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Objectives: This review aimed to gather and summarize the existing information on the clinical application of allogeneic umbilical and placental derivatives in the treatment of temporomandibular joint disorders. Methods: Research on the impact of the use of umbilical and placental derivatives on reducing pain and improving mobility in the temporomandibular joint was included in the article. Medical databases, including ACM, BASE, Cochrane, Scopus, Google Scholar, ClinicalTrials.gov, and PubMed, were searched. The final search was conducted on 20 October 2024. Results: Out of the 43 records found, 5 were considered eligible for further analysis and showed that the use of placental and umbilical derivatives has the greatest potential in the treatment of ankylosis. The intra-articular administration of these tissues into the TMJ brings beneficial results, but they are similar to other, parallel methods, such as PRP or corticosteroids. Conclusions: The studies discussed may guide researchers in expanding clinical trials, particularly by including more patients with TMDs, and have promising potential in ankylotic disorders, where amniotic membrane use has shown clear benefits. [ABSTRACT FROM AUTHOR]

Diabetic wounds are hard-to-heal due to complex multifactorial dysregulation within the micro-environment, necessitating the development of novel regenerative approaches to stimulate healing. This study investigated whether the combined therapeutic application of two novel cellular tissue products, namely a decellularized collagen-rich amniotic membrane (AmR) and growth factor-rich umbilical cord blood serum (UCBS) could have a positive synergistic effect on long-term healing outcomes by stimulating both superficial wound closure and wound bed regeneration. Full thickness excisional wounds were induced on obese diabetic mice (B6.Cg-lepob/J, ob/ob, n = 23) and treated with either: 1) Standard wound care (control); 2) UCBS; 3) AmR or 4) UCBS + AmR. Macroscopic wound closure was assessed on days 0, 3, 7, 10 and 14 post wounding. To determine the potential impact on wound recurrence, endpoint analysis was performed to determine both the overall quality of healing histologically as well as the molecular state of the wounds on day 14 via proteomic analysis. The data demonstrated the presence of both healers and non-healers. Re-epithelization took place in the healers of all treatment groups, but underlying tissue regeneration was far more pronounced following application of the combined treatment (UCBS + AmR), suggesting improved quality of healing and potentially a reduced change of recurrence long term. In non-healers , wounds failed to heal due to excessive slough formation and a reduction in LTB4 expression, suggesting impaired antimicrobial activity. Care should thus be taken since the cellular tissue product therapy could pose an increased risk for infection in some patients. • Combined use of amniotic membrane and UCBS can promote regeneration of diabetic wounds. • Umbilical cord blood serum contains growth factors and chemokines in abundance. • Cellular tissue product therapy could pose an increased risk for infection. • In non-healers excessive slough formation coincided with a reduction in LTB4 expression. [ABSTRACT FROM AUTHOR]

Background: Football is a leading cause of sports-related injuries, accounting for more than half of time-loss injuries in men's collegiate sports. Amniotic membrane and umbilical cord (AM/UC) powder injection is a novel treatment that may aid in functional recovery and return to play in collegiate athletes due to its anti-inflammatory, anti-scarring, and pro-regenerative properties. Methods: A single-center, retrospective chart review was performed on consecutive college football players who sustained acute muscle or ligament tear and were subsequently treated with 50 or 100 mg injection of AM/UC powder (Clarix Flo, BioTissue, Miami, FL). Data collection included patient demographics, diagnosis, grade and extent of injury, position of the player, time to return to play (in days), and complications. Results: Ten athletes with tears of the medial collateral ligament (n=3), hamstring (n=6), and abdomen (n=1) were included for analysis. The majority (n=6) of tears were partial (grade 2), with partial to full tears (grade 2± 3) noted in 2 patients, and a complete tear (grade 3) noted in 2 patients. Athletes returned to play 29.6 ± 15.2 days post-injury, with 80% of athletes returning to play within 4 weeks. No complications or re-injuries occurred during the follow-up period of 6 months. Conclusion: Injection of AM/UC powder is a safe treatment that enables quick return to play in this cohort of football players suffering from muscle or tendon tears. Prospective, randomized studies are warranted to verify whether injection of AM/UC can hasten return to play compared to the current standard treatment. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Introduction: Globally, the health and quality of life of millions of people are negatively affected by diabetic foot ulcers (DFUs). To treat these chronic wounds, a novel injectable drug for closing DFUs composed of micronized amniotic membrane was developed. This new therapeutic drug for wound repair expands on traditional allograft therapies by allowing extracellular matrix proteins, growth factors, and cytokines to reach wound anatomies in DFUs that are difficult to treat. The aim of this study was to evaluate the components of the injectable drug. Methods: Liquid chromatography with tandem mass spectrometry and a Quantibody® human cytokine array were conducted to identify and characterize growth factors and proteins known to contribute to wound healing. In addition, hyaluronic acid was quantified and compared between the injectable and human amniotic fluid using a hyaluronan enzyme-linked immunosorbent assay. Cell proliferation, migration, angiogenesis, and viability were evaluated to assess the performance of the novel injectable in vitro. The rheometric properties of the product were evaluated by assessing it pre- and post-injection through a 22-gauge needle to measure the viscosity using a shear- and temperature-dependent viscosity protocol. Results: Liquid chromatography with tandem mass spectrometry and Quantibody® human cytokine array revealed growth factors and proteins imperative for wound healing. The quantified hyaluronic acid was compared between the injectable and human amniotic fluid, resulting in a statistically significant difference, with higher protein concentrations found in the injectable. In vitro qualitative and quantitative analysis confirmed an increase in cell viability, proliferation, and migration when treated with the drug. An evaluation of the rheometric properties of the injectable drug after passing through a 22-gauge cannula presented no alterations to the biologic drug. Conclusions: Collectively, these data present the potential of a novel injectable drug for the treatment of DFUs. [ABSTRACT FROM AUTHOR]

Purpose: To propose an ultrathin biological amniotic membrane (btAM) thinner than 10 μm as the graft to treat highly myopic macular holes (MH). Methods: This pilot study included 14 patients affected by refractory macular holes associated with high myopia. btAM was used as a bandage covering the holes. The best-corrected visual acuity (BCVA), fundus photography, and optical coherence tomography (OCT) before and after surgery were compared. Results: The mean MH size was 865.93 ± 371.72 μm and all the MHs achieved anatomical closure. The btAM located centrally and fully on MHs from fundus photography yet no obvious visual masking was complained. The average BCVA 1 month, 3, and 6 months after surgery were 0.95 ± 0.24, 0.92 ± 0.23, 0.92 ± 0.23 logMAR, respectively, improved significantly compared to pre-operative BCVA (1.24 ± 0.42 logMAR, all P < 0.05). Ten out of 14 (71.4%) exhibited 2C closure patterns (formally closed and no bare RPE) on OCT. Conclusion: The btAM thinner showed a favorable anatomical success with less risk of parafoveal atrophy or iatrogenic injuries and shortened the dissolving time. [ABSTRACT FROM AUTHOR]

Allogeneic hematopoietic stem cell transplantation (alloSCT) is the cornerstone treatment for various hematopoietic disorders, but its utility is often compromised by chronic graft-versus-host disease (cGvHD), affecting skin integrity and leading to ulcer formations. Traditional treatments, including systemic and topical therapies, frequently fail in severe cases. This study retrospectively examines three patients with therapy-resistant ulcers due to cGvHD post-alloSCT treated at the University Hospital of Regensburg in 2023. We evaluated the therapeutic impact of human amniotic membrane (hAM) transplantation—a novel approach utilizing hAM's anti-inflammatory, anti-microbial, and anti-fibrotic properties for wound healing. Surgical debridement was followed by hAM application and routine follow-up. HAM transplantation led to complete wound closure in two out of three patients and a significant reduction in local pain and infection rates. The treatment alleviated the need for regular dressing changes within three months in two patients, demonstrating the hAM's efficacy in fostering rapid and sustained healing. The utilization of hAM represents a promising alternative for the management of refractory skin ulcers in cGvHD patients, particularly when conventional methods are inadequate. [ABSTRACT FROM AUTHOR]

The multifactorial nature of diabetic wounds necessitates a mixed approach for successful treatment. Compensation of degenerated wound tissue extracellular matrix (ECM) and application of anti-inflammatory and antioxidant agents have been shown to be promising. Here, an attempt was made to fabricate a biocompatible wound dressing from curcumin-incorporated human amniotic membrane (HAM) ECM-derived scaffold to accelerate diabetic wound healing in rats. Therefore, after inducing diabetes, an excisional ischemic wound was created on rat skin, then treatments were administered for a period of 21 days. The main groups were the diabetic animals that received an engraftment of HAM scaffold (HAMS group) and the curcumin-incorporated HAMS (HAMS/β/C group). Evaluation at post-wounding days 7, 14, and 21 indicated that the parameters related to regeneration, including wound closure, volume of new epidermis and dermis, proliferating cells, fibroblasts, blood vessels, collagen deposition, and tensile strength, as well as transcripts of Vegf, bFgf, and Tgf-β genes of the healed wound in both HAMS and HAMS/β/C groups were considerably greater than those of the diabetic group. Conversely, the presence of inflammatory cells, i.e., neutrophils and macrophages, and the transcripts of Tnf-α and Il-1β showed a dramatic decrease in the treated groups relative to the diabetic group. Finally, compared to the HAMS group, considerable differences were found with the HAMS/β/C group in almost all evaluated parameters. Overall, these results suggest that using the complementary or synergistic effects of curcumin and HAMS could be a promising approach to improve diabetic wound healing. [ABSTRACT FROM AUTHOR]

Chronic wounds result from the body's inability to heal, causing pain, pathogen entry, limited treatment options, and societal burden. Diabetic foot ulcers are particularly challenging, often leading to severe complications like leg amputation. A clinical study tested AMNIODERM+®, a new device with a lyophilized human amniotic membrane (HAM), on chronic diabetic foot ulcers. Participants had diabetic neuropathic or neuroischemic leg wounds (2–16 cm2) unhealed by 20% after six weeks of standard care. This study showed significant wound healing improvements with AMNIODERM+®. The median wound size reduction after 12 weeks was 95.5%, far exceeding the null hypothesis of 20% change. Additionally, 65% of patients achieved complete ulceration healing, surpassing the 50% efficacy requirement. The median time to full closure was 11.4 weeks, with the proportion of completely healed patients rising progressively, reaching 55% by week 11. These findings, from the clinical trial "Freeze-dried amniotic membrane in the treatment of nonhealing wounds", suggest AMNIODERM+® as a promising future treatment for chronic diabetic foot ulcers. The published results were obtained as part of a clinical trial entitled "Freeze-dried amniotic membrane in the treatment of nonhealing wounds: a single-arm, retrospectively-perspective clinical trial", EUDAMED Nr. CIV-SK-22-10-041146. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility of using a novel device designed for minimally invasive suturing to anchor fetal membranes to the uterine wall and to close surgical defects after fetoscopy. Methods: We tested the WestStitch™ suturing device both ex vivo and in vivo. In the ex‐vivo studies, 12‐Fr trocar defects were created with a fetoscope in five specimens of human uterine tissue with fetal membranes attached. Specimens were examined for integrity of the anchoring stitch. For the in‐vivo studies, trocar defects were created in the two uterine horns of three pregnant ewes, each carrying twins at approximately 79–90 days' gestation. One trocar defect in each ewe was repaired using the suture device, and the other was left unrepaired as a control. The repair sites were examined for membrane‐anchoring integrity when the defect was created and at delivery. Results: Fetal membranes were anchored successfully to the uterine myometrium using the suture‐delivery device in all five experiments performed ex vivo. The in‐vivo experiments also revealed successful membrane anchoring compared with controls, both at the time of device deployment and 1–9 weeks after the procedure. Conclusions: We successfully anchored amniotic membranes to the underlying myometrium using a suturing device, both ex vivo and in vivo. Further studies are needed to evaluate the efficacy of the device and to determine whether it can successfully anchor fetal membranes percutaneously in human patients. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Purpose: Chronic radiation cystitis (CRC) develops after radiation therapy and can present with symptoms like urinary frequency, urgency, pelvic pain, and nocturia. We have previously reported that amniotic bladder therapy (ABT) provides symptomatic improvement in refractory CRC patients for up to 3 months. Herein, we evaluated the durability of ABT up to 6 months. Materials and methods: CRC patients recalcitrant to previous treatments received ABT comprised of intra-detrusor injections of 100 mg micronized AM diluted in 10 mL 0.9% preservative-free sodium chloride. Clinical evaluation and questionnaires (Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Bladder Pain/Interstitial Cystitis Symptom Score (BPIC-SS), Overactive Bladder (OAB) Assessment Tool, SF-12 Health Survey) were repeated at pre-op and 2, 4, 8, 12, 16, 20, 24, and 36 weeks post-injection. Results: Five consecutive patients with a mean age of 64.4 ± 20.1 years with a median CRC duration of 10 years were included and followed for 6 months. After ABT, the lower urinary tract symptoms improved as early as 2 weeks and were maintained up to 20 weeks. BPIC significantly improved from 36.6 ± 1.1 at baseline to 12.6 ± 1.5 at 16 weeks and 13.8 ± 2.9 at 20 weeks. At 24 and 36 weeks, the improvement was maintained in four (80%) of the five patients (BPIC = 13.8 ± 1.0). Uroflow assessment showed voiding volume improved two-fold in four of the five patients at 24 weeks compared to baseline. Conclusion: Our data suggest that a significant number of CRC patients may have durable benefit after ABT. Despite this, some of them can show symptoms rebound at 24 weeks. [ABSTRACT FROM AUTHOR]

Objective Animal Studied Procedures Results Conclusions The application of canine amniotic membrane (cAM) for corneal reconstruction is widely used in the veterinary field. However, the information on biological properties and alternative forms of cAM for corneal wound healing is limited. This study aimed to investigate the proteomic profiles and corneal wound healing properties of cAM, cAM extract (cAME), and lyophilized cAM extract (cAMX).A total number of 14 cAMs were sterilely harvested from healthy full‐term puppies and randomly divided into three different forms: cAM (n = 14), cAME (n = 14), and cAMX (n = 14).Each form of cAMs was subjected to proteomic analysis using label‐free liquid chromatography coupled with tandem mass spectrometry (LC–MS/MS), followed by bioinformatic analysis. The proteins were classified into properties by comparing them with the literature search on human amniotic membrane (hAM) properties and the effect on corneal wound healing when given topically.The analyses identified 8136 proteins in cAM, 8211 proteins in cAME, and 7093 proteins in cAMX. A total number of 100 proteins were matched with proteins in hAM properties and were classified into anti‐inflammatory, anti‐fibrotic, anti‐microbial, anti‐angiogenic, promotion of epithelialization, analgesic, and support cell adhesion and growth properties. Furthermore, proteins with corneal wound healing effects were identified in cAME and cAMX.cAM and its extracts contain numerous proteins, including proteins related to corneal wound healing properties. Additionally, cAME and cAMX showed proteins involved in corneal wound healing and their potential benefits for topical use in ophthalmology. [ABSTRACT FROM AUTHOR]

Background and objective. There are different types of skin substitutes, including human amniotic membrane, which is the oldest of all. It has different properties: it acts as an analgesic barrier, is antimicrobial, anti-inflammatory, promotes epithelialization and reduces fibrosis, among others. Its use is described in different types of wounds, such as chronic ulcers, refractory vascular ulcers, burns, etc. The aim of this paper is to present our experience with the use of human amniotic membrane in different types of wounds in a specialized center in La Paz, Bolivia, where we do not have a tissue bank nor do we have amniotic membrane available in its commercial form. Methods. Retrospective study describing the method of obtaining, storing and using human amniotic membrane in different cases, and its behavior while it is stored in cold storage. Results. We present 4 clinical cases as an example: burn, dissecting hematoma with chronic wound, chemical burn and dog bite. Regarding the conservation of the amniotic membrane, in our study it was free of contamination for up to 3 months. Conclusions. In our experience, the amniotic membrane is a useful and easy-to-obtain dermal substitute, which can be used in various types of wounds, with a storage that was simple for us and that we believe can be easily reproduced in those places that do not have a tissue bank. [ABSTRACT FROM AUTHOR]

Introduction: Root coverage procedures are often carried out for compromised aesthetics, dentinal hypersensitivity, difficulty in the maintenance of plaque control, root caries and bone loss. Regenerative attempts are hindered by the root surface’s avascularity and microbiologically compromised condition. Furthermore, freshly created tissue needs to withstand the physical pressures of mastication and procedures related to the maintenance of oral hygiene by the patient. The key issues include surgical challenges, time and patients’ discomfort despite the various surgical methods that have been performed for the root coverage. The complications related to donor site, sparked interest for the development of newer innovative techniques that helps to meet patient’s aesthetic and functional needs. Pinhole surgical technique (PST) being minimally invasive is used in our study to treat gingival recession using amniotic membrane. Materials and Methods: A total of 20 participants were selected randomly with having Miller’s Class I or II recession. Each patient received thorough information on how to practice good oral hygiene. A scaling and root planning process was carried out across the entire mouth. Re-evaluation of research sites was done 1 month after phase I therapy to validate its appropriateness. PST was done randomly on the chosen sites, along with the application of amniotic membrane. Results: All the clinical parameters i.e., recession depth (RD), recession width (RW) and clinical attachment level (CAL), were seen improving significantly at 6 months postoperatively compared to baseline except width of keratinized gingiva (WKG) (P = 0.08) and thickness of keratinized gingiva (TKG) (P = 0.14). All the clinical parameters i.e., RD (P = 0.017), RW (P = 0.017), probing depth (P = 0.03) and CAL (P = 0.05) improved significantly at 12 months postoperatively compared to baseline. However, WKG and TKG showed statistically insignificant changes at 12 months postoperatively (P = 0.08, P = 0.14). Significant difference in Visual Analogue Scale score was seen postoperatively at day 1, 3 and 5. Conclusion: Pinhole surgical approach is used to treat Miller’s Class I-II recession. It may be a better option than the other techniques because it is less invasive, time and money efficient. For the establishment of a normal vasculature and early wound healing, the usage of amniotic membrane as an adjunct is a better alternative. [ABSTRACT FROM AUTHOR]

The reparative properties of amniotic membrane allografts are well-suited for a broad spectrum of specialties. Further enhancement of their utility can be achieved by designing to the needs of each application through the development of novel processing techniques and tissue configurations. As such, this study evaluated the material characteristics and biological properties of two PURION® processed amniotic membrane products, a lyophilized human amnion, intermediate layer, and chorion membrane (LHACM) and a dehydrated human amnion, chorion membrane (DHACM). LHACM is thicker; therefore, its handling properties are ideal for deep, soft tissue deficits; whereas DHACM is more similar to a film-like overlay and may be used for shallow defects or surgical on-lays. Characterization of the similarities and differences between LHACM and DHACM was conducted through a series of in vitro and in vivo studies relevant to the healing cascade. Compositional analysis was performed through histological staining along with assessment of barrier membrane properties through equilibrium dialysis. In vitro cellular response was assessed in fibroblasts and endothelial cells using cell proliferation, migration, and metabolic assays. The in vivo cellular response was assessed in an athymic nude mouse subcutaneous implantation model. The results indicated the PURION® process preserved the native membrane structure, nonviable cells and collagen distributed in the individual layers of both products. Although, LHACM is thicker than DHACM, a similar composition of growth factors, cytokines, chemokines and proteases is retained and consequently elicit comparable in vitro and in vivo cellular responses. In culture, both treatments behaved as potent mitogens, chemoattractants and stimulants, which translated to the promotion of cellular infiltration, neocollagen deposition and angiogenesis in a murine model. PURION® processed LHACM and DHACM differ in physical properties but possess similar in vitro and in vivo activities highlighting the impact of processing method on the versatility of clinical use of amniotic membrane allografts. [ABSTRACT FROM AUTHOR]

An artificial ovary based on the alginate (ALG) hydrogel has been widely implemented to preserve prepubertal female fertility. However, this platform is not fully capable of successful an ovary microenvironment simulation for follicle development, holding great potential for its improvement. Therefore, this experimental study aimed to evaluate the effect of an amniotic membrane extract (AME) -loaded hydrogel on the mouse preantral follicles in vitro development. In order to have better follicle development, first, the impact of different concentrations of follicle-stimulating hormone (FSH) was evaluated on the mouse preantral follicles encapsulated in ALG. Later, the appropriate dose was adjusted for the follicles encapsulated in the ALG-AME hydrogel. Results demonstrated that 100 mIU/ml FSH showed a significant follicle survival rate compared with 10 mIU/ml FSH (P=0.005). According to MTT assay finding, the rate of weight loss, and rheology evaluations, ALG containing 1 mg/ml AME was identified as an optimal sample of follicle culture instead of other AME concentrations. Follicle diameter significantly increased in the ALG-AME 1 hydrogel compared with the ALG control group without AME (P=0.027). The storage modulus of ALG-AME 1 was 773 Pa and retained the follicle morphology for 13 days. No statistically substantial difference was seen in survival, antrum cavity formation, and competent oocyte in terms of the normal chromosomal arrangement and meiotic spindle rate in comparison with the control group. It can be concluded that ALG-AME 1 could not significantly impact the mouse preantral follicle [ABSTRACT FROM AUTHOR]

Background: The perfect repair of damaged skin has always been a constant goal for scientists; however, the repair and reconstruction of skin is still a major problem and challenge in injury and burns medicine. Human amniotic membrane (hAM), with its good mechanical properties and anti‐inflammatory, antioxidant and antimicrobial benefits, containing growth factors that promote wound healing, has evolved over the last few decades from simple skin sheets to high‐tech dressings, such as being made into nanocomposites, hydrogels, powders, and electrostatically spun scaffolds. This paper aims to explore the historical development, applications, trends, and research hotspots of hAM in wound healing. Methods: We examined 2660 publications indexed in the Web of Science Core Collection (WoSCC) from January 1, 1975 to July 12, 2023. Utilizing bibliometric methods, we employed VOSviewer, CiteSpace, and R‐bibliometrix to characterize general information, identify development trends, and highlight research hotspots. Subsequently, we identified a collection of high‐quality English articles focusing on the roles of human amniotic epithelial stem cells (hAESCs), human amniotic mesenchymal stem cells (hAMSCs), and amniotic membrane (AM) scaffolds in regenerative medicine and tissue engineering. Results: Bibliometric analysis identified Udice–French Research Universities as the most productive affiliation and Tseng S.C.G. as the most prolific author. Keyword analysis, historical direct quotations network, and thematic analysis helped us review the historical and major themes in this field. Our examination included the knowledge structure, global status, trends, and research hotspots regarding the application of hAM in wound healing. Our findings indicate that contemporary research emphasizes the preparation and application of products derived from hAM. Notably, both hAM and the cells isolated from it – hADSCs and hAESCs are prominent and promising areas of research in regenerative medicine and tissue engineering. Conclusion: This research delivers a comprehensive understanding of the knowledge frameworks, global dynamics, emerging patterns, and primary research foci in the realm of hAM applications for wound healing. The field is rapidly evolving, and our findings offer valuable insights for researchers. Future research outcomes are anticipated to be applied in clinical practice, enhancing methods for disease prevention, diagnosis, and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Oral epithelial cells were recently shown to be able to differentiate into corneal epithelium, and the efficacy of cultured autologous oral mucosal epithelial cells (CAOMEC) has been suggested by the presence of epithelium replacement. Therefore, the aim of this study was to evaluate the treatment outcome in limbal stem cell deficiency (LSCD) by adding CAOMEC to regular amniotic membrane (AM) treatment. Material and methods: Eyes with LSCD were randomized to two groups to undergo either autologous oral mucosal epithelial cell sheet (CAOMECS) combined with AM transplantation (A group) or AM transplantation alone (B group). Clinical outcome measures were corneal epithelium healing, best corrected visual acuity, symblepharon, corneal transparency, corneal neovascularization and ocular surface inflammation. Results: The normal corneal epithelialization rate in group A (73.33%) was higher than that in group B (35.48%), and the average healing time was shorter (3.45 ±2.12 weeks vs. 4.64 ±1.63 weeks). The symblepharon in the above two groups was improved in the first 3 months after surgery, but after 6 months, part of the B group had recurrence. In improving corneal transparency, group A has obvious advantages. Corneal neovascularization (CNV) was improved to some extent in the first 3 months after surgery, but group A (1.47 ±0.64) was better than group B (1.94 ±0.85) after 6 months. Both groups can improve the inflammatory state to some extent. Conclusions: The transplantation of CAOMECS offers a viable and safe alternative in the reconstruction of a stable ocular surface. The effect is better than that of traditional AM transplantation, mainly in promoting corneal epithelialization, improving ocular surface structure, and reducing fiber and vascular infiltration. [ABSTRACT FROM AUTHOR]

Purpose: To assess changes in symptoms and ocular surface signs following a bilateral sutureless treatment of dehydrated amniotic membrane (dAM) under a specialised bandage contact lens (sBCL) in patients with moderate-to-severe dry eye disease (DED). Patients and Methods: In this prospective pre-post interventional study, 35 patients diagnosed with moderate-to-severe DED, with an Ocular Surface Disease Index (OSDI) score > 30 on current treatment, were enrolled. Assessments were conducted at baseline (day − 30), after 30 days run-in with no additional treatment (day 0 – control), and 30 days post sBCL+dAM treatment (day 30 – treatment). Intervention involved two successive bilateral 4-5 day sutureless applications of dAM (17mm diameter, with a 6 mm central aperture, Omnigen® VIEW) under an 18mm sBCL (OmniLenz®). Symptomatology and ocular signs were measured using OSDI, Dry Eye Questionnaire-5 (DEQ-5), Symptom Assessment iN Dry Eye (SANDE), and other ocular surface health indicators including non-invasive breakup time, corneal and conjunctival staining, and lid wiper epitheliopathy length and width (LWE). Results: While symptomatology remained stable during the 30-day no-treatment run-in, 1-month post-dAM treatment, there was a significant reduction in OSDI scores (from 55.8 to 32.3, p< 0.001), DEQ-5 (from 14.6 to 10.0, p< 0.001), SANDE frequency (from 65.2 to 43.6, p< 0.001), and SANDE severity (from 59.8 to 41.1, p< 0.001). Additionally, there was a notable decrease in the width of LWE staining, from grade 2 (50– 75% of the lid wiper) to grade 1 (25– 50% of the lid wiper) (p=0.011). Conclusion: A bilateral 8– 10-day treatment duration with dAM applied with sBCL demonstrated a 31 to 42% improvement in symptomatology and a decrease in ocular surface signs of mechanical stress. This innovative bilateral treatment approach offers a promising treatment modality for patients with refractory moderate-to-severe DED. [ABSTRACT FROM AUTHOR]

Background: Aplasia cutis congenita (ACC) is a rare congenital skin defect characterized by a focal or extensive absence of the epidermis, dermis, and occasionally, subcutaneous tissue. When the wound caused by this defect is wide or deep, various treatments are used, including skin grafting. The amniotic membrane (AM) is a biological dressing that facilitates re‐epithelialization as it contains mesenchymal cells and numerous growth factors. Objective: To report the efficacy of AM dressings in treating the skin defects of ACC. Method: This study was conducted on five neonates diagnosed with ACC born between 2018 and 2022, referred to the Children's Medical Center in Tehran, Iran. AM dressings were applied on wounds larger than 1 cm2. The wounds were assessed weekly and, if required, an additional AM dressing was applied. Results: The skin defects gradually re‐epithelialized after application of the AM. The complete healing process took around 3.5 weeks on average. No hypertrophic scarring was observed. Conclusion: The application of AM dressing resulted in satisfactory cosmetic outcomes, with no hypertrophic scar formation. Complete healing occurred in all cases except one. The length of the hospital stay ranged from 2 to 6 weeks, depending on the size of the wound. [ABSTRACT FROM AUTHOR]

Background: The amniotic membrane (AM) has shown immense potential in repairing wounds due to its great regenerative qualities. Although the role of AM as a biological scaffold in repairing wounds has been studied well, the tissue regenerative potential of AM‐derived mesenchymal stem cells (MSCs) and conditioned media (CM) derived from it remains to be discovered as of now. Here, we examined the wound healing abilities of fresh and frozen thawed rabbit AM (rAM) along with the MSCs and their lyophilised CM in rabbits challenged with skin wounds. Methods: To elucidate the role of rAM‐MSCs and its CM in repairing the wound, we isolated it from the freshly derived placenta and characterised their differentiation potential by performing an in vitro tri‐lineage differentiation assay besides other standard confirmations. We compared the wound repair capacities of rAM‐MSCs and lyophilised CM with the fresh and cryopreserved AM at different timelines by applying them to excision wounds created in rabbits. Results: By monitoring wound contractions and tissue histology of wounded skin at different time points after the application, we observed that rAM‐MSCs and rAM‐MSC‐derived CM significantly promoted wound closure compared to the control group. We also observed that the wound closure capacity of rAM‐MSCs and rAM‐MSC‐derived CM is as efficient as fresh and cryopreserved rAM. Conclusion: Our findings suggest that rAM‐MSCs and rAM‐MSC derived CM can be effectively used to treat skin wounds in animals and correctly delivered to the damaged tissue using AM as a bioscaffold, either fresh or frozen. [ABSTRACT FROM AUTHOR]

The therapeutic effect of mesenchymal stromal cells (MSCs) has been described for a variety of disorders, including those affecting musculoskeletal tissues. In this context, the literature reports several data about the regenerative effectiveness of MSCs derived from bone marrow, adipose tissue, and an amniotic membrane (BMSCs, ASCs, and hAMSCs, respectively), either when expanded or when acting as clinical-grade biologic pillars of products used at the point of care. To date, there is no evidence about the superiority of one source over the others from a clinical perspective. Therefore, a reliable characterization of the tissue-specific MSC types is mandatory to identify the most effective treatment, especially when tailored to the target disease. Because molecular characterization is a crucial parameter for cell definition, the need for reliable normalizers as housekeeping genes (HKGs) is essential. In this report, the stability levels of five commonly used HKGs (ACTB, EF1A, GAPDH, RPLP0, and TBP) were sifted into BMSCs, ASCs, and hAMSCs. Adult and fetal/neonatal MSCs showed opposite HKG stability rankings. Moreover, by analyzing MSC types side-by-side, comparison-specific HKGs emerged. The effect of less performant HKG normalization was also demonstrated in genes coding for factors potentially involved in and predicting MSC therapeutic activity for osteoarthritis as a model musculoskeletal disorder, where the choice of the most appropriate normalizer had a higher impact on the donors rather than cell populations when compared side-by-side. In conclusion, this work confirms HKG source-specificity for MSCs and suggests the need for cell-type specific normalizers for cell source or condition-tailored gene expression studies. [ABSTRACT FROM AUTHOR]

Objectives: Laryngeal cartilage defects are a major problem that greatly impacts structural integrity and function. Cartilage repair is also a challenging issue. This study evaluated the efficacy of a collagen scaffold enveloped by amniotic membrane (AM/C) on laryngeal cartilage repair. Study Design: Experimental animal study. Methods: Fourteen Dutch rabbits were enrolled in the study. A 5 mm cartilage defect was created in the right and left thyroid lamina. The animals were divided into two groups randomly. Group 1 collagen scaffolds and group 2 AM/C were applied to the right side defects. Left side defects were not repaired, serving as control. Histologic evaluation was done 45 and 90 days following collagen and AM/C application with criteria of tissue and cell morphology, lacuna formation, vascularization, and inflammation. Results: Significant improvement in cartilage repair was observed in the AM/C side compared to the control side in all histologic criteria after 45 days (p<.05). After 90 days, cartilage repair improved in cell morphology, lacuna formation, and inflammation significantly (p<.05). Conclusion: The combination of amniotic membrane and collagen scaffolds provides a promising treatment modality for improving the repair of laryngeal cartilage defects. Level of Evidence: NA. [ABSTRACT FROM AUTHOR]

Introduction: Human amniotic membrane (hAM), obtained after birth, is used in the treatment of various diseases due to its anti-angiogenic, antimicrobial and anti-proliferative properties. In recent years, researches have been focused on the anti-cancer properties of the amniotic membrane. However, reports on this subject are limited. In this study, we aimed to evaluate the anti-cancer effect of the conditioned medium (CM) derived from hAM on various cancer cell lines in vitro. Methods: After cesarean section, placentas of healthy donor mothers were taken and amniotic membrane was obtained. hAM-CM was obtained by incubating amniotic membrane pieces with DMEM with 10% FBS and 1% PSA for 24 hours. HEK293, HUVEC and BV2 for normal cell groups; HEp2, PANC, MDA, A549 for cancer cell groups were cultured. To evaluate the cell viability of hAM-CM in normal and cancer cell lines, XTT test was performed by treating with 75% hAM-CM for 48 hours and the effects on the viability of cancer and normal cells compared to control cells were evaluated. Results:According to the XTT results, after AM-CM treatment, the viability of normal cells decreased by an average of 13% (p<0.05), while there was also a decrease in the viability of cancer cells (HEp2, PANC, MDA, A549) by 4% (ns), 12% (p<0.01), 35% (ns), 18% (p<0.001), respectively. Conclusion: Our results showed that the CM produced from hAM inhibited the proliferation of some cancer cells, while it would not be effective in others. hAM application for breast and lung cancer may be a new hope. [ABSTRACT FROM AUTHOR]

Aim The goal of this study is to assess the effectiveness of implantation of an Ahmed glaucoma valve (AGV) augmented with the use of mitomycin-C (MMC) and preserved amniotic membrane (AM), as a first line of intervention in cases of advanced primary congenital glaucoma (PCG). Patients and methods Prospective clinical and interventional trial was done on 30 eyes of 24 patients, aged between 6 months and 3 years, with advanced PCG at presentation. AGV (model FP8) implantation augmented with use of MMC and two layers of cryopreserved human AM as a primary intervention. Results At all-time intervals (at day 1, 1, 3, and 12 months following surgery), the postoperative intraocular pressures (IOPs) were significantly lower than the preoperative IOPs (16.83±2.78 mmHg at month 12 compared with a preoperative IOP of 38.29±4.23 mmHg). At all times, the postoperative corneal diameter was not noticeably smaller than the preoperative values (13.79±0.57 mm at month 12 compared with preoperative value of 13.93±0.58 mm). Conclusion AGV augmented with the use of MMC and AM can be considered as a secure and reliable approach for management of cases of advanced PCG, without additional risks compared with other techniques. [ABSTRACT FROM AUTHOR]

The occurrence of wounds and defects in the healing process is one of the main challenges in diabetic patients. Herein, we investigated whether adipose-derived stem cells (ADSCs)-derived exosomes loaded bioengineered micro-porous three-dimensional amniotic membrane-scaffold (AMS) could promote healing in diabetic rats. Sixty diabetic rats were randomly allocated into the control group, exosome group, AMS group, and AMS + Exo group. On days 7, 14, and 21, five rats from each group were sampled for stereological, immunohistochemical, molecular, and tensiometrical assessments. Our results indicated that the wound closure rate, the total volumes of newly formed epidermis and dermis, the numerical densities of fibroblasts and proliferating cells, the length density blood vessels, collagen density as well as tensiometrical parameters of the healed wounds were considerably greater in the treated groups than in the control group, and these changes were more obvious in the AMS + Exo ones. Furthermore, the expression of TGF-β, bFGF, and VEGF genes was meaningfully upregulated in all treated groups compared to the control group and were greater in the AMS + Exo group. This is while expression of TNF-α and IL-1β, as well as cell numerical densities of neutrophils, M1 macrophages, and mast cells decreased more considerably in the AMS + Exo group in comparison with the other groups. Generally, it was found that using both AMS transplantation and ADSCs-derived exosomes has more effect on diabetic wound healing. [ABSTRACT FROM AUTHOR]

Background: Omnigen is a vacuum-dehydrated amniotic membrane transplant. It can be delivered to the eye pre-mounted on a special bandage contact lens (Omnilenz) that enables its application without the need for sutures or glue; the aim of this study is to evaluate the short-term clinical outcomes of Omnilenz-Omnigen complex in eyes with acute chemical injury (CEI). Methods: A prospective interventional study included patients with different grades of acute CEI attending the casualty between July 2021 and November 2022. All patients received first aid measures followed by the application of Omnilenz-Omnigen within the first 2 days. Patients were followed up for at least 1 month. Primary outcomes include epithelial defect and limbal ischemia. Secondary outcomes include best-corrected visual acuity (BCVA) and tolerability. Results: The study included 23 eyes of 21 patients with acute CEI mostly due to alcohol (34.8%). After the 1st application, the size of the epithelial defect showed a statistically significant reduction (p = 0.016) with improvement in BCVA (p < 0.001). Restoration of the limbal vascularity was obtained in 56.5% of the eyes. Repeated application of Omnilenz was required in 5 eyes (21.7%). The size of the epithelial defect was reduced after the second application (p = 0.504) with improved BCVA (p = 0.185). After 1st month, complete epithelial healing was achieved in all the eyes. Mild limbal ischemia persists in 3 (13%) of the eyes. Final BCVA showed statistically significant improvement (p < 0.001). None of the patients develops any serious complications. Conclusion: Omnilenz proved to be easy to apply and well tolerated by patients, with promising clinical outcomes. [ABSTRACT FROM AUTHOR]

Musculoskeletal spine disorders, especially low back pain, induce enormous amounts of stress and financial burden on individuals and healthcare systems throughout the world. Disorders of the facet joints in the lumbar spine are the most predominant cause of back pain, resulting in facet joint syndrome (FJS). Conventional treatments for FJS are short-lived and have limitations and side effects. Thus, safer and more effective alternatives that can reduce pain and improve patient-reported outcomes are needed. Recently, the utilization of biologics, including the ones derived from perinatal tissue such as amniotic membrane (AM) and umbilical cord (UC), has significantly increased for regenerative medicine applications. This manuscript summarizes the outcomes of preclinical and clinical studies utilizing AM and/or UC for FJS. We identified no preclinical studies and 3 retrospective studies utilizing the search terms "amniotic membrane" and/or "umbilical cord" and "facet joint syndrome". The administration of AM + UC is safe and potentially efficacious for patients with FJS. However, more preclinical studies and appropriately powered, multi-center, prospective non-randomized and randomized controlled studies with longer follow-up are warranted to further evaluate the efficacy of AM + UC to justify its clinical use. [ABSTRACT FROM AUTHOR]

Objective: To determine the in vitro antibacterial efficacy of equine and canine autologous conditioned plasma (ACP) and amniotic membrane extract eye drops (AMEED) against aerobic bacteria common to the corneal surface. Procedures: Canine (n = 4) and equine (n = 4) anticoagulated whole blood samples were sterilely collected, pooled for each species, and processed using the Arthrex ACP® Double-Syringe System. Platelet counts were performed on ACP and pooled blood. AMEED were obtained from a commercial source. An electronic medical records search (2013-2022) identified aerobic bacteria cultured from canine and equine corneal ulcers at Mississippi State University College of Veterinary Medicine (MSU-CVM). Ten commonly isolated bacteria for each species were collected from cultures submitted to the MSU-CVM Microbiology Diagnostic Service and frozen at -80°C. The Kirby-Bauer disk diffusion method was used to determine the sensitivities of these isolates to ACP and AMEED. Bacterial isolates were plated onto Mueller-Hinton +5% sheep blood agar and blank sterile discs saturated with 20 µL of ACP or AMEED were tested in duplicate. Imipenem discs served as positive controls and blank discs as negative controls. Zones of inhibition were measured at 18 h. Results: ACP platelet counts were 1.06 and 1.65 times higher than blood for equine and canine samples, respectively. Growth of a multi-drug resistant Enterococcus faecalis was partially inhibited by canine and equine ACP. AMEED did not inhibit growth of any examined bacteria. Conclusions: Canine and equine ACP partially inhibited E. faecalis growth in vitro. Further studies using varying concentrations of ACP against bacterial isolates from corneal ulcers are warranted. [ABSTRACT FROM AUTHOR]

We present a case of unilateral full-thickness macular hole (MH) successfully repaired with an amniotic membrane (AM) graft in a patient with Alport syndrome. A 58-year-old Asian female with past medical history of Alport syndrome diagnosed at early stage, presented with a 5-week history of vision loss in her right eye. Examination of her eyes showed normal retinal vessels and an MH measuring 1,300 μm in basal diameter, 806 μm in minimum linear diameter, and 490 μm in height in the right eye and macular thinning with laser scars inferiorly in the left eye. The patient underwent 23-g pars plana vitrectomy with intraocular lens explantation. After multiple unsuccessful attempts in inducing a posterior vitreous detachment around the optic nerve and in the posterior pole, a 1 mm AM graft placed on the MH and the edges tucked under the edges of the hole using a bimanual technique. Five months after surgery, the MH remained sealed with improved final vision. MHs are rare manifestations of Alport syndrome, and surgical treatment of Alport syndrome-associated MHs is challenging. However, further studies to explore new techniques using AM are needed. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate effectiveness of human amniotic membrane (hAM) transplantation in patients with nontraumatic corneal perforation. METHODS: This retrospective chart review included the patients who underwent hAM transplantation with sandwich technique between March 2020 and January 2023 at Ege University Hospital, Turkey. Medical records of the patients including demographic data, best-corrected visual acuity that was measured with Snellen chart, detailed ophthalmological examination, and the need for additional surgical intervention after hAM transplantation were evaluated. Complications and anatomical and functional results were presented. RESULTS: A total 9 eyes of 9 patients with nontraumatic corneal perforations were evaluated between 2020 and 2023. Size of perforation was ≤3 mm in all the eyes. The mean age of the patients was 67.77 ± 15.52. Female-to-male ratio was 1/8. Sandwich technique was used in all patients for hAM transplantation. Five (55.55%) cases had infectious etiology and 4 (44.44%) of them had inflammatory etiology. Of the infectious corneal perforations, 3 (33.33%) were herpes simplex virus-induced neurotrophic keratopathy and 2 (22.22%) were bacterial keratitis. The mean residence time of the amniotic membrane on the ocular surface was 21 ± 8.05 days. Tectonic keratoplasty was needed in 1 (11.11%) eye. Corneal patch grafting was required in 1 (11.11%) eye. Evisceration was performed in 1 (11.11%) eye of a patient with no light perception who had no visual prognosis. Amniotic membrane detachment was observed in one patient as a surgical-related complication associated with hAM transplantation. CONCLUSION: hAM transplantation is one of the successful treatment methods in treatment of relatively small corneal perforation. Considering the difficulty of finding a donor cornea and the easier access to the amniotic membrane, it seems like a good alternative treatment to reduce or postpone the need for tectonic keratoplasty. [ABSTRACT FROM AUTHOR]

Musculoskeletal spine disorders, especially low back pain, induce enormous amounts of stress and financial burden on individuals and healthcare systems throughout the world. Disorders of the facet joints in the lumbar spine are the most predominant cause of back pain, resulting in facet joint syndrome (FJS). Conventional treatments for FJS are short-lived and have limitations and side effects. Thus, safer and more effective alternatives that can reduce pain and improve patient-reported outcomes are needed. Recently, the utilization of biologics, including the ones derived from perinatal tissue such as amniotic membrane (AM) and umbilical cord (UC), has significantly increased for regenerative medicine applications. This manuscript summarizes the outcomes of preclinical and clinical studies utilizing AM and/or UC for FJS. We identified no preclinical studies and 3 retrospective studies utilizing the search terms "amniotic membrane" and/or "umbilical cord" and "facet joint syndrome". The administration of AM + UC is safe and potentially efficacious for patients with FJS. However, more preclinical studies and appropriately powered, multi-center, prospective non-randomized and randomized controlled studies with longer follow-up are warranted to further evaluate the efficacy of AM + UC to justify its clinical use. [ABSTRACT FROM AUTHOR]

Introduction: Decellularization techniques are widely used in the fabrication of suitable scaffolds for the regeneration of damaged tissues, addressing the issue of insufficient donor tissues. The amnion membrane has qualities such as availability, affordability, low immunogenicity, and anti-inflammatory and regenerative effects. Gelatin is a natural and biocompatible polymer with favorable interactions for cell adhesion and growth. Thus, this study focused on creating and assessing gelatin-decellularized amniotic membrane scaffolds for potential use in tissue engineering. Methods: Initially, the amniotic membrane underwent decellularization, and the extent of this process was assessed using hematoxylin-eosin staining. Following the fabrication of the scaffolds, their physical, chemical, and mechanical properties, were characterized. Additionally, mesenchymal stem cells derived from the uterine endometrium were cultured on the scaffolds, and their biocompatibility was assessed through an MTT assay. Results: The findings indicated successful decellularization of the amnion tissue. Scanning electron microscope (SEM) images revealed a rough surface on the scaffolds. While all scaffolds exhibited hydrophilic properties, those made of the gelatin-decellularized amniotic membrane were particularly hydrophilic due to the presence of the hydrophilic gelatin polymer in their structure. The constructed scaffolds demonstrated water absorption and swelling. Additionally, the results of the mechanical properties assessment indicated that the scaffolds possessed adequate strength. In terms of biocompatibility, the proliferation of stem cells derived from the uterine endometrium on the scaffolds surpassed that of the control group (cell only). Conclusion: The scaffolds fabricated with amino-gelatin curtains show promising potential for use in tissue engineering applications. [ABSTRACT FROM AUTHOR]

(1) Background: To evaluate the efficacy of conjunctival limbal autograft (CLAU) combined with the amnion-assisted conjunctival epithelial redirection (ACER) procedure for patients with unilateral total limbal stem cell deficiency (LSCD) caused by severe chemical burn. (2) Methods: A retrospective interventional case series of unilateral total LSCD after chemical burn who underwent CLAU combined with ACER surgery between September 2021 and July 2023 was collected. Outcome measures included epithelialization of the cornea with donor limbus-derived epithelium, best corrected visual acuity (BCVA), and complications. (3) Results: Nine males and one female were included in this study. The mean age was 40.9 ± 9.63 (range, 26 to 55) years. The average duration between injury and CLAU combined with the ACER procedure was 7.67 ± 3.97 (range, 4 to 18) months. All patients achieved corneal epithelialization and improved BCVA. Postoperative complications occurred in four cases, including delayed corneal epithelial healing in one case, delayed amniotic membrane dissolution and detachment in two cases, and recurrence of symblepharon in one case. No complications were noted in the healthy donor eyes. (4) Conclusions: CLAU combined with ACER is a safe and effective treatment for unilateral total LSCD caused by severe chemical burn. This combined surgery restores visual function for patients with corneal blindness caused by chemical burn, reducing the burden on the families and society. [ABSTRACT FROM AUTHOR]

The amniotic membrane (AM) is the innermost part of the fetal placenta, which surrounds and protects the fetus. Due to its structural components (stem cells, growth factors, and proteins), AMs display unique biological properties and are a widely available and cost-effective tissue. As a result, AMs have been used for a century as a natural biocompatible dressing for healing corneal and skin wounds. To further increase its properties and expand its applications, advanced hybrid materials based on AMs have recently been developed. One existing approach is to combine the AM with a secondary material to create composite membranes. This review highlights the increasing development of new multilayer composite-based AMs in recent years and focuses on the benefits of additive manufacturing technologies and electrospinning, the most commonly used strategy, in expanding their use for tissue engineering and clinical applications. The use of AMs and multilayer composite-based AMs in the context of nerve regeneration is particularly emphasized and other tissue engineering applications are also discussed. This review highlights that these electrospun multilayered composite membranes were mainly created using decellularized or de-epithelialized AMs, with both synthetic and natural polymers used as secondary materials. Finally, some suggestions are provided to further enhance the biological and mechanical properties of these composite membranes. [ABSTRACT FROM AUTHOR]

The potential of perinatal tissues to provide cellular populations to be used in different applications of regenerative medicine is well established. Recently, the efforts of researchers are being addressed regarding the evaluation of cell products (secreted molecules or extracellular vesicles, EVs) to be used as an alternative to cellular infusion. The data regarding the effective recapitulation of most perinatal cells' properties by their secreted complement point in this direction. EVs secreted from perinatal cells exhibit key therapeutic effects such as tissue repair and regeneration, the suppression of inflammatory responses, immune system modulation, and a variety of other functions. Although the properties of EVs from perinatal derivatives and their significant potential for therapeutic success are amply recognized, several challenges still remain that need to be addressed. In the present review, we provide an up-to-date analysis of the most recent results in the field, which can be addressed in future research in order to overcome the challenges that are still present in the characterization and utilization of the secreted complement of perinatal cells and, in particular, mesenchymal stromal cells. [ABSTRACT FROM AUTHOR]

BACKGROUND: Traditional treatments for corneal alkali burns are limited, especially in controlling inflammation, preventing neovascularization, and inhibiting corneal scarring. Natural, synthetic, or composite materials provide a wide range of treatment options. However, the mechanism by which biomaterials promote corneal alkali burn repair has not yet been systematically understood. OBJECTIVE: To summarize the current research on biomaterials in promoting corneal alkali burn repair in and outside China, and review the mechanism and application of biomaterials in repairing corneal alkali burn. METHODS: The first author searched "cornea, alkali burn, amniotic membrane, hyaluronic acid, collagen, chitosan, polymer materials" as Chinese keywords and "amniotic membrane, hyaluronic acid, collagen, chitosan, polymer, cornea, alkali burn" as English keywords in PubMed, Web of Science, CNKI, and WanFang databases. According to inclusion and exclusion criteria, 76 eligible articles were finally included for review. RESULTS AND CONCLUSION: (1) In the field of corneal alkali burn repair, biomaterials such as amniotic membrane, hyaluronic acid, collagen, chitosan, and degradable polymer materials have been widely studied and applied. Each of these biomaterials has its own characteristics, advantages, and disadvantages, and stands out in different aspects. (2) First and foremost, amniotic membranes are considered one of the most promising biomaterials due to their abundance of bioactive factors. They are biocompatible and can regulate the corneal inflammatory response. However, there are issues with donor shortages and susceptibility to infectious diseases. (3) Hyaluronic acid has good moisturizing properties and biocompatibility, and is able to improve the survival rate of corneal cells and increase corneal transparency. (4) The good biocompatibility and scaffold structure of collagen enable the promotion of corneal cell adhesion and proliferation, as well as the reconstruction of corneal tissue structure. (5) Chitosan is recognized for its good biocompatibility and degradability, making it suitable as a carrier for drug delivery and cell transplantation. (6) Degradable polymer materials have good controllability over degradation and can provide a good support and delivery platform for the repair of corneal alkali burns, but further research is needed on their stability and biocompatibility. (7) Overall, there is currently no single biomaterial that can completely address the repair problem of corneal alkali burns, and each biomaterial has its own specific application scenarios and limitations. (8) Future research directions should focus on further improving the properties and structure of biomaterials, exploring more effective combination applications, and deeply understanding the interaction mechanism between biomaterials and corneal tissue, in order to enhance the therapeutic effect of corneal alkali burns and the quality of life of patients. [ABSTRACT FROM AUTHOR]

