progressing Plyometrics and Deceleration Training 44:06 The Role of Physical Therapists in ACL Rehab 47:30 Knee Strategy vs. Hip Strategy in Rehabilitation 52:07 Re-injury Rates and Return to Sport Statistics 53:40 Education Gaps in Physical Therapy Schools 57:43 Improving ACL Rehabilitation Practices 01:01:17 Collaboration Between Therapists and Strength Coaches Takeaways Derek Garza is a licensed physical therapist with a background in athletics. He emphasizes the importance of education in ACL rehabilitation. The type of graft used in ACL surgery significantly affects recovery. Early intervention in rehabilitation can lead to better outcomes. Managing swelling is crucial for effective recovery post-surgery. Different graft types have unique healing timelines and considerations. Patient education is key to understanding the rehabilitation process. The strength of the graft can vary significantly based on the type used. Rehabilitation strategies should be tailored to the individual athlete. Understanding the risks and timelines of recovery can help prevent re-injury. The quality of physical therapy coaching is crucial for recovery. Limb symmetry index should be at least 90% for strength. Plyometrics should be introduced gradually in rehabilitation. Deceleration training is essential for athletes returning to sport. Many physical therapists lack knowledge in plyometric training. Re-injury rates for ACL injuries are alarmingly high. Education on plyometrics is lacking in physical therapy schools. Collaboration between therapists and strength coaches is vital. Athletes often shy away from loading their knees post-injury. Understanding knee and hip strategies can improve rehabilitation outcomes. Derek on Instagram: https://www.instagram.com/dr.derekpt/ Derek's Linktree: https://linktr.ee/drderekgarza?fbclid=PAZXh0bgNhZW0CMTEAAafGwPFbijuM4jTC0YjCcgMH2cY3-masDnDR00SYM7QCAyHfVaMUxWiB4ij1GQ_aem_Yj9twOyX7Rp7Un4fBhKFGg Notes: https://jackedathlete.com/podcast-148-acls-and-quad-patellar-hamstring-tendon-grafts-with-derek-garza/
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
In this 306th episode I welcome Dr. Beth Wilson to the show to discuss Early Allograft Dysfunction (EAD) after liver transplantation and what anesthesiologists can do to prevent or mitigate it. Our Sponsors:* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Factor: https://factormeals.com/accrac50off* Check out Thrive Market: https://thrivemarket.com/ACCRAC* Check out Truelearn and use my code ACCRAC for a great deal: https://truelearn.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy
Contributor: Travis Barlock, MD Educational Pearls: Key clinical considerations when managing heart transplant patients due to their unique pathophysiology 1. Arrhythmias A transplanted heart is denervated, meaning it lacks autonomic nervous system innervation The lack of vagal tone results in an increased resting heart rate Adenosine can be used since it primarily slows conduction through the AV node Atropine is ineffective in treating transplant bradyarrhythmia because its mechanism is to inhibit the vagus nerve - but the heart lacks vagal tone Allograft rejection can also cause tachycardia Consult transplant surgery - treatment is usually 500 mg methylprednisolone 2. Rejection Transplant patients are administered immunosuppressants Clinical presentation of acute rejection looks similar to heart failure with increased BNP, increased troponin, and pulmonary edema Cardiac allograft vasculopathy is a form of chronic rejection Patients will not report chest pain due to denervated heart Symptoms are usually weakness and fatigue 3. High risk of infection due to immunosuppression Increased risk of infections which includes CMV, legionella, tuberculosis, etc Immunosuppressants have side effects such as acute kidney injury or pancytopenia 4. Radiographic Cardiomegaly A study found that radiographic cardiomegaly does not connote heart failure They hypothesized it is instead the result of a mismatch between the size of the transplanted heart and the space in the thoracic cavity References Murphy JD, Mergo PJ, Taylor HM, Fields R, Mills RM Jr. Significance of radiographic cardiomegaly in orthotopic heart transplant recipients. AJR Am J Roentgenol. 1998 Aug;171(2):371-4. doi: 10.2214/ajr.171.2.9694454. PMID: 9694454. Park MH, Starling RC, Ratliff NB, McCarthy PM, Smedira NS, Pelegrin D, Young JB. Oral steroid pulse without taper for the treatment of asymptomatic moderate cardiac allograft rejection. J Heart Lung Transplant. 1999 Dec;18(12):1224-7. doi: 10.1016/s1053-2498(99)00098-4. PMID: 10612382. Pethig K, Heublein B, Wahlers T, Dannenberg O, Oppelt P, Haverich A. Mycophenolate mofetil for secondary prevention of cardiac allograft vasculopathy: influence on inflammation and progression of intimal hyperplasia. J Heart Lung Transplant. 2004 Jan;23(1):61-6. doi: 10.1016/s1053-2498(03)00097-4. PMID: 14734128. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/
Our next AAOS 2025 Annual Meeting poster is titled Mid-term Follow-up of Patellofemoral Osteochondral Allograft Transplantation. This study was performed by Dr. Bill Bugbee and his team at the Scripps Clinic. Dr. Bugbee was a guest on our show back in November 2023. That is episode 59 and 60, if you want to go check it out. In that episode, we discussed osteochondral allograft transplantation for various cartilage defects of the knee, including medial and lateral tibiofemoral, which are the more common locations for OCA transplantation. This study focuses specifically on outcomes of OCA transplantation for patellofemoral cartilage defects.This study identified 127 patients undergoing OCA transplantation in the patellofemoral compartment – 51 to the patella, 47 to the trochlea and 29 bipolar patella and trochlea. The most common indication was a degenerative cartilage lesion at 47%, followed by a traumatic cartilage injury at 25% and osteochondritis dissecans at 15%. All patients had a minimum follow-up of 2 years. OCA failure was defined as any reoperation that involved removal of the allograft. Patient reported outcomes were also assessed pre-op and post-op, including the IKDC score and KOOS score.So, what did this study find? First, reoperations occurred in 39% of the knees. Rate of reoperation was not statistically significant between patella, trochlea and bipolar grafts. Second, OCA failures occurred in 16% of the knees at a median 4.4 years following the index surgery, and the most common revision procedure was arthroplasty. Although it did not reach statistical significance, trochlear grafts had a lower failure rate of 9% compared to patellar grafts at 20% and bipolar grafts at 21%.Overall, graft survivorship at 5 and 10 years was 91% and 82%, respectively. Patients with patellar, trochlear and bipolar grafts all had significant improvement in IKDC scores and KOOS scores from preop to the latest follow-up and no statistically significant differences were observed between the groups. Overall, 77% of patients reported being satisfied with the results of the OCA transplantation with no statistically significant differences in satisfaction between the groups.Also check out:Episode 91: Dr. Tom DeBerardino 0n Advances in Patellofemoral Cartilage Restoration
Olivier Visa, President and CEO of Evergen specializes in developing and manufacturing biomaterials for use in regenerative medicine. These customized biomaterial solutions use xenografts, allografts, and emerging technologies inside and outside the body with applications in wound healing, cardiac, dental, breast, neuro, and spine repair. This approach provides surgeons with a broader range of biomaterials to better tailor treatments for individual patients. Olivier explains, "There is a multitude that we can support. There is form and function, and I can give you a couple of examples of biomaterials in regenerative medicine. One is bovine pericardium, which is bovine collagen that we use for the development and manufacturing of cardiac heart valves. Another one would be acellular dermal matrix from human tissue that we use for reconstruction in plastic and, of course, with surgeries such as breast reconstruction after mastectomy." "Think about the body as a whole, and I'll give you a couple of examples where- when you're in cardiac - whether it's a patch or a valve, we're inside the body. When we're in breast reconstruction, we are totally inside the body. When we're in the neuro spine, we're totally inside the body, whether you're repairing or restoring or regenerating peripheral nerves or dura around the brain, you're inside the body. And yes, you are right, wound management is part of it, whether it's diabetic food, ulcer, ulcer or some form of a burn, then I would say you're looking at the skin as an organ and repairing, restoring, and regenerating that skin." #Evergen #TissueEngineering #RegenerativeMedicine #CDMO #Biomaterials #Biotechnology #LifeSciences #MedicalDevices #SportsMedicine #Orthopedics #Surgeons evergenbio.com Download the transcript here
Olivier Visa, President and CEO of Evergen specializes in developing and manufacturing biomaterials for use in regenerative medicine. These customized biomaterial solutions use xenografts, allografts, and emerging technologies inside and outside the body with applications in wound healing, cardiac, dental, breast, neuro, and spine repair. This approach provides surgeons with a broader range of biomaterials to better tailor treatments for individual patients. Olivier explains, "There is a multitude that we can support. There is form and function, and I can give you a couple of examples of biomaterials in regenerative medicine. One is bovine pericardium, which is bovine collagen that we use for the development and manufacturing of cardiac heart valves. Another one would be acellular dermal matrix from human tissue that we use for reconstruction in plastic and, of course, with surgeries such as breast reconstruction after mastectomy." "Think about the body as a whole, and I'll give you a couple of examples where- when you're in cardiac - whether it's a patch or a valve, we're inside the body. When we're in breast reconstruction, we are totally inside the body. When we're in the neuro spine, we're totally inside the body, whether you're repairing or restoring or regenerating peripheral nerves or dura around the brain, you're inside the body. And yes, you are right, wound management is part of it, whether it's diabetic food, ulcer, ulcer or some form of a burn, then I would say you're looking at the skin as an organ and repairing, restoring, and regenerating that skin." #Evergen #TissueEngineering #RegenerativeMedicine #CDMO #Biomaterials #Biotechnology #LifeSciences #MedicalDevices #SportsMedicine #Orthopedics #Surgeons evergenbio.com Listen to the podcast here
It is a Reboot Special with one of our faves - Dr. Brian Cole!Today's episode is going to focus on osteochondral allograft transplantation, and specifically how basic science research can and should impact your clinical practice.We are joined today by Dr. Brian Cole, a Professor of Orthopedic Surgery and Chair of the Department of Orthopedic Surgery at Rush University Medical Center, Chair of Surgery at Rush Oak Park Hospital and Section Head of the Rush Cartilage Restoration Center. He is also a past president of the Arthroscopy Association of North America and a team physician for the Chicago Bulls and Chicago White Sox.
شرکت ریجن آلوگرافت (فرآورده بافت ایرانیان) داره روی فرآوری بافتهایی کار میکنه که از بدن آدمهایی که دیگه زنده نیستن گرفته میشه. اونا از پزشک قانونی، اندامها و قسمتهایی از بدن رو دریافت میکنن تا از اونا برای تولید محصولاتشون استفاده کنن. محصولاتی که قراره دوباره به بدن آدمهای دیگه پیوند یا توی عملهای مختلف ازشون استفاده بشه. فوربو اینسایدر سوم؛ داستان ریجن آلوگرافت.این قسمت از پادکست فوربو با همکاری پارک فناوری پردیس منتشر میشه.منطقه بینالمللی نوآوری ایران | iiid.techلینک یوتوب فوربوhttps://youtube.com/@furbodm فوربو در اینستاگرام (@furbodm)فوربو در توییتر (@FurboPodcast) لینک حمایت مالی | https://furbodm.com/plus/برای خوندن مقالات حوزهی دیجیتال مارکتینگ به سایت فوربو سر بزنیدhttps://furbodm.com/صفحه اختصاصی پادکست فوربو در سایتhttps://furbodm.com/podcast/بلاگ شخصی من – رضا توکلیRezaTavakoli.comاینستاگرام (@r.t98)توییتر (@RezaTavakoli98) Hosted on Acast. See acast.com/privacy for more information.
In this show we have Dr. Gregory Nicholson from Rush University (Chicago, USA) who presents a study where they used preshaped and predrilled bone grafts to address shoulder instability. Jörn Kircher from Germany is my SECEC expert today who will ask the right questions to get deeper into this topic - Enjoy! Music under CC Licence: Artist: Malyssa Bellarosa Title: PretendArtist: Dr. Turtle Title: Which that is this?
Welcome to Season 2 of the Orthobullets Podcast. Today's show is Podiums, where we feature expert speakers from live medical events. Today's episode will feature Dr. Cliff Tribus and is titled Spinal Interbody Alternatives: Allograft Bone. Today's episode will be sponsored by the 28th Annual Selby Spine Conference, taking place Jan 29th - Feb 01st, 2025 in Park City, UT. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube
Łąkotka jest bardzo ważną strukturą stawu kolanowego. Urazy i przeciążenia kolana doprowadzają do jej uszkodzenia, co w rezultacie może spowodować zmiany zwyrodnieniowe stawu, ból, wysięki, ograniczenia w aktywności, a wreszcie konieczność wymiany stawu na protezę. Perspektywa straszna. Dzisiaj spróbuję przeanalizować, czy w takim razie łąkotkę można wymienić…
JACC Heart Failure Associate Editor Sean Pinney, MD, discusses a recently published original research paper that explores the results of a randomized controlled trial to test whether evolocumab reduces the burden of cardiac allograft vasculopathy.
Osteochondritis dissecans (OCD) of the humeral capitellum is a rare and challenging condition to treat. Several surgical options exist, but in the last few years, the pendulum has swung from debridement and microfracture to restoration of the articular surface. Osteochondral autografts from the rib and knee have been described, but donor-site morbidity is a concern. In conclusion, FOCAT is an excellent option for treating OCD lesions of the humeral capitellum. Excellent outcomes and high return-to-sport rates were observed, with midterm follow-up showing no graft failures. FOCAT eliminates donor-site morbidity. Click here to read the article.
Today's episode is going to focus on osteochondral allograft transplantation, and specifically how basic science research can and should impact your clinical practice.We are joined today by Dr. Brian Cole, a Professor of Orthopedic Surgery and Chair of the Department of Orthopedic Surgery at Rush University Medical Center, Chair of Surgery at Rush Oak Park Hospital and Section Head of the Rush Cartilage Restoration Center. He is also a past president of the Arthroscopy Association of North America and a team physician for the Chicago Bulls and Chicago White Sox. So, without further ado, let's get to the Field House!
Dr. Medhat Askar joins the podcast to discuss the utility and validation of donor-derived cell-free DNA (dd-cfDNA) testing for solid-organ recipients. Dr. Askar also discusses the regulatory status of dd-cfDNA in the United States.
OCD Lesions are unique injuries to both cartilage and bone and not only occur in adults, but also often occur in the bodies of today's youth. It's time to find out more from a series of answers, details and lightbulb-conjuring lessons from 3 orthopedic surgeons inside this episode of The 6 to 8 Weeks Podcast. Connect with The 6-8 Weeks Podcast: There's a LOT of detail included in this program. Do you want to share YOUR perspective about it? Connect with The 6-8 Weeks Podcast Now! Subscribe to, Like and Share The 6-8 Weeks Podcast Everywhere: The Detailed Shownotes for This Episode of The 6-8 Weeks Podcast: -- -- What is an Osteochondrial Lesion? https://www.sportsmedicinenewyork.com/osteochondral-lesions-ankle-ankle-orthopedic-foot-ankle-surgeon-new-york-ny.html -- What is Cartalige? https://my.clevelandclinic.org/health/body/23173-cartilage -- What is Bone? https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/bones -- What is an X-Ray? https://my.clevelandclinic.org/health/diagnostics/21818-x-ray -- What is the Capitellum? https://radiopaedia.org/articles/capitellum Timestamps for This Episode of The 6-8 Weeks Podcast: 00:00 Knee pain and swelling, potentially from injury or degeneration. It can manifest as weakness and restricted motion, possibly due to a loose piece in the joint. 06:10 Ankle injuries can occur traumatically or atraumatically, with ankle sprains often affecting the outside or inside part of the talus bone. Treatment options for knee and elbow injuries are generally effective, but data for ankle osteochondral defects (OCDs) remains limited, and the appropriate treatment approach is still unclear. 08:44 Smaller knee lesions located in atypical areas have a better chance of healing, as they are not subjected to as much stress. However, lesions in common high-stress areas, such as the medial part of the knee, may struggle to heal. Non-operative treatments like bracing may be challenging for active children, leading some families to opt for early surgical intervention, particularly for older children, to avoid a long drawn-out treatment process. 11:02 Kids' cartilage repair relies on piece condition and age, with early intervention yielding higher success rates. However, invasive techniques may not be worth the risk. 13:54 Allograft is recommended for larger, younger lesions. Seek medical advice if symptoms worsen, even in younger individuals. Various treatment options are available. Expert guidance is crucial due to the complexity and conflicting information online. Connect with the Hosts of The 6-8 Weeks Podcast: It's never been easier to connect with the hosts of The 6-8 Weeks Podcast. Read on below to share your perspectives on this episode of The 6-8 Weeks Podcast. === Connect with Dr. Brian Feeley: On the Web -- On X === Connect with Dr. Nirav Pandya: On the Web:-- On X: === Connect with Dr. Drew Lansdown: On the Web
Human tissue is amazing. To think that a section of it can be harvested - whether it be your own or from another source, to change the future movement that will propel your body, career choices and life, makes the mind reel. It's time to learn what three orthopedic surgerons think about the various types of ACL grafts that can be made (patellar, hamstring and quadricep) to impact patients of all kinds inside this episode of The 6 to 8 Weeks Podcast. Connect with The 6-8 Weeks Podcast: There's a LOT of detail included in this program. Do you want to share YOUR perspective about it? Connect with The 6-8 Weeks Podcast Now! Subscribe to, Like and Share The 6-8 Weeks Podcast Everywhere: The Detailed Shownotes for This Episode of The 6-8 Weeks Podcast: -- What is the UCL? https://www.nationwidechildrens.org/conditions/ulnar-collateral-ligament-injury -- What is the ACL? https://kidshealth.org/en/teens/acl-injuries.html -- What is the MCL? https://kidshealth.org/en/teens/mcl-injuries.html -- What is a Graft? The process of a soft tissue graft involves collecting a small amount of tissue from another area within your mouth and placing it in the recessed area. During this procedure, the patient is given a local anesthetic to provide comfort and can choose to have nitrous oxide (laughing gas) to help them relax further -- What is a Patella? https://my.clevelandclinic.org/health/body/25038-patella -- What is a Hamstring? https://my.clevelandclinic.org/health/body/21904-hamstring-muscles -- What is a Quadricep? https://www.physio-pedia.com/Quadriceps_Muscle -- How Important is The Human Knee? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178997/ -- Who is Martha Murray? https://www.childrenshospital.org/directory/martha-murray -- What is the Boston Children's Health Physicians? https://bchp.childrenshospital.org/ -- What is Gore-Tex? https://www.gore-tex.com/technology/gore-tex-products -- What is Synovial Fluid? https://medlineplus.gov/lab-tests/synovial-fluid-analysis/ -- What is Autograft Tissue? https://www.sciencedirect.com/topics/medicine-and-dentistry/autograft -- What is Allograph Tissue? https://intermountainhealthcare.org/ckr-ext/Dcmnt -- What is the Difference Between a Tendon and a Ligament? https://medlineplus.gov/ency/imagepages/19089.htm#:~:text=Overview,move%20the%20bone%20or%20structure. -- A Listing of Peroneal Tendon Syndromes? -- What is a Biologic Scaffold? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580515/ -- Cadaver Tissue Donation: A Pathologist's Perspective: https://jme.bmj.com/content/29/3/135 -- Are Donor Tissues and Grafts Safe? https://www.verywellhealth.com/are-donor-tissues-and-grafts-safe-2549895 -- What Does It Mean to Be Skeletally Mature? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5257250/ Timestamps for This Episode of The 6-8 Weeks Podcast: 05:17 Options: - ACL surgery: autograft or allograft tissue - Autograft is from your own tissue - Allograft comes from cadaver donor tissue 06:49 Biologic scaffold supports new ligament growth effectively. 12:11 Allograft may fail due to early activity. 14:10 Drew's research identifies bone shape ACL risk. 18:52 Study results and surgeon's expertise matter. 22:07 Choice of graft depends on growth plate status. 23:02 Hamstrings preferred for young patients with ACL. Connect with the Hosts of The 6-8 Weeks Podcast: It's never been easier to connect with the hosts of The 6-8 Weeks Podcast. Read on below to share your perspectives on this episode of The 6-8 Weeks Podcast. === Connect with Dr. Brian Feeley: On the Web -- On X === Connect with Dr. Nirav Pandya: On the Web:-- On X: === Connect with Dr. Drew Lansdown: On the Web
On this episode, we're going to continue our discussion with Dr. William Bugbee and focus on OCA surgical technique and then discuss clinical outcomes including return to sports.Our conversation picks back up with a recent paper from the July issue of Cartilage this year titled “Young Age and Concomitant or Prior Bony Realignment Procedures are Associated with Decreased Risk of Failure of Osteochondral Allograft Transplantation in the Knee.” This retrospective nationwide database study represents the largest OCA cohort study to date and found that less than 2% of patients required salvage surgery. Young age, less than 29, and having a bony realignment procedure were associated with a significantly lower rate of salvage surgery – include revision cartilage procedures and arthroplasty.We finish up today with an article from the June 2017 issue of AJSM titled “Return to Sport and Recreational Activity after Osteochondral Allograft Transplantation in the Knee.” Dr. Bugbee and colleagues at Scripps Clinic in La Jolla California reported that at a mean follow up of 6 years, 75% of patients were able to return to sport or recreational activity. Patients who did not return were more likely to be female and have a large graft size. 25% of knees underwent further surgery and 9% were considered allograft failures. Of the patients without OCA failure, 91% were satisfied with the results of surgery.
On today's episode we're focusing on osteochondral allograft transplantation or “OCA” with Dr. William Bugbee. We have some great articles for you that contribute well to our conversation on OCA, including allograft preparation and storage, graft choice, surgical technique, clinical outcomes of OCA and return to sport. We'll start off our discussion today with an article authored by our guest, Dr. William Bugbee, from the May 2022 issue of AJSM titled “Fresh Osteochondral and Chondral Allograft Preservation and Storage Media: A Systematic Review of the Literature.” There was significant variability in experimental designs and incomplete reporting across the studies, so no real conclusions could be drawn regarding optimal storage conditions. While 60% of animal model studies suggest storage time may impact outcomes and 80% indicate inferior outcomes with frozen OCA compared to fresh OCA, the authors note that 75% of clinical studies reported no correlation between storage time and outcomes. So, we have a lot left to learn here.Then, from the March 2022 issue of AJSM, we review an article titled “Association of Sex Mismatch Between Donor and Recipient With Graft Survivorship at 5 Years After OCA Transplantation.” Dr. Gomoll and colleagues at Brigham and Women's reported that a significantly lower rate of graft survival was observed after different sex donor-recipient transplant compared to same sex donor-recipient OCA – 63% compared to 92%. Patients who received a donor-recipient sex-mismatch transplantation were 2.9X more likely to fail. Male donor to female recipient demonstrated the highest likelihood of failure compared to all other combinations.We are joined today by Dr. William Bugbee, a board-certified orthopedic surgeon specializing in joint reconstruction and cartilage restoration at Scripps Clinic in La Jolla, California. Dr. Bugbee received his medical degree from UC San Diego and remained at UC San Diego for his orthopedic surgery residency. He then went on to complete a fellowship in joint reconstruction at the Anderson Orthopaedic Research Institute. Dr. Bugbee has published extensively on the topic of osteochondral allograft transplantation, so we're very excited that he is joining us today to share his expertise with all of you!
In this episode of Behind the Knife the vascular surgery subspecialty team discusses a case of an infected endovascular aortic graft. Although rare, aortic graft infections remain a devastating complication. What options do you have to fix this problem? In this episode, we will cover the who is at risk of this, how they present, and what options you have to fix it. Hosts: Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. David Schechtman is a Vascular Surgery Fellow at the University of Michigan Dr. Drew Braet is a PGY-3 Integrated Vascular Surgery Resident at the University of Michigan Learning Objectives · Understand the incidence of and the relevant risk factors for aortic graft infections · Review the spectrum of presenting symptoms and relevant workup for aortic graft infections · Understand surgical treatment options including options for in-situ bypass and extra-anatomic bypass · Review the different conduits that can be used for in-situ and extra-anatomic reconstruction · Discuss relevant post-operative considerations for patients undergoing operative intervention for aortic graft infection References · Chiesa R, Astore D, Frigerio S, Garriboli L, Piccolo G, Castellano R, Scalamogna M, Odero A, Pirrelli S, Biasi G, Mingazzini P, Biglioli P, Polvani G, Guarino A, Agrifoglio G, Tori A, Spina G. Vascular prosthetic graft infection: epidemiology, bacteriology, pathogenesis and treatment. Acta Chir Belg. 2002 Aug;102(4):238-47. doi: 10.1080/00015458.2002.11679305. PMID: 12244902. · Bisdas T, Bredt M, Pichlmaier M, Aper T, Wilhelmi M, Bisdas S, Haverich A, Teebken OE. Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg. 2010 Aug;52(2):323-30. doi: 10.1016/j.jvs.2010.02.277. Epub 2010 Jun 8. PMID: 20570473. · PereraG. B.FujitaniR. M.KubaskaS. M.2006Aortic graft infection: Update on Management and Treatment Options.Vasc Endovascular Surg, 401Jan), 1101538-5744 · Hallett J., Marshall D.M., Petterson T.M., et. al.: Graft-related complications after abdominal aortic aneurysm repair: Population-based experience. J Vasc Surg 1977; 25: pp. 277-284. · Kieffer E, Sabatier J, Plissonnier D, Knosalla C. Prosthetic graft infection after descending thoracic/ thoracoabdominal aortic aneurysmectomy: management with in situ arterial allografts. J Vasc Surg. 2001 Apr;33(4):671-8. doi: 10.1067/mva.2001.112314. PMID: 11296316. · Gutowski P. Zakazenie aortalno-biodrowej protezy naczyniowej jako problem diagnostyczny i leczniczy [Aortoiliac graft infection as a diagnostic and treatment problem]. Ann Acad Med Stetin. 1998;Suppl 41:1-72. Polish. PMID: 9766086. · Capoccia L, Mestres G, Riambau V. Current technology for the treatment of infection following abdominal aortic aneurysm (AAA) fixation by endovascular repair (EVAR). J Cardiovasc Surg (Torino). 2014;55:381–389. · Setacci C, Chisci E, Setacci F, Ercolini L, de Donato G, Troisi N, Galzerano G, Michelagnoli S. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair. Aorta (Stamford). 2014 Dec 1;2(6):255-64. doi: 10.12945/j.aorta.2014.14-036. PMID: 26798744; PMCID: PMC4682678. · Reinders Folmer E.I., Von Meijenfeldt G.C.I., Van der Laan M.J., Glaudemans A.W.J.M., Slart R.H.J.A., Saleem B.R., Zeebregts C.J. Diagnostic Imaging in Vascular Graft Infection: A Systematic Review and Meta-Analysis. Eur. J. Vasc. Endovasc. Surg. 2018;56:719–729. doi: 10.1016/j.ejvs.2018.07.010. · Rafailidis V., Partovi S., Dikkes A., Nakamoto D.A., Azar N., Staub D. Evolving clinical applications of contrast-enhanced ultrasound (CEUS) in the abdominal aorta. Cardiovasc. Diagn. Ther. 2018;8:S118–S130. doi: 10.21037/cdt.2017.09.09. · Hayes P.D., Nasim A., London N.J., et. al.: In situ replacement of infected aortic grafts with rifampicin-bonded prostheses: The Leicester experience (1992 to 1998). J Vasc Surg 1999; 30: pp. 92-98. · Oderich GS, Bower TC, Hofer J, Kalra M, Duncan AA, Wilson JW, Cha S, Gloviczki P. In situ rifampin-soaked grafts with omental coverage and antibiotic suppression are durable with low reinfection rates in patients with aortic graft enteric erosion or fistula. J Vasc Surg. 2011 Jan;53(1):99-106, 107.e1-7; discussion 106-7. doi: 10.1016/j.jvs.2010.08.018. PMID: 21184932. · Bisdas T., Bredt M., Pichlmaier M., et. al.: Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg 2010; 52: pp. 323-330. · O'Hara P.J., Hertzer N.R., Beven E.G., et. al.: Surgical management of infected abdominal aortic grafts: Review of a 25-year experience. J Vasc Surg 1986; 3: pp. 725-731. · Quiñones-Baldrich WJ, Hernandez JJ, Moore WS. Long-term Results Following Surgical Management of Aortic Graft Infection. Arch Surg. 1991;126(4):507–511. doi:10.1001/archsurg.1991.01410280111018 · Kieffer E., Gomes D., Chieche L., et. al.: Allograft replacement for infrarenal aortic graft infection: Early and late results in 179 patients. J Vasc Surg 2004; 39: pp. 1009-1017. · Zhou W., Lin P.H., Bush R.L., et. al.: In situ reconstruction with cryopreserved arterial allografts for management of mycotic aneurysms or aortic prosthetic graft infections: A multi-institutional experience. Texas Heart Institute J 2006; 33: pp. 14-18. 2006 · Ali AT, Modrall JG, Hocking J, Valentine RJ, Spencer H, Eidt JF, Clagett GP. Long-term results of the treatment of aortic graft infection by in situ replacement with femoral popliteal vein grafts. J Vasc Surg. 2009 Jul;50(1):30-9. doi: 10.1016/j.jvs.2009.01.008. PMID: 19563952. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other vascular episodes here: https://behindtheknife.org/podcast-category/vascular/
This month on Episode 45 of Discover CircRes, host Cynthia St. Hilaire highlights four original research articles featured in the February 3rd and February 17th issues of Circulation Research. This episode also features an interview with Dr Hind Lal and Dr Tousif Sultan from the University of Alabama at Birmingham about their study Ponatinib Drives Cardiotoxicity by S100A8/A9-NLRP3-IL-1β Mediated Inflammation. Article highlights: Pi, et al. Metabolomic Signatures in PAH Carnevale, et al. Thrombosis TLR4-Mediated in SARS-CoV-2 Infection Cai, et al. Macrophage ADAR1 in AAA Koide, et al. sEVs Accelerate Vascular Calcification in CKD Cindy St. Hilaire: Hi, and welcome to Discover CircRes, the podcast of the American Heart Association's journal, Circulation Research. I'm your host, Dr Cynthia St. Hilaire from the Vascular Medicine Institute at the University of Pittsburgh, and today I'm going to be highlighting the articles from our February 3rd and 17th issues of Circulation Research. I'm also going to have a chat with Dr Hind Lal and Dr Tousif Sultan from the University of Alabama at Birmingham about their study, Ponatinib Drives Cardiotoxicity by S100A8/A9-NLRP3-IL-1β Mediated Inflammation. But before I get to the interviews, here are a few article highlights. Cindy St. Hilaire: The first article I want to highlight comes from the laboratory of Dr Peter Leary at the University of Washington, and the title is Metabolomic Signatures Associated With Pulmonary Arterial Hypertension Outcomes. Pulmonary Arterial Hypertension or PAH is a rare but life-threatening disease in which progressive thickening of the walls of the lung's blood vessels causes increased blood pressure and that increased blood pressure ultimately damages the heart's right ventricle. Interestingly, progression to heart failure varies considerably among patients, but the reasons why there is variability are not well understood. To find out, this group turned their attention to patient metabolomes, which differ significantly from those of healthy people and thus may also change with severity. Blood samples from 117 PAH patients were analyzed for more than a thousand metabolites by mass spectrometry and the patient's progress was followed for the next three years. 22 patients died within a three-year period and 27 developed significant right ventricle dilation. Other measures of severity included pulmonary vascular resistance, exercise capacity and levels of BNP, which is a metric of heart health. Two metabolic pathways, those relating to polyamine and histidine metabolism, were found to be linked with all measures of severity suggesting a key role for them in disease pathology. While determining how these pathways influence disease as a subject for further study, the current findings may nevertheless lead to new prognostic indicators to inform patient care. Cindy St. Hilaire: The next article I want to discuss is coming from our February 3rd issue of Circulation Research and this is coming from the laboratory of Dr Francisco Violi at the University of Rome and the title is Toll-Like Receptor 4-Dependent Platelet-Related Thrombosis in SARS-CoV-2 Infection. Thrombosis can be a complication of COVID-19 and it is associated with poor outcomes, including death. However, the exact mechanism by which the virus activates platelets, which are the cells that drive thrombosis, is not clear. For one thing, platelets do not appear to express the receptor for SARS-CoV-2. They do however, express the TLR4 receptor and that's a receptor that mediates entry of other viruses as part of the immune response. And TLR4 is ramped up in COVID-19 patient platelets. This group now confirms that, indeed, SARS-CoV-2 interacts with TLR4, which in turn triggers thrombosis. The team analyzed platelets from 25 patients and 10 healthy controls and they found that the platelet activation and thrombic activity were both boosted in the patient samples and could not be blocked using a TLR4 inhibitor. Additionally, immunoprecipitation and immunofluorescent experiments further revealed colocalization between the virus protein and the TLR4 receptor on patient platelets. The team went on to show that the signaling pathway involved reactive oxygen species producing factors p47phox and Nox2, and that inhibition of phox 47, like that of the TLR4 receptor itsel,f could prevent platelet activation. As such, this study suggests that inhibiting either of these proteins may form the basis of an antithrombotic treatment for COVID-19. Cindy St. Hilaire: The third article I want to highlight is coming from the lab of Shi-You Chen at University of Missouri and the title of this article is ADAR1 Non-Editing Function in Macrophage Activation and Abdominal Aortic Aneurysm. Macrophage activation plays a critical role in abdominal aortic aneurysm development, or AAA development. Inflammation is a component of this pathology; however, the mechanisms controlling macrophage activation and vascular inflammation in AAA are largely unknown. The ADAR1 enzyme catalyzes the conversion of adenosine to inosine in RNA molecules and thus this conversion can serve as a rheostat to regulate RNA structure or the gene coding sequence of proteins. Several studies have explored the role of ADAR1 in inflammation, but its precise contribution is not fully understood, so the objective of this group was to study the role of ADAR1 in macrophage activation and AAA formation. Aortic transplantation was conducted to determine the importance of nonvascular ADAR1 in AAA development and dissection and angiotensin II infusion of ApoE knockout mice combined with a macrophage specific knockout of ADAR1 was used to study the role of ADAR1 macrophage specific contributions to AAA formation and dissection. Allograft transplantation of wild type abdominal aortas to ADAR1 haploinsufficient recipient mice significantly attenuated AAA formation. ADAR1 deficiency in hematopoietic stem cells also decreased the prevalence and the severity of AAA and it also inhibited macrophage infiltration into the aortic wall. ADAR1 deletion blocked the classic macrophage activation pathway. It diminished NF-κB signaling and it enhanced the expression of a number of anti-inflammatory microRNAs. Reconstitution of ADAR1 deficient but not wild type human monocytes to immunodeficient mice blocked the aneurysm formation in transplanted human arteries. Together these results suggest that macrophage ADAR1 promotes aneurysm formation in both mouse and human arteries through a novel mechanism of editing the microRNAs that target NF-κB signaling, which ultimately promotes vascular inflammation in AAA. Cindy St. Hilaire: The last article I want to highlight is also from our February 17th issue of Circulation Research and it is coming from the lab of Shintaro Mandai at Tokyo Medical and Dental University and the title of the article is Circulating Extracellular Vesicle Propagated MicroRNA signatures as a Vascular Calcification Factor in Chronic Kidney Disease. Chronic Kidney Disease or CKD accelerates vascular calcification in part by promoting the phenotypic switching of vascular smooth muscle cells to osteoblast like cells. This study investigated the role of circulating small extracellular vesicles or SUVs from the kidneys in promoting this osteogenic switch. CKD was induced in rats and in mice by an adenine induced tubular interstitial fibrosis and serum from these animals induced calcification in in vitro cultures of A-10 embryonic rat smooth muscle cells. Intraperitoneal administration of a compound that prevents SEV biosynthesis and release inhibited thoracic aortic calcification in CKD mice under a high phosphorus diet. In Chronic Kidney Disease, the microRNA transcriptome of SUVs revealed a depletion of four microRNAs and the expression of the microRNAs inversely correlated with kidney function in CKD patients. In vitro studies found that transected microRNA mimics prevented smooth muscle cell calcification in vitro. In silico analyses revealed that VEGF-A was a convergent target of all four microRNAs and leveraging this, the group used in vitro and in vivo models of calcification to show the inhibition of the VEGF-A, VEGFR-2 signaling pathway mitigated calcification. So in addition to identifying a new potential therapeutic target, these SUV propagated microRNAs are a potential biomarker that can be used for screening patients to determine the severity of CKD and possibly even vascular calcification. Cindy St. Hilaire: Today I have with me Dr Hind Lal who's an associate professor of medicine at the University of Alabama Birmingham and his post-doctoral fellow and the lead author of the study Dr Tousif Sultan. And their manuscript is titled Ponatinib Drives Cardiotoxicity by S100A8/A9-NLRP3-IL-1β Mediated Inflammation. And this article is in our February 3rd issue of Circulation Research. So thank you both so much for joining me today. Tousif Sultan: Thank you. Hind Lal: Thank you for taking time. Cindy St. Hilaire: So ponatinib, it's a tyrosine kinase inhibitor and from my understanding it's the only treatment option for a specific group of patients who have chronic myelogenous leukemia and they have to harbor a specific mutation. And while this drug helps to keep these patients alive essentially, it's extremely cardiotoxic. So cardiotoxicity is somewhat of a new field. So Dr Lal, I was wondering how did you get into this line of research? Hind Lal: So I was fortunate enough to be in the lab of Dr Tom Force and he was kind of father of this new area, now is very developed, it's called cardio-oncology. On those days there were basically everything started in cardio-oncology. So I just recall the first tyrosine kinase approved by FDA was in 2000 and that was... Imagine and our paper came in Nature Medicine 2005 and discovering there is... so to elaborate it a little bit, the cancer therapy broadly divided in two parts. One is called non-targeted therapy like chemotherapy, radiations, et cetera, and then there are cytotoxic drugs. So those cytotoxic drugs because they do not have any targeted name on it so they are, cardiotoxic are toxic to any organ was very obvious and understanding. When these targeted therapy came, which is mainly kinase inhibitor are monoclonal antibodies. So these are targeted to a specific pathway that is activated only in the cancer cells but not in any other cells in the body so they were proposed as like magic bullets that can take off the cancer without any cardiotoxity or minimal side effects. But even in the early phase like 2005 to 2010, these came out, these so-called targeted, they are not very targeted and they are not also the magic bullets and they have serious cardiotoxicity. Cindy St. Hilaire: And so what's the mechanism of action of ponatinib in the leukemia and how does that intersect with the cardiovascular system? Hind Lal: Yeah, so this is very good question I must say. So what we believe at this point because, so leukemia if you know is driven by the famous Philadelphia chromosome, which is a translicational gene, one part of human chromosome nine and one part of human chromosome 22 and they translocate make a new gene which is BCR-ABL gene. And because it was discovered in Philadelphia UPENN, is named that Philadelphia chromosome, which is very established mechanism, that's how CML is driven. But what we have discovered that the cardiotoxicity driven by totally, totally different from the ponatinib is one of the inflammatory So it's kind of goodening. So this question is so good. One kind of toxicity is called on-target, when toxicity is mediated by the same mechanism, what is the mechanism of the drug to cure the cancer? So in that case your absolute is minimal because if you manipulate that, the drug's ability to cure the cancer will be affected but if the toxicity and the efficacy is driven by two different mechanism, then as in case of ponatinib seems like it's NLRP3 and inflammasome related mechanism. So this can be managed by manipulating this pathway without hampering the drug efficacy on the cancer. Cindy St. Hilaire: So what exactly is cardiotoxicity and how does it present itself in these patients? Hind Lal: So these drugs like ponatinib, they call broader CVD effects. So it's not just cardiac, so they also in hypertensives and atherosclerosis and thrombosis, those kind of thing. But our lab is primarily focused on the heart. So that's why in this paper we have given impresses on the heart. So what we believe at this point that ponatinib lead to this proinflammatory pathway described in this paper, which is just 108A9-NLRP3-IL-1β and this inflammatory pathway lead to a cytokine storm very much like in the COVID-19 and these cytokine storms lead to excessive myocarditis and then finally cardiac dysfunction. Cindy St. Hilaire: Is the cytokine storm just local in the cardiac tissue or is it also systemic in the patients? Is cardiotoxicity localized only or is it a more systemic problem? Tousif Sultan: I would like to add in this paper we have included that we look this cytokine things and explain blood circulation, bone marrow. So the effect is everywhere, it's not local. So we didn't check other organs, maybe other organs also being affected with the ponatinib treatment. Cindy St. Hilaire: And what's the initial phenotype of a patient has when they start to get cardiotoxicity, what's kind of like a telltale symptom? Hind Lal: So good thing that in recent years cardio-oncology developed. So initially the patient that were going for cancer treatment, they were not monitored very closely. So they only end up in cardiology clinic when they are having some cardiac events already. So thanks to the lot of development and growth in the cardio-oncology field, now most patients who going for a long-term cancer treatment, they are closely monitored by cardiology clinics. Cindy St. Hilaire: Got it. So they can often catch it before a symptom or an event. That's wonderful. Hind Lal: Yeah, so there's a lot of development in monitoring. Cindy St. Hilaire: Wonderful. So you were really interested in figuring out why ponatinib induces cardiotoxicity and you mentioned that really up until now it's been very difficult to study and that's because of the limitation of available murine models. If you just inject a wild type mouse with ponatinib, nothing happens really. So what was your approach to finding relatively good murine models? How did you go about that? Hind Lal: So this is the top scientific question you can ask. So like science, the field is try and try again. So initially this is the first paper with the ponatinib toxicity using the real in vivo models. Any paper before this including ours studies published, they were done on the cellular model in hiPSC, that isolated cardiomyocytes. So you directly putting the ponatinib directly the isolated cells. So this is first case when we were trying to do in vivo, maybe other attempt in vivo but at least not published. So first we also treated the animals with ponatinib and that failed, we don't see any cardiotoxic effect. And then when we going back to the literature, the clinical data is very, very clear from pharmacovigilance that ponatinib is cardiotoxic in humans. So when we're not able to see any phenotype in mouse, we realize that we are not mimicking what's happening in the humans. So we certainly missing something. Now once again I quote this COVID-19, so many people get infected with COVID-19 but people are having preexisting conditions are on high risk to developing CVD. So there was some literature on that line. So we use this very, very same concept that if there is preexisting conditions, so likely who'd have developing future cardiac event will be more. So we use two model in this paper one atherosclerosis model which is APoE null mice mice, another is tag branding which is pressure overload model for the heart and as soon as we start using what we call comorbidity model like patient is having some preexisting conditions and we very clearly see the robust defect of ponatinib on cardiac dysfunction. Cindy St. Hilaire: Yeah, it's really, really well done and I really like that you use kind of two different models of this. Do you think it's also going to be operative in maybe like the diabetic mirroring models? Do you think if we expand to other comorbidities, you might also recapitulate the cardiotoxicity? Hind Lal: So you got all the best questions. Cindy St. Hilaire: Thank you. I try. Hind Lal: So because this is CML drug and lot of the risk factor for cardiovascular and cancer are common and even metabolic disease. So most of the time these patients are elderly patients and they're having metabolic conditions and most of the time they have blood pressure or something CVD risk factors. So I agree with you, it'll be very relevant to expand this to the diabetes or metabolic models, but these were the first study, we put all our focus to get this one out so news is there then we can expand the field adding additional models et cetera. But I agree with you that will be very logical next step to do. Cindy St. Hilaire: Yeah. And so I guess going back to what you know from the human study or the clinical trials or the human observations, are different populations of patients with CML more predisposed to cardio toxicity than others or is that not known yet? Hind Lal: So one other area called pharmacovigilance. So what pharmacovigilance does patient all over the world taking these drugs. So WHO have their own vigilance system and FDA have their own, so it's called BG-Base for the WHO and it's called the FAERS for the FDA. So one can go back in those data sets and see if X patient taking this Y drug and what kind of symptoms or adverse effect they are seeing and if these symptoms are associated with something else. So there is data that if patients having CVD risk factor, they are more prone to develop ponatinib induced cardiac events. But it needs more polish like you asked the just previous question, diabetes versus maybe blood pressure means hypertension, atherosclerosis, or thrombosis. So it has not been delineated further but in a one big bucket if patients are having CVD risk factor before they are more prone and more likely to develop the cardiac events. Cindy St. Hilaire: So after you established that these two murine models could pretty robustly recapitulate the human phenotype, what did you do next? How did you come upon the S100A8/A9-NLRP3-IL-1β signaling circuit? How did you get to that? Hind Lal: So in basic science work, whenever we do mouse is called until we get there is cardiac dysfunction, it's called phenotype, right? So mouse had a cardiac phenotype. So next step is, "Why? What is leading to that phenotype?" That's what we call mechanism. So there the best idea to fit the mechanism is using one of the unbiased approaches like you do unbiased proteomics, unbiased RNC analysis, something like this that will analyze the entire transcript like RNC and say, "Okay, these pathway are," then you can do further analysis that will indicate these pathway are different, are altered. So in this case we used RNC analysis and it came out that this yes A8 and yes A9, 100A8 and nine, they were the most upregulated in this whole set. And thereafter we were very lucky. So we started this study at Vanderbilt, where my lab was and thereafter we very lucky to move here and found Sultan who had a lot of experience with this inflammation and immune system and then Sultan may add something on this so he'll be the better person to say something on this. Tousif Sultan: So after our RNC analysis, so we got this S100A8 and nine as top hit with the ponatinib treatment. So then we validated this finding with our flow cytometric, qRT PCR aand then we started which pathway is going to release cytokine and all that. So we found that is NLRP3 inflammasome. Cindy St. Hilaire: Yeah and well and I guess maybe step back, what is S100A8/A9? What are those? Tousif Sultan: Yeah, S10A8/A9 is a calcium binding protein. So that's also called alarmin and they basically binds with the pathogen associated pattern and other TLR2 like receptors and then start inflammatory pathway to release cytokine and all that and it's stable in heterodimer form. So S100A8 heterodimer with A9 and then bind with TLR and a start in this inflammatory pathway. Cindy St. Hilaire: And what type of cell is that happening in? Is that happening in the immune cells only or is it also in the cardiomyocyte, or...? Tousif Sultan: Yeah, we have included all this data. So from where this alarmin is coming with ponatinib treatment, so literature also suggested that neutrophils and monocytes, those cells are the potential to release the alarmin. So here we also found these two type of cells, neutrophils and monocytes. They release huge alarmin with the treatment of ponatinib. Cindy St. Hilaire: And so really taking this really neat mechanism to the next level, you then tried attenuating it by using broad anti-inflammatory steroid dexamethasone but also by targeting these specific components, the NLRP and the S100A specific inhibitors and they worked well. It worked really nicely. Does your data show that any of these therapies work better than the other and then are these viable options to use in humans? Hind Lal: Yeah, we have some data in the paper. Are very broad which help a lot in COVID patients, far very acute infections. So in this case, situation is very different cause most of CML patients will going to take ponatinib for lifelong, there is no remission, right? So in those case, its certainly not a very attractive option. We have shown data in the paper that dexamethasone help with the heart but lead to some metabolic changes. So we have compared those with the NLRP3 inhibitors, those metabolic alterations, dexa versus the NLRP3 inhibitors, CY-09. And we demonstrated that targeting is specifically with paquinimod, our NLRP3 inhibitor CY-09, feel better. It can still rescue the cardiac phenotype without having those adverse effect on metabolic parameters. Cindy St. Hilaire: That's wonderful. Do you think though that because you have to take ponatinib for life, that long-term NLRP inhibition would also cause problems or...? Hind Lal: So because not every patient who taking ponatinib would develop the cardiac phenotype, right? Which is like a 10%, 12%, patient developing cardiac dysfunction. So I think someone like I strongly believe paquinimod, which is inhibitor of S100A9, will be really good option or at least we have enough data that make us nail for at least a small clinical trial. And we quickly moving on that. At UAB we have our clinical cardio-oncology program and we are already in touch with the director for the clinical cardio-oncology program. So what we trying to do in that small trial is if one of the standard therapy for heart like beta blocker or ARBs inhibitor, is there any preference like one work better than the other in the standard care? So first we doing that project, then we obviously looking forward if one small clinical trial can be done with paquinimod. I strongly believe it should be helpful. Cindy St. Hilaire: That is wonderful. And so do you think... There's other chemotherapeutic agents or probably even other non-cancer drugs that cause cardiotoxicity, do you think this mechanism, this pathway, this S100A-NLRP-IL-1β axis is operative in all cardiotoxicities or do you think it's going to be very specific to the ponatinib? Hind Lal: So it's certainly not all, but it'll be certainly more than ponatinib. So in our lab we are using another kinase inhibitor, which is osimertinib and it's not published yet, but now we know that it's also cardiotoxic because it's taking metabolic root or energetics disruption but not this pro-inflammatory part, but we're doing another project which is strep pneumonia induced cardiac dysfunction, which is called pneumonia. So strep pneumoniae, which leads to the pneumonia ,and lot patient die because of the failing heart we see here in the hospitals and we see these pathways operational over there and we gearing up to do clinical trial on that aspect as well, but it's not generalized like all kind of heart will have the same mechanism. Cindy St. Hilaire: It's wonderful to see you're already taking those next steps towards really kind of bringing this to a translational/clinical study. So what was the most challenging aspect of this study? Tousif Sultan: The challenging aspect, ponatinib is a kinase inhibitor and that was surprising for us how it's activating immune cells. Generally kinase inhibitors, inhibits all the cells like that. So that was challenging. So we repeated it many times did in vitro experiment to confirm that. So we just added, just treated in vitro immune cells with the ponatinib and confirmed it. So that was little challenging. Cindy St. Hilaire: So what's next? You mentioned you're going to try some clinical trials, early stage clinical trials. What's next mechanistically, what do you want to go after? Hind Lal: So what we are doing next and we are very, very eagerly trying to do that. So what it was done, we used the cardiac comorbidity models, but as you know, anybody who will take ponatinib will have cancer, right? So we strongly believe that we miss one factor. There was no cancer on these. So that is very logical next step. What that will allow us to do, what rescue experiment we'll have done in this paper. So we saw, "Okay, this rescue the cardiac phenotype, which is taken care of now," but very same time, we not able to demonstrate that this is happening without hurting the cancer efficacy. So if we have the dual comorbid mouse, which have CML a real thing and we have cardiac thing, then that will allow us to demonstrate, "Okay, we got something that can take care of the cardiac problem without hurting the efficacy on the cancer." And it will be best if you also help little bit to more potentiate the cancer efficacy. Cindy St. Hilaire: Yes. Excellent. Well, congratulations on a beautiful study, really exciting findings. Dr Lal and Dr Sultan, thank you so much for taking the time to talk with me today. Tousif Sultan: Thank you so much. Hind Lal: Well thank you, Cynthia. We really appreciate your time. Thank you for having us. Cindy St. Hilaire: Yeah, it was great. Cindy St. Hilaire: That's it for our highlights from the February 3rd and February 17th issues of Circulation Research. Thank you so much for listening. Please check out the Circulation Research Facebook page and follow us on Twitter and Instagram with the handle @CircRes and #DiscoverCircRes. Thank you to our guests, Dr Hind Lal and Dr Tousif Sultan. This podcast is produced by Ishara Ratnayake, edited by Melissa Stoner and supported by the editorial team at Circulation Research. Some of the copy text for the highlighted articles was provided by Ruth Williams. I'm your host, Dr Cynthia St. Hilaire, and this is Discover CircRes, you're on-the-go source for most exciting discoveries in basic cardiovascular research. This program is copyright of the American Heart Association 2023. And the opinions expressed by the speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more information, please visit ahajournals.org.
Cardiac Allograft Rejection Using AI-ECG Guest: Demilade A. Adedinsewo, M.B., Ch.B., M.P.H. Hosts: Anthony H. Kashou, M.D. (@anthonykashoumd) Joining us today to discuss cardiac allograft rejection using AI-ECG is Demilade A. Adedinsewo, M.B., Ch.B., M.P.H., assistant professor of medicine and non-invasive cardiologist at Mayo Clinic, Florida. Her research interests include the application of artificial intelligence tools in cardiology. Specific topics discussed: In order to introduce this project to our listeners, can you tell us a bit about why this study is important? Can you describe the steps involved in developing this project? Could you share the summary results from your study? What are the potential implications of your findings for patient care? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. Facebook: MayoCVservices LinkedIn: Mayo Clinic Cardiovascular Services NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.
• Host Austin Beason, MD • Articles summarized from the January 15, 2022 issue (https://journals.lww.com/Jaaos/toc/2023/01150) o Research article “Documented Penicillin Allergies Should Not Preclude Use of Pre-Operative Cefazolin in Hip and Knee Arthroplasty” o Research article “Assessing Leg Length and Offset in Anterior Total Hip Arthroplasty: Overlay versus AP Pelvis Intraoperative Radiographic Techniques” o Research article “Outcomes of Plug Osteochondral Allograft Transplantation with or without Concomitant Osteotomy for Cartilage Defects in the Knee: Minimum 2-year Follow-up” Follow this link to download these and other articles from the January 1, 2023 issue of JAAOS (https://journals.lww.com/Jaaos/toc/2023/01010) and the January 15, 2023 issue of JAAOS (https://journals.lww.com/Jaaos/toc/2023/01150). The JAAOS Unplugged podcast series is brought to you by the Journal of the American Academy of Orthopaedic Surgeons and the AAOS Resident Assembly.
Commentary by Dr. Valentin Fuster
Riz Hatton talks about what's new in the Spine and Orthopedic industry.
Welcome to The Sports Docs Podcast with Dr. Catherine Logan and Dr. Ashley Bassett. On each episode we chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.On today's episode we're focusing on cartilage defects of the knee with Dr. Clayton Nuelle, Assistant Clinical Professor at the University of Missouri and team physician for Mizzou athletics. His current research focuses on improving cartilage restoration and joint preservation techniques, so we are very excited to have him join us for our discussion today.We have some great articles for you that contribute well to our conversation on the surgical treatment of knee cartilage disease. The first article is a level I prospective RCT published in the May 2018 issue of AJSM titled “Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture – Five Year Follow-up of a Prospective Randomized Trial.” This multicenter study was performed at 14 sites across 7 different countries. Patients with symptomatic full thickness cartilage defects greater than 3 cm in size and involving the femoral condyle or trochlea were randomized to either the MACI procedure or microfracture procedure. If you're not familiar with the MACI procedure, we definitely recommend checking out our last Overtime episode where we do a deep dive into the details of that surgical technique. In this 5-year clinical trial, Brittberg and colleagues found that while both groups significantly improved after surgery, patients who underwent the MACI procedure were both clinically and statistically significantly better at 5 years compared to patients who underwent microfracture.Then, from the February issue of AJSM this year, we review the publication titled “Isolated Osteochondral Autograft versus Allograft Transplantation for the Treatment of Symptomatic Cartilage Lesions of the Knee.” Bryan Saltzman and his team at OrthoCarolina performed a systematic review of Llevel I and II studies investigating osteochondral transplant techniques. For our listeners, osteochondral transplants can be performed using autograft – the patient's own tissue, or allograft – donor tissue. Traditionally, autograft transplant or “OATs” has been used for smaller defects, to minimize donor-site morbidity, and has the benefits of avoiding an immune response and no concern for disease transmission.The osteochondral graft is typically harvested from nonweightbearing areas of the knee, such as the intercondylar notch or supracondylar ridge. Allograft transplant or “OCA” is indicated for larger defects. Benefits include the lack of donor site morbidity and the ability to take a graft from an area that correlates with the defect being addressed, such as patella to patella. Grafts can also be size-matched during the ordering process. Downsides include having to wait for allograft availability and cost, in addition to the immunologic and disease transmission risks already discussed, though those are very rare. Both techniques have the benefit of addressing not only the cartilage disease but also underlying bone loss. This systematic review concluded that both OATs and OCA resulted in favorable patient outcomes and graft survival rates at 5-year follow up, with no significant differences between the two. The autograft group was significantly younger, had smaller defect size, used a larger number of plugs and more frequently treated medial femoral condyle lesions. The allograft group had a larger number of patients with lateral femoral condyle and trochlear lesions.
Dr. Briggs summarizes findings in a study published in the June issue of JASN. The study examines the impact of continued immunosuppression in patients with failed allografts; the effects are surprising and suggest current guidelines may not be optimum.
In this episode we take you through an approach to the kidney transplant patient presenting with acute allograft dysfunction. We will cover differential, key questions on history, and an overview to management. Written by Dr. Susan Thanabalasingam (Internal Medicine Resident)Reviewed by Dr. Khaled Shamseddin (Nephrologist) and Dr. David Taylor (General Internist)
In cases of tibialis anterior tendon (TAT) ruptures associated with significant tendon defect, an interposition graft is often needed for reconstruction. Both auto- and allograft reconstructions have been described in the literature. Our hypothesis was that both graft types would have a good integrity and provide comparable outcomes. In conclusion, reconstructions of TAT achieved good PROs, as well as functional and imaging results with a preserved graft integrity in all cases. There were no substantial differences between allograft and autograft reconstructions. To view the article click here.
Commentary by Dr. Valentin Fuster
Drs Dekker and Provencher discuss Distal Tibia Allograft Glenoid Reconstruction in Recurrent Anterior Shoulder Instability: Clinical and Radiographic Outcomes
W gabinecie, kiedy tylko kieruję kogoś na operację rekonstrukcji więzadła krzyżowego przedniego, od razu pada pytanie o to, jak przebiega zabieg. No i jak tu wybrąć z sytuacji? Opowiedzenie pacjentowi jak cały zabieg będzie wyglądał zajmuje sporo czasu, a w czasie konsultacji czas mamy limitowany. A tu jeszcze trzeba wszystkie dokumenty wystawić. W tym odcinku pacjent może posłuchać sobie, jak taki zabieg będzie wyglądał. Omawiam ogólnie jakie kroki trzeba po kolei wykonać aby zabieg przeprowadzić, ale przybliżam również techniki poszczególnych etapów. Pod koniec nagrania jest również coś o konieczności (lub jej braku) usuwania implantów oraz o czasie takiej operacji.
This week we delve into the world of heart transplantation and echocardiography to review a recent work on non-invasive assessment of the pediatric heart transplant patient. Can stress echo and real time myocardial contrast echo identify coronary vasculopathy in this patient group? How do the results compare to coronary angiography? How difficult is this form of imaging and can it be done by pediatric echo techs and staff physicians? Professor Jonathan N. Johnson of the Mayo Clinic shares his insights this week. DOI: 10.1016/j.echo.2020.12.009
Drs Nuelle and Levy discuss the Editorial Commentary: Autograft Beats Allograft For Most Knee Ligament Surgery
Previous studies have demonstrated success in using autogenous bone graft for arthrodesis in patients with failed surgeries of the hallux. These patients have several causes for pain and dysfunction preoperatively, including a shortened first ray, nonunion, and poor hallux alignment. In conclusion, the use of an interposition patellar wedge allograft can restore length to the first ray and provide successful salvage of arthrodesis nonunions and bone loss from failed hemiarthroplasty and total joint implants of the great toe MP joint. To view the article click here.
Download Show Notes at: www.naileditortho.com/tkaextensor Dr. Antonia Chen, who specializes in hip and knee replacements, is the Director of Research for the Division of Adult Reconstruction and Total Joint Arthroplasty at the Department of Orthopaedic Surgery at Brigham and Women's Hospital (BWH) and Associate Professor of Orthopaedic Surgery at Harvard Medical School. She is a certified Orthopaedic Surgeon by the American Board, and her professional practice focuses on patients with arthritic hips and knees, as well as avascular necrosis. She also specializes in the management of complicated patients who may require revision surgery or further therapy for earlier hip and knee surgeries and gives treatment to patients who have hip and knee problems, such as infection, stiffness, and fractures. Dr. Chen obtained her undergraduate degree in Molecular, Cellular, and Developmental Biology from Yale University in New Haven, CT, and her medical degree from Rutgers Medical School, where she graduated with Distinction in Research and was admitted into the Alpha Omega Alpha Medical Honor Society. During her medical studies, Dr. Chen also earned an MBA from Rutgers Business School and is a member of the Beta Gamma Sigma Honor Society. She then completed her orthopaedic surgery residency at the University of Pittsburgh, followed by a fellowship in hip and knee replacement at the Rothman Institute in Philadelphia. Dr. Chen is an orthopaedic surgeon in active practice, as well as a committed researcher and clinician-scientist. Dr. Chen is a recognized and sought-after leader in her profession, both nationally and internationally. She also actively collaborates with fundamental scientists exploring these challenging scientific challenges in laboratories around Harvard Medical School. She is the Appropriate Use Criteria Leader for the American Academy of Orthopaedic Surgeons (AAOS) Evidence-Based Quality and Value Committee and recently served as President of the Musculoskeletal Infection Society (MSIS). Goal of episode: To develop a baseline knowledge on KA w/ Extensor Mechanism Failure . We cover: Extensor Mechanism Rupture Patellar fracture Quad tendon rupture Patella tendon rupture Allograft extensor reconstruction Post-op protocol Complications
Drs Sheean and Gomoll discuss Safety and Efficacy of an Amniotic Suspension Allograft Injection over 12 Months in a Single-Blinded, Randomized Controlled Trial for Symptomatic Osteoarthritis of the Knee
Drs Nuelle and Smith discuss Superior Capsular Reconstruction Using Dermal Allograft Is a Safe and Effective Treatment for Massive Irreparable Rotator Cuff Tears: 2-Year Clinical Outcomes
Host Praveen Ranganath (@PraveenRangana9) discusses the recently-published review titled "Chronic Lung Allograft Dysfunction: Review of CT and Pathologic Findings" with lead authors Dr. Danielle Byrne, Dr. Roland Nador, and Dr. John C English. This episode is jam packed with clinical, pathological, and radiological information on lung transplantation and chronic lung allograft dysfunction -- tune in and enjoy!
Recurrent shoulder instability is a prevalent condition, with glenoid bone loss as a common cause. Arthroscopic repair using distal tibial allografts provides long-lasting treatment by restoring glenoid surface area and presumably avoids risks of sensitization against donor human leukocyte antigen (HLA). Two case studies have challenged this assumption, suggesting that small bone allografts are able to induce host adaptive immune responses to donor HLA. The incidence of small bone allograft HLA sensitization and its effects on resorption and patient outcomes are unclear. In conclusion, sensitization against donor HLA after small bone graft allografting was not previously considered but has been brought to light as a possibility. Aside from potential complications for future organ transplants, HLA sensitization does not introduce a risk for adverse outcomes or higher grades of resorption compared with nonsensitized patients after small bone allografting for shoulder instability. Click here to read the article.
Drs Nuelle and Feldman discuss the Editorial Commentary: Hamstring ACL augmentation with allograft: Not in patients
Galli SH, Ferguson CM, Davis WH, Anderson R, Cohen BE, Jones CP, Odum S, Ellington JK. Cheilectomy With or Without Cryopreserved Amniotic Membrane–Umbilical Cord Allograft for Hallux Rigidus. Foot Ankle Ortho. 2021;6(1) 1-10. https://doi.org/10.1177/2473011420967999
Clinical Journal of the American Society of Nephrology (CJASN)
Dr. James Lan discusses findings from his study "Pretransplant Calculated Panel Reactive Antibody in the Absence of Donor-Specific Antibody and Allograft Survival," on behalf of his colleagues.
Episode 1, season 2. Chuck and Chris talk more about Chris' favorite topic- nerve surgery. We begin a three part discussion on nerve surgery, focused on the technical aspects of nerve repair including use of allografts, digital nerve repair, and sural nerve grafts.As always, thanks to @iampetermartin for the amazing introduction and conclusion music. And thanks to Eric Zhu, the Upper Hand intern extraordinaire.theupperhandpodcast.wustl.eduSurvey Link:Help Chuck and Chris understand better what you like and what we can improve. And be entered for drawing to win a mug! https://bit.ly/349aUvz
CardioNerds (Amit Goyal & Daniel Ambinder) join University of California San Diego (UCSD) cardiology fellows (Harpreet Bhatia, Dan Mangels, and Quan Bui) for a relaxing beach bonfire in the beautiful city of San Diego! They discuss a challenging case of post-transplant cardiac allograft vasculopathy. Dr. Hao (Howie) Tran provides the E-CPR and program director Dr. Daniel Blanchard provides a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Richard Ferraro with mentorship from University of Maryland cardiology fellow Karan Desai. Jump to: Patient summary - Case media - Case teaching - References The CardioNerds Cardiology Case Reports series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an “Expert CardioNerd Perspectives & Review” (E-CPR) for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus. We are teaming up with the ACC FIT Section to use the #CNCR episodes to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an E-CPR segment and a message from the program director. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza Patient Summary A man in his late 20s with a past medical history of orthotopic heart transplant, presents with one-week of progressive lower extremity edema and dyspnea with NYHA class IV symptoms. 5 years prior, he underwent orthotopic heart transplant for arrhythmogenic right ventricular cardiomyopathy. Subsequently, he has had multiple episodes of rejection or recurrent graft dysfunction. On presentation, he was normotensive and borderline tachycardic. Exam revealed elevated JVP, decreased breath sounds, and pitting edema. Labs demonstrated leukocytosis, acute kidney injury, and elevated pro-BNP. TTE demonstrated LVEF 35%, apical akinesis, and grade III diastolic dysfunction (all similar to prior). He was initially diuresed and RHC/EMB was performed to evaluate for rejection. Early in his course, the patient unfortunately suffered a PEA arrest with ROSC was quickly achieved after 1 minute of CPR. He was intubated and cannulated for VA ECMO. EMB demonstrated ISHLT Grade 1R cellular rejection and he was ultimately listed for re-transplant. Shortly thereafter, the patient received an OHT. His pathology demonstrated intimal thickening of all his coronaries, consistent with coronary artery vasculopathy, felt to be the major contributor to his presentation. Case Media ECG Episode Schematics & Teaching Click to enlarge! The CardioNerds 5! – 5 major takeaways from the #CNCR case 1. What is CAV? CAV stands for cardiac allograft vasculopathy. Within the transplanted heart, CAV is the proliferation of vascular smooth muscle and intimal thickening in the epicardial coronary arteries and microvasculature leading to diffuse narrowing. CAV is common, present in greater than 30% of patients at 5 years post-transplant. It is a significant contributor to post-transplant mortality after the first year. CAV, in contrast to typical atherosclerotic lesions, is diffuse and concentric while atherosclerosis tends to be focal with eccentric luminal narrowing and heterogenous plaque composition. Patients s/p OHT can still develop typical coronary artery disease,
Drs Nuelle and Williams discuss Fresh Precut Osteochondral Allograft Core Transplantation for the Treatment of Femoral Cartilage Defects
Drs Nuelle and Williams discuss Fresh Precut Osteochondral Allograft Core Transplantation for the Treatment of Femoral Cartilage Defects
Drs Arner and Millett discussClinical and Imaging Outcomes After Arthroscopic Superior Capsular Reconstruction with Human Dermal Allograft for Irreparable Non-Pseudoparalytic Posterior Superior Rotator Cuff Tears: A Minimum Two-year Follow-up
Get inside the black box of transplant medicine as we discuss: Kidney transplant for the internist. Join Dr. Cyrus Askin, @askins_razor, one of our Curbsiders Correspondents, as he teams up with the fine folks from freely Filtered in this NephMadness episode exploring topics in kidney transplant! On this show, the gang turns to Dr. Samira Farouq, @ssfarouk, a Mount Sinai transplant nephrologist, to take the reins during this guided tour of concepts in transplant medicine that internists should be familiar with. During this episode, you’ll learn about indications for kidney transplant, immunosuppressive agents, what to watch out for in your post-transplant patients and so much more! And of course, we will talk a little NephMadness as we wrap things up. So maybe you need to learn about kidney transplant or perhaps you’re still mourning the loss of March Madness 2020 - either way, we encourage you to take a listen and hope you’ll enjoy! Listeners can claim free CE credit for this episode at curbsiders.vcuhealth.org (goes live at 1200 ET on the episode’s release date). Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME It's time for NephMadness 2020! Fill out your bracket before the April 30, 2020 deadline and be sure to list The Curbsiders as your team. Read this year’s region posts here. Submit an individual or team bracket here. Discuss your picks with #NephTwitter! Credits Written and Produced by: Cyrus Askin MD, Matthew Watto MD and the Freely Filtered Crew Infographic: Cyrus Askin MD Cover Art: Kate Grant MBChB DipGUMed Hosts: Cyrus Askin MD, Joel Topf MD, Samira Farouk MD, Swapnil Hiremath MD, Jennie Lin MD & Matt Sparks MD Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Sponsor We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information. Time Stamps 00:00 Announcement, Intro to Freely Filtered and NephMadness 04:00 Case of advanced CKD; Who/when to refer for transplant 12:05 Benefits of renal transplant 16:22 Counseling patients with advanced CKD about transplant and a bit on living donors 20:40 Medications after transplant; Drug-drug interactions 25:50 Dr. Sparks’ 30 second exam for the transplant patient; Diarrheal illness 32:07 Calcineurin inhibitor levels 36:42 Prophylaxis for long term complications 40:21 Allograft rejection; BAMF criteria 50:40 Cardiovascular risk; Statins 56:11 Malignancy after kidney transplant 60:00 NephMadness Transplant Region: Biomarkers vs Biopsy 72:23 Outro Goal Listeners will learn valuable skills to assist in the management and counseling of pre- and post- kidney transplant patients. Learning objectives After listening to this episode listeners will… Recognize the criteria for kidney transplant referral and evaluation, as well as the importance of referring a patient as soon as they are eligible. Be able to counsel a patient regarding what to expect before, during and after the transplant process. Know the main classes of medication used after patients have received transplants, to include their side effects and any relevant monitoring. Be familiar with the different types of rejection, the clinical signs/symptoms of rejection and the utility / limitations of kidney biopsy. Be able to discuss the post-transplant complications of kidney transplantation (cardiovascular, malignancy, etc.) as well as what type of prophylactic medications should be considered in these patients. Disclosures Drs. Cyrus Askin MD, Samira Farouk MD, Swapnil Hiremath MD, Jennie Lin MD & Matt Sparks MD report no relevant financial disclosures. Dr. Topf has received honoraria from Astra Zeneca and Cara Therapeutics. He is joint venture partner in Davita Dialysis centers receiving dividends. The Curbsiders report no relevant financial disclosures. Citation Cyrus A, Topf J, Farouk S, Swapnil H, Lin J, Sparks M, Watto MF. “#210 NephMadness: Kidney Transplant for the Internist”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. April 27, 2020
Drs Lynch and Hirahara discuss Ultrasound Assessment of the Superior Capsule Reconstruction with Dermal Allograft: An Evaluation of Graft Thickness and Vascularity
Drs Lynch and Hirahara discuss Ultrasound Assessment of the Superior Capsule Reconstruction with Dermal Allograft: An Evaluation of Graft Thickness and Vascularity
On this episode of the #AskMikeReinold show we talk about some of the differences in our programs when someone has an allograft, instead of an autograft, after ACL reconstruction. There are pros and cons of using an allograft or autograft, … Read more > The post How Our Rehabilitation Changes with an Allograft ACL Reconstruction appeared first on Mike Reinold.
In this new episode of the Regenerative Warrior podcast, I sat down with Dr. Tim Ganey, Chief Science Officer of Vivex Biomedical to talk about the latest study him and his team had on allograft treatment for disc degeneration. We talked about the objective of the study, safety and efficacy of viable allograft transplantation for the treatment of patients with symptomatic disc degeneration and tissue loss. Dr. Ganey also shared his thoughts on the future of allografts tissue in the regenerative space and how this new study could impact its future use as viable treatment for disc degeneration issues. To find out more about our guest, become a guest on our show, or if you want Dr. Carter present at your event or podcast, learn more about coaching, consulting, allografts, exosomes, supplements, legal help, or how to create a million dollar business card and dominate your area, we're here to help you. Just text your name and question to 561-962-1231 or go to our website at drrosscarter.com to learn more. Thanks for listening! Please subscribe to be notified of all new episodes. You can also like and share each episode to help us grow!
Drs Neulle and Gomoll discuss Open Meniscal Allograft Transplantation with Transosseous Suture Fixation of the Meniscal Body Significantly Decreases Meniscal Extrusion Rate Compared with Arthroscopic Technique
Drs Neulle and Gomoll discuss Open Meniscal Allograft Transplantation with Transosseous Suture Fixation of the Meniscal Body Significantly Decreases Meniscal Extrusion Rate Compared with Arthroscopic Technique
Session 28 A patient with a 2-month-old kidney transplant has elevated creatinine, fever, and tenderness at the graft region. What other finding is likely present? As always, we’re joined by Dr. Karen Shackelford of BoardVitals as we dig into today’s case to help give you a better understanding. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:02] BoardVitals If you're preparing for your USMLE Step 1 or COMLEX Level 1, check out how BoardVitals can help you prepare for your exam. Use the promo code BOARDROUNDS to save 15% off their QBanks. They have the 3-month version with over 1,700 questions. Once you're in medical school, they also have QBanks for the SHELF exams. [02:24] Question of the Week The patient who has a history of kidney failure as a result of multicystic kidneys has an allograft kidney transplant. Two months later, she presents with fever, malaise, and tenderness in the graft region. Her lab work shows a rise in creatinine. What other finding is characteristic of her condition? (A) Hypotension (B) Decreased graft size on the ultrasound (C) Patchy mononuclear cell infiltrates without tubulitis (D) Urinary obstruction (E) Oliguria [03:20] Thought Process The correct answer is E. The oliguria is a frequent finding. She has fever, malaise, and graft tenderness. Some patients can actually be asymptomatic during acute renal transplant rejection. They usually have hypertension that's why answer choice A is wrong. The graft may actually be enlarged on ultrasound. Creatinine only rises when there's significant histologic damage. If the graft rejection progressed, there would be weakness and fibrosis. You would have a decreased graft size but not at this point. Patchy mononuclear cell infiltrates without tubulitis is a pathological description of something that occurs in patients who have a normal functional renal allopath. So the histopathological findings in patients with rejection may have findings of interstitial infiltration with mononuclear cells, sometimes eosinophils. And the tubular basement membrane will be disrupted by these infiltrating cells. This is tubulitis. Along with inch-small arteritis, it's considered the primary lesion of acute cellular rejection. Acute antibody-mediated rejection is characterized by vasculitis with neutrophils, anti-glomerular and peritubular capillaries fibrin, thrombi, or nephrosis. Then there's interstitial hemorrhage, the presence of CD4 and antibody-specific to the donor suggest an antibody-mediated reaction. In chronic allograft dysfunction, you will see peritubular basement membrane splitting and multi-layering of the basement membrane. The antibody-mediated rejection is an albumin response that occurs as antigen-antibody complex fixes complement with the activation of multiple complement protein. C4D is the component of the normal complement pathway. When C4 is split into C4A and C4B, C4B is then converted to C4D. This binds covalently to the endothelial basement membrane and the collagen basement membrane. In a normal kidney, C4D can be found in the glomerular mesangium and at the vascular pole. But the excessive reduction of immune complex deposition disease results in accumulation in the glomerular capillaries. The CD4 deposition can be seen by monoclonal antibodies staining and fluorescent tissue immunofluorescence. Peritubular capillaries staining is useful in just renal allografts. In acute allogra rejection graft, they appear large. Urinary obstruction is not the mechanism of oliguria in patients with renal allograft rejection. [09:20] Definition of Acute Rejection Graft versus host reaction is an immune condition that occurs immediately after a transplant procedure when the immune cells from the donor attack the recipient patient's host tissue. Acute rejection goes the other direction that is characterized by oliguria, fever, malaise, and graft tenderness. So you're having this inflammatory reaction. When you have chronic rejection, like anything else she developed, there was significant tissue damage from chronic inflammation. The most common cause of graft failure after the first year is called chronic rejection under the Banff classification system. Chronic allograft nephropathy, which is chronic rejection, is characterized by interstitial fibrosis and tubular atrophy. Links: BoardVitals (Use the promo code BOARDROUNDS to save 15% off their QBanks.)
The ability of lateral meniscal allograft transplantation (MAT) to improve knee stability and the meniscal load-bearing function in patients after meniscectomy is critical for surgical success. Lateral MAT partially restored medial translation of the tibia, and the resultant forces in the meniscal allograft were only 50% to 60% of the intact lateral meniscus forces in the cadaver model. In the majority of testing conditions, no significant changes of the in situ force in the anterior cruciate ligament were observed. Surgeons should consider the potential benefits of lateral MAT when deciding the appropriate treatment for symptomatic patients after lateral meniscectomies. Both lateral MAT techniques functioned similarly. Click here to read the article.
Drs Tucker and Jones discuss Fresh Osteochondral Allograft Transplantation for Uncontained, Elongated Osteochondritis Dissecans Lesions of the Medial Femoral Condyle
Drs Tucker and Jones discuss Fresh Osteochondral Allograft Transplantation for Uncontained, Elongated Osteochondritis Dissecans Lesions of the Medial Femoral Condyle
Commentary by Dr. Valentin Fuster
Drs Leland and Hartzler discuss Arthroscopic Joint Preservation in Severe Glenohumeral Arthritis Using Interpositional Human Dermal Allograft
Drs Leland and Hartzler discuss Arthroscopic Joint Preservation in Severe Glenohumeral Arthritis Using Interpositional Human Dermal Allograft
00:45 | Sperm Speed 02:48 | Sponsored by HAPS 03:32 | Hematopoiesis in the Gut 07:04 | Sponsored by AAA 07:22 | Swallow Legos Much? 10:41 | New Sponsor: MS-HAPI Program 15:23 | Featured: Mid-Semester Check-Ins Keep Your A&P Course on Track If you cannot see or activate the audio player click here. Questions & Feedback: 1-833-LION-DEN (1-833-546-6336)Follow The A&P Professor on Twitter, Facebook, Blogger, Nuzzel, Tumblr, or Instagram! Vulnerability sounds like truth and feels like courage. Truth and courage aren't always comfortable, but they're never weakness. (Brené Brown) 1 | Sperm Speed 2 minutes We know that some sperm are fast and some are slow. And it seems that if the sperm are generally pretty slow, that may reduce fertility. Now we have a clue why that may be so. Slow sperm may fail at crashing ‘gates' on their way to an egg (brief summary; includes video) my-ap.us/2BP9yb0 Strictures of a microchannel impose fierce competition to select for highly motile sperm (research article) my-ap.us/2BLNi1J 2 | Sponsored by HAPS 0.5 minute The Human Anatomy & Physiology Society (HAPS) is a sponsor of this podcast. Did you know there's a one-day regional HAPS conference in March? Check it out. You can help appreciate their support by clicking the link below and checking out the many resources and benefits found there. Anatomy & Physiology Society theAPprofessor.org/haps 3 | Hematopoiesis in the Gut 3.5 minutes In Episode 37, I mentioned the "reserve hematopoiesis" in bone marrow. New information shows that significant hematopoiesis occurs in the adult intestine. In an allograft of intestinal tissue, as may occur in patients with a GI disorder, donor stem cells and progenitor cells produce white blood cells that circulate in the recipient's blood stream. Some blood cells have a surprising source—your gut (brief summary) my-ap.us/2BMjEsZ Human Intestinal Allografts Contain Functional Hematopoietic Stem and Progenitor Cells that Are Maintained by a Circulating Pool (research article) my-ap.us/2BMr8vY 4 | Sponsored by AAA 0.5 minutes The searchable transcript for this episode, as well as the captioned audiogram of this episode, are sponsored by The American Association of Anatomists (AAA) at anatomy.org. Their big meeting is in April at the Experimental Biology (EB) meeting in Orlando FL. Check it out! Searchable transcript Captioned audiogram 5 | What Happens When You Swallow a Lego? 3.5 minutes How long does it take for a Lego piece to travel through the alimentary canal? The answer is in—er, I mean out. And learn about the Stool Hardness and Transit (SHAT) score and the all-important Found-and-Retrieved Time (FART) score. That alone is worth the price you paid to listen to this episode. Study reveals how long it takes for LEGO head to pass through adult human digestive tract (brief summary) my-ap.us/2BGZ4dF Everything is awesome: Don't forget the Lego (research article) my-ap.us/2BMjGB7 6 | New Sponsor! MS-HAPI Graduate Program in A&P 4.5 minutes The Master of Science in Human Anatomy & Physiology Instruction—the MS-HAPI—is graduate program for A&P teachers. A combination of science courses (enough to qualify you to teach at the college level) and courses in instructional practice, this program helps you power up your teaching. Kevin Patton is a faculty member in this program. Check it out! nycc.edu/hapi 7 | Featured: Mid-Semester Check-Ins Keep Your A&P Course on Track 25.5 minutes A recent conversation with Krista Rompolski brought up her practice of a mid-semester student survey. Why does she do that? Find out in this episode that focuses on ways to "take the temperature" of your course while there's still time to fix anything that needs fixing. End-of-Term Reviews Help Keep Your Course on Track | Episode 17 (where I first bring up deconstructing your A&P course) Lion Tamers Guide to Teaching (Kevin's blog) Lion tamers are very vulnerable, because nobody is stronger than a lion (which can eat you). But it works if you listen to the lions and find ways to get them to want to do what you want them to do. That can work with human students, too, even if they seem ready to eat you alive. Spaced Retrieval Practice | Episode 1 Advice for faculty members on how to teach students how to learn (opinion piece from Inside Higher Ed) my-ap.us/2BPMIQj Clickers (Kevin's online seminar on using student response systems) Using mid-semester course evaluation as a feedback tool for improving learning and teaching in higher education (a recent journal article) my-ap.us/2tCDNxk If the hyperlinks here are not active, go to TAPPradio.org to find the episode page. More details at the episode page. Transcript available at the script page. Listen to any episode on your Alexa device. Join The A&P Professor social network: Blog Twitter @theAPprofessor Facebook theAPprofessor Instagram theAPprofessor YouTube Transcript and captions for this episode are supported by the American Association of Anatomists.anatomy.org The Human Anatomy & Physiology Societyprovides marketing support for this podcast. theAPprofessor.org/haps NYCC's online graduate program in Human Anatomy & Physiology Instruction (HAPI) supports distribution of this podcast free to all users. nycc.ed/hapiAmazon and TextExpander referrals also help defray podcasting expenses. (Clicking on sponsor links helps let them know you appreciatetheir support of this podcast!)
Host Kevin Patton previews the content of the upcoming full episode, which features a discussion of how mid-term check-ins can help in teaching A&P. There's more... some listener feedback, word dissections, and recommendations from The A&P Professor Book Club. If you cannot see or activate the audio player click here. Questions & Feedback: 1-833-LION-DEN (1-833-546-6336)Follow The A&P Professor on Twitter, Facebook, Blogger, Nuzzel, Tumblr, or Instagram! Topics 1 minute Sperm speed Hematopoiesis in the gut How long does a Lego take to get through the alimentary canal? We have a new sponsor? Who is it? Mid-Semester Check-Ins Keep Your A&P Course on Track Listener Feedback 2.5 minutes Listener Charlie Taylor has feedback on how he handles incorrect student answers after a test. Word Dissections 4.5 minutes Chimerism Allograft Progenitor cell Kevin's Unofficial Guide to the Annual HAPS Conference 1.5 minutes I need your help for the next edition of Kevin's episode on getting ready for the HAPS conference. Questions Your own experiences What you've taken away from HAPS conferences Tips and advice (especially secret, superlative tips from longtimers) I need a bit of SOUND from you. Call in or send a recording! (but text is okay, too) Book Club 3.5 minutes Small Teaching: Everyday Lessons from the Science of Learning by James Lang amzn.to/2Em0FY3 Check out The A&P Professor Book Club If the hyperlinks here are not active, go to TAPPradio.org to find the episode page. More details at the episode page. Transcript available at the script page. Listen to any episode on your Alexa device. Join The A&P Professor social network: Blog Twitter @theAPprofessor Facebook theAPprofessor Instagram theAPprofessor YouTube Amazon and TextExpander referrals help defray podcasting expenses.Transcript and captions for this episode are supported by the American Association of Anatomists.anatomy.org The Human Anatomy & Physiology Societyalso provides support for this podcast. theAPprofessor.org/haps(Clicking on sponsor links helps let them know you appreciatetheir support of this podcast!)
Drs. Nuelle and Cole discuss "Can Competitive Athletes Return to High-Level Play After Osteochondral Allograft Transplantation of the Knee?"
Drs. Nuelle and Cole discuss "Can Competitive Athletes Return to High-Level Play After Osteochondral Allograft Transplantation of the Knee?"
Drs Leland and Tokish discuss "Preliminary Results of Superior Capsule Reconstruction Using Dermal Allograft Patch"
Drs Leland and Tokish discuss "Preliminary Results of Superior Capsule Reconstruction Using Dermal Allograft Patch"
Amanda Drobnis has a technology that facilitates the use of tissue from animal placentas to regenerate tissue in other animals. The procedure, known as a placental allograft, is gaining acceptance in human medicine. Amanda plans to translate that trend to the veterinary space. I met Amanda at a mentoring session at The Capital Network (TCN), a really valuable institution that helps founders and investors. Some of the highlights of the interview include: Intro and a Shout Out to The Capital Network How Amanda Discovered What She Wanted to Do in Life Regenerative Technology in Use in Human Medicine Being Applied to the Animal Space “…this therapy in particular is really interesting because it has all of the proteins and all of the properties to regenerate tissue, and we can now have the technology to use it at a room temperature.” “…almost no chance of [tissue] rejection” Creating a New Source of Recurring Revenue for Vets “…you already have a population of veterinarians and influencers that understand the value of the product…” Some Research Will Be Needed Amanda’s Father Is an Entrepreneurial Physician Who Has Invented the Technology Amanda’s Experience with TCN Horseback Riding Teaches Important Lessons Amanda Thinks Her Business Could Grow to Annual Sales of $20 million It Even Re-Grows Hair at the Wound Site!
Chris Graham is Chief Business Development Officer at Community Tissue. Responsible for the successful performance of the Business Development, Sales, Marketing, and Customer Service & Distribution departments for the world’s largest tissue bank Chris is located in-Dayton, OH Dr. Nikhil Verma of Mdwest Orthopaedics at Rush, Steve Kashul and Chris discuss allograft tissue in Sports Medicine, how it functions today and how It will function in the future.
Dr. Nikhil Verma from Midwest Orthopaedics at Rush and Steve Kashul talk with Chris Graham from Community Tissue Services about tissue donation, the use of Allograft Tissue in Sports Medicine: how it functions today and in the future. Chris Graham is … Continue reading →
Dr. Domingue interviews dental regenerative therapy experts, Drs. Kevin Frawley, Craig Heinen, and Chase White at the Voices of Dentistry conference. This quick-witted quartet revels in past practices of implant dentistry, specifically with IMZ implants, and compares them to the methods of today. They warn young dentists to avoid clutching to the newest, flashiest procedures, and instead, to have a basic comprehension of all the techniques so they “have all the tools in their quiver.” Because in the end, you can’t beat or cheat biology. Recorded live from the Voices of Dentistry Conference in Phoenix, AZ by Drs. Danny Domingue and Justin Moody. The views expressed in this episode are those of the individual participants and not necessarily that of the AAID. Links from this Episode: To find course by AAID credentialed members, check the education section of the AAID website here. To learn more about surgical esthetics, visit https://www.surgicalesthetics.com/ See what’s possible at the AAID’s 67th Annual Conference September 26 - 29, 2018 in Dallas TX. Register now! September 26-29, 2018 | Hyatt Regency Dallas | Dallas, Texas REGISTER NOW FOR THE AAID 67TH ANNUAL CONFERENCE American Academy of Implant Dentistry Founded in 1951, the Academy is the first professional organization in the world dedicated to implant dentistry. Its membership includes general dentists, oral and maxillofacial surgeons, periodontists, prosthodontists and others interested in the field of implant dentistry. As a membership organization, we currently represent over 5,500 dentists worldwide. Want to be a guest on the podcast? Email us at podcast@aaid.com. Subscribe to us on iTunes, Stitcher Radio, Podcasts, SoundCloud and, of course, check out our website at www.aaidpodcast.com.
Commentary by Dr. Valentin Fuster
Commentary by Dr. Valentin Fuster
The association between preoperative tibial subchondral bone marrow lesion (BML) patterns and outcomes after isolated meniscus allograft transplantation (MAT) are unknown. The purpose of this study was to determine (1) if a superior classification means exists (ie, high interrater reliability [IRR]) for grading tibial subchondral BML before isolated MAT and (2) whether quality and/or severity of preoperative tibial subchondral BML patterns was associated with clinical outcomes and/or failure rates after isolated MAT. Nearly two-thirds of patients who undergo isolated MAT have subchondral BML on preoperative MRI. Our findings suggest that increasing BML size (Welsch et al) is correlated with worse postoperative pain measures (KOOS pain, WOMAC pain) and worse activity ratings (Marx Activity Rating Scale). Additionally, increasing disruption or depression of the normal contour of the cortical surface, with or without lesion contiguity with the subjacent articular surface (Costa-Paz et al), is correlated with greater postoperative satisfaction. Click here to read the article.
The last time OIS Podcast talked with David Muller, he was leaving Avedro to start a new company. Two years later, Allotex has raised capital from a strategic investor and is preparing to enter clinical trials in Europe.
Regenerative medicine is fast becoming an area of medicine with the potential to help heal damaged tissues and organs. It can also possibly offer solutions and hope today for people who have conditions that many thought before were beyond repair.Amniotic placental tissue injection is a treatment to help resolve acute tendon injuries, and is showing promise for regenerative effects on injured, painful joints, and back pain without the need for drugs or surgery.Here to discuss Placenta Allograft for regeneration of tissue, is Thomas Plut, DO. He is a sports medicine specialist with the Orthopedic program at Lourdes Health System.
Irreparable peroneus brevis tendon tears are uncommon, and there is scant evidence on which to base operative treatment. Options include tendon transfer, segmental resection with tenodesis to the peroneus longus tendon, and allograft reconstruction. However, the relative effectiveness of the latter 2 procedures in restoring peroneus brevis function has not been established. Allograft reconstruction of a peroneus brevis tendon tear in this model substantially restored distal tension when the peroneal tendons and their antagonists were loaded to 50% and 100% of physiologic load. Tenodesis to the peroneus longus tendon did not effectively restore peroneus brevis tension under the tested conditions. To view the article, click here.
Commentary by Dr. Valentin Fuster
Background: Oronasal fistulas are a frequent complication after cleft palate surgery. Numerous repair methods have been described, but wound-healing problems occur often. The authors investigated, for the first time, the suitability of multilayered amniotic membrane allograft for fistula repair in a laboratory experiment (part A), a swine model (part B), and an initial patient series (part C). Methods: In part A, one-, two-, and four-layer porcine and human amniotic membranes (n = 20 each) were fixed in a digital towing device and the force needed for rupture was determined. In part B, iatrogenic oronasal fistulas in 18 piglets were repaired with amniotic membrane allograft, autofetal amniotic membrane, or small intestinal submucosa (n = 6 each). Healing was evaluated by probing and visual inflammation control (no/moderate/strong) on postoperative days 3, 7, 10, and 76. Histological analysis was performed to visualize tissue architecture. In part C, four patients (two women and two men, ages 21 to 51 years) were treated with multilayered amniotic membrane allograft. Results: In part A, forces needed for amniotic membrane rupture increased with additional layers (p < 0.001). Human amniotic membrane was stronger than porcine membrane (p < 0.001). In part B, fistula closure succeeded in all animals treated with amniotic membrane with less inflammation than in the small intestinal submucosa group. One fistula remained persistent in the small intestinal submucosa group. In part C, all fistulas healed completely without inflammation. Conclusions: Amniotic membrane is an easily available biomaterial and can be used successfully for oronasal fistula repair. The multilayer technique and protective plates should be utilized to prevent membrane ruptures.
CD160 is a cell surface molecule expressed by most NK cells and approximately 50% of CD8(+) cytotoxic T lymphocytes. Engagement of CD160 by MHC class-I directly triggers a costimulatory signal to TCR-induced proliferation, cytokine production and cytotoxic effector functions. The role of CD160 in alloimmunity is unknown. Using a newly generated CD160 fusion protein (CD160Ig) we examined the role of the novel costimulatory molecule CD160 in mediating CD4(+) or CD8(+) T cell driven allograft rejection. CD160Ig inhibits alloreactive CD8(+) T cell proliferation and IFN-γ production in vitro, in particular in the absence of CD28 costimulation. Consequently CD160Ig prolongs fully mismatched cardiac allograft survival in CD4(-/-), CD28(-/-) knockout and CTLA4Ig treated WT recipients, but not in WT or CD8(-/-) knockout recipients. The prolonged cardiac allograft survival is associated with reduced alloreactive CD8(+) T cell proliferation, effector/memory responses and alloreactive IFN-γ production. Thus, CD160 signaling is particularly important in CD28-independent effector/memory CD8(+) alloreactive T cell activation in vivo and therefore may serve as a novel target for prevention of allograft rejection.
Riley J. Williams III, MD performs a demonstration of a dowel-method medial femoral condyle osteochondral allograft transplantation on a cadaveric right knee.
Fakultät für Biologie - Digitale Hochschulschriften der LMU - Teil 03/06
Chronic allograft dysfunction (CAD) following kidney transplantation is characterized by progressive fibrosis and a smoldering inflammatory infiltrate. A modified Fischer 344 (RT1lvl) to Lewis (RT1l) rat renal allograft model was used to study transcriptomic changes during the initiation and progression of CAD and to identify potential therapeutic modes of action of treatment with 13cRA previously shown to limit the development of CAD. Transcriptomic profiling was performed using Affymetrix DNA arrays at time points 0, 7, 14 and 56 days after transplantation. The animal model showed development of significant chronic fibrotic damage with accompanying inflammatory infiltrate by day 56 after transplantation. Regulatory pathways were identified by the Database for Annotation, Visualization, and Integrated Discovery (DAVID) and modulated, based on the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways database. Microarray analysis revealed dramatic changes in the mRNA expression levels of genes associated with inflammation and fibrosis, as well as the hedgehog and WNT pathways, with a gradual increase in the number of differentially regulated genes during progression of tissue damage. Disease phenotype, as well as differential regulation of select components of the hedgehog, canonical WNT and WNT-Ca2+ signaling pathways could be verified by quantitative PCR (qPCR) and immunohistochemistry. Treatment with 13cRA, not only attenuated disease progression, but even reversed early effects of CAD. The overall effects of the treatment are mediated by a potentially direct influence on fibrosis and inflammation associated gene expression, as well as by a specific modulation, observed for hedgehog and WNT pathway activations. The results identify a series of potential pathways that may represent therapeutic targets in chronic allograft dysfunction.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 08/19
In der vorliegenden Studie wurde das klinische Ergebnis nach vorderer Kreuzbandplastik durch mechanisch gereinigtes fresh frozen Allograft aus dem mittleren Patellarsehnendrittel mit der, unter Zufallsauswahl bestimmten vorderen Kreuzbandplastik aus dem mittleren Patellarsehnendrittel Autograft verglichen. 20 Patienten, die während einer Zweitrekonstruktion des vorderen Kreuzbandes mit einem Patellarsehnendrittel Allograft versorgt worden waren, wurden durchschnittlich 20,4 Monate postoperativ nachuntersucht. Als Vergleichspopulation dienten 20 Patienten die, in der Operationsfolge als jeweils nächste, im Rahmen eines Revisionseingriffs mit einem mittleren Patellarsehnendrittel Autograft versorgt worden waren. Beide Gruppen unterschieden sich weder in Bezug auf das durchschnittliche Alter noch auf das Geschlecht signifikant voneinander. Als Hauptzielkriterium fand das Formblatt zur Untersuchung des Knies des IKDC 2000 Scores Anwendung. Die Patienten wurden auf Stabilität, Bewegungsumfang, Schmerzsymptomatik und auf radiologische Veränderungen hin untersucht. Die objektive Messung der vorderen Translation durch den KT 1000™ Knee Ligament Arthrometer® zeigte keinen signifikanten Unterschied zwischen beiden Gruppen. Das durchschnittliche postoperative Schmerzverhalten erwies sich in der Allograftgruppe als signifikant niedriger im Vergleich zur Autograftgruppe (kleinstes p= 0.007). Ein signifikanter Unterschied im Schmerzverhalten zum Zeitpunkt der Nachuntersuchung konnte nicht nachgewiesen werden. Bei deutlich mehr Patienten der Autograftgruppe konnte während der Nachuntersuchung ein Extensionsdefizit festgestellt werden (p=0,008). Hingegen zeigte die radiologische Diagnostik keine signifikanten Unterschiede hinsichtlich degenerativer Veränderungen. Bei der subjektiven Beurteilung durch die Patienten auf Grundlage des IKDC 2000 Scores (Formblattes zur subjektiven Beurteilung des Knies) konnte ebenfalls kein signifikanter Unterschied zwischen beiden Gruppen ermittelt werden. Die Auswertung des Formblattes zur Untersuchung des Knies des IKDC 2000 Scores ergab bei 15% der Patienten der Allograftgruppe eine Zuordnung zur Leistungsgruppe A, bei 75% zur Leistungsgruppe B. 10% der Patienten konnten hier der Kategorie C zugeordnet werden. Bei der Auswertung der Autograftgruppe konnten 10% der Patienten der Leistungsgruppe A zugeordnet werden, 75% der Gruppe B und 15% der Gruppe C. Dieser Unterschied war nicht signifikant. Bei allen in der Studie untersuchten Patienten wurde durch den Revisionseingriff eine deutliche klinische Verbesserung erreicht. Die von uns verwendeten Allografttransplantate erwiesen sich gegenüber den damit verglichenen Autografttransplantaten sowohl im Hinblick auf Stabilität, als auch in anderen wichtigen klinischen Aspekten, zum Zeitpunkt der Nachuntersuchung als gleichwertig. Den Vorteilen des günstigeren postoperativen Schmerzverhaltens, der nicht vorhandenen Entnahmemorbidität, sowie des besseren Extensionsverhaltens, stehen Nachteile wie ein, wenn auch geringes, potentielles Infektionsrisiko und höhere Kosten gegenüber. Unserer Ansicht nach stellen mechanisch gereinigte fresh frozen Allografts eine empfehlenswerte Alternative zu autologen Transplantaten des mittleren Patellarsehnendrittels dar.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 07/19
Thu, 15 Nov 2007 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/8059/ https://edoc.ub.uni-muenchen.de/8059/1/Reich_Philipp.pdf.pdf Reich, Philipp ddc:600, ddc:610, Medizi
Hurst's the Heart Online Update
Background: The CD40-CD40L (CD154) costimulatory pathway plays a critical role in the pathogenesis of kidney allograft rejection. In renal transplant biopsies, CD4+ CD40L+ graft-infiltrating cells were detected during chronic rejection in contrast to acute rejection episodes. Using a rapid noninvasive FACS procedure, we were able to demonstrate CD40L upregulation in peripheral blood of patients with chronic renal allograft dysfunction. Materials and Methods: Whole blood from recipients of renal allografts was stimulated with PMA and ion-omycin and measured by flow cytometry. Patients were assigned to three groups based on transplant function. Group 1: 26 patients with excellent renal transplant function; group 2: 28 patients with impaired transplant function; group 3: 14 patients with chronic allograft dysfunction and group 4: 8 healthy controls. Results: The median percentage +/-SEM of CD4+/ CD40L+ cells stimulated ex vivo at 10 ng/ml PMA was as follows: group 1: 28.3 +/- 4.1%; group 2: 18.4 +/- 2.4%; group 3: 50.1 +/- 5.0% and group 4: 40.4 +/- 3.4%. Subdivisions of groups 2 and 3 resulted in different CD40L expression patterns. Patients with increased serum creatinine since the initial phase after transplantation ( groups 2a and 3a) revealed a higher percentage of CD4+ CD40L+ cells than patients showing a gradual increase over time ( groups 2b and 3b). Consequently, patients of group 3a exhibited a significantly reduced transplant function compared with those of group 3b. Conclusion: After PMA + ionomycin stimulation, patients with excellent kidney graft function displayed significantly reduced expression of CD40L surface molecules on CD4+ cells early after transplantation. Those with a chronic dysfunction of the renal graft showed significantly more CD4+ cells expressing CD40L compared to the other transplanted groups. These results demonstrate that the percentage of CD4+ CD40L+ cells stimulated ex vivo in peripheral blood may be a valuable marker for chronic allograft nephropathy. Copyright (C) 2004 S. Karger AG, Basel.
Fri, 1 Jan 1993 12:00:00 +0100 http://epub.ub.uni-muenchen.de/3015/ http://epub.ub.uni-muenchen.de/3015/1/006.pdf Brockmeyer, Carsten; Ulbrecht, Matthias; Schendel, Dolores J.; Weiß, Elisabeth; Hillebrand, Günther; Burkhardt, Klaus; Land, Walter; Gokel, Michael J.; Riethmüller, Gert; Feucht, Helmut E. Brockmeyer, Carsten; Ulbrecht, Matthias; Schendel, Dolores J.; Weiß, Elisabeth; Hillebrand, Günther; Burkhardt, Klaus; Land, Walter; Gokel, Michael J.; Riethmüller, Gert und Feucht, Helmut E. (1993): Distribution of cell adhesion molecules (ICAM-1, VCAM-1, ELAM-1) in renal tissue during allograft rejection. In: Transplantation, Vol. 55: pp. 610-615.
© 2020-2025 Ivy Podcast Discovery LLC