Background: While sutureless, cryopreserved amniotic membrane (cAM) has been shown to significantly improve signs and symptoms of dry eye disease (DED), no studies have assessed the association of cAM treatment duration to the differential response in clinical outcomes.Methods: A multi-center, retrospective study was conducted on patients with moderate-to-severe DED who were treated with self-retained cAM (Prokera® Slim) for 2 to 7 days. The primary outcome measure was DEWS severity score assessed at 1 week, 1 month, and 3 months. Secondary outcome measures included ocular discomfort, visual symptoms, corneal staining, and visual acuity.Results: A total of 89 eyes (77 patients) with moderate-to-severe DED (DEWS severity 3.24 ± 0.56) received treatment with self-retained cAM for 2 days (n = 10), 3 days (n = 15), 4 days (n = 12), 5 days (n = 19), 6 days (n = 6), or 7 days (n = 27). DEWS scores significantly improved at 1 week, 1 month, and 3 months for all treatment duration groups, with no significant difference observed between groups at any timepoint. In addition to an improvement in DEWS severity scores, those receiving cAM treatment for 2 days demonstrated a significant improvement in corneal staining, visual symptoms, and ocular discomfort at 1 week, 1 month, and 3 months.Conclusion: This retrospective study suggests that a single placement of self-retained cAM for 2 days can significantly improve signs and symptoms of DED with a lasting benefit observed for up to 3 months. [ABSTRACT FROM AUTHOR]

We report a case of severe burn injury in a 42-year-old pregnant patient referred to our hospital’s burn unit after experiencing a scald burn injury that burned her neck, chest, trunk, abdomen and limbs. The patient had burn wounds distributed on her neck, all four extremities, the chest and abdomen, with a total burn area of 46.5%. The burn wounds were treated with surgical debridement and then covered with silver sulfadiazine and damp gauze. The patient’s wounds were treated every three days. The patient delivered a healthy baby full-term through a spontaneous, vaginal delivery. After delivery, the amniotic membrane from the patient was used as an amniotic membrane graft and was planted on the patient’s chest, right arm and right thigh. The amniotic membrane in this patient helped to accelerate the preparation of the wound bed for skin grafting. Split-thickness skin grafts were then used on the wounds and the patient was discharged from the hospital one week later. Patients that present with burn injuries during pregnancy require intense monitoring and careful management from a multidisciplinary team. A collaborative effort needs to be made in order to plan the best outcome for the mother and fetus. Precise and early resuscitation is the first step to treating such cases. The administration of fluids should be titered based on the patient’s hemodynamic condition and urine output. Wound management can also be optimized using the amniotic membrane as a temporary dressing before skin grafting [ABSTRACT FROM AUTHOR]

Background: Enhancing the efficiency of cell‐based skin tissue engineering (TE) approaches is possible via designing electrospun scaffolds possessing natural materials like amniotic membrane (AM) with wound healing characteristics. Concentrating on this aim, we fabricated innovative polycaprolactone (PCL)/AM scaffolds through the electrospinning process. Methods: The manufactured structures were characterized by employing scanning electron microscope (SEM), attenuated total reflection‐Fourier transform infrared (ATR‐FTIR) spectroscopy, tensile testing, Bradford protein assay, etc. In addition, the mechanical properties of scaffolds were simulated by the multiscale modeling method. Results: As a result of conducting various tests, it was concluded that the uniformity and distribution of fibers decreased with an increase in the amniotic content. Furthermore, PCL‐AM scaffolds contained amniotic and PCL characteristic bands. In the case of protein release, greater content of AM led to the release of higher amounts of collagen. Tensile testing revealed that scaffolds' ultimate strength increased when the AM content augmented. The multiscale modeling demonstrated that the scaffold had elastoplastic behavior. In order to assess cellular attachment, viability, and differentiation, human adipose‐derived stem cells (ASCs) were seeded on the scaffolds. In this regard, SEM and 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyl‐2H‐tetrazolium bromide (MTT) assays showed significant cellular proliferation and viability on the proposed scaffolds, and these analyses illustrated that higher cell survival and adhesion could be achieved when scaffolds possessed a larger amount of AM. After 21 days of cultivation, particular keratinocyte markers, such as keratin I and involucrin, were identified through utilizing immunofluorescence and real‐time polymerase chain reaction (PCR) tests. The markers' expressions were higher in the PCL‐AM scaffold with a ratio of 90:10 v v−1 compared with the PCL‐epidermal growth factor (EGF) structure. Moreover, the presence of AM in the scaffolds resulted in the keratinogenic differentiation of ASCs even without employing EGF. Consequently, this state‐of‐the‐art experiment suggests that the PCL‐AM scaffold can be a promising candidate in skin bioengineering. Conclusion: This study showed that mixing AM with PCL, a widely used polymer, in different concentrations can overcome PCL disadvantages such as high hydrophobicity and low cellular compatibility. [ABSTRACT FROM AUTHOR]

Introduction: Breast reconstruction by prosthesis is frequently performed in breast cancer treatments, and a temporary substitute is used in the first step of two-stage operations. Aim: Due to the advantageous biological features of the human amniotic membrane, we aimed to evaluate its use for temporary implants. Method: We prepared small spherical implants from human amniotic membranes and inserted them into BALB/c mice's subcutaneous flanks. Then, we compared the bulging they produced, the durability, and the host reaction with implants made from the chorionic membrane, folded membrane patches, and sterile plastic beads. Results: All amionitic cases were healthy throughout the study and only mild inflammation occurred in them. Furthermore, the bulging of the implants was acceptable and faded gradually. However, moderate inflammation was observed in chorionic implant mice, and the bulging disappeared very soon. Finally, the control group had severe inflammation and the beads implant was rejected. Conclusion: Our study showed that the human amniotic membrane could represent a safe and valid tool for breast reconstruction, however, further studies on larger animals and more implants are suggested. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a novel sutureless glueless technique using a triple-layer dehydrated amniotic membrane (TLDAM) for pterygia excisions in surgical time, postoperative pain, epiphora, irritation, and FBS.Methods: Twenty eyes with pterygia underwent excision with mitomycin C. The conjunctival defect was closed with TLDAM placed on the dried scleral bed with the edges of the amniotic membrane tucked under the edges of the conjunctival defect. Surgical times were measured from injection of lidocaine to final placement of bandage contact lens. After a bandage contact lens was placed, the eye was patched until POD1. Patients graded self-administered questionnaires to rate pain, FBS, irritation, and epiphora on a scale of 1– 5 (1-none; 5-severe) at POD1 and POW1.Results: Surgical times ranged from 6:55 to 12:00, with mean of 8:29. Compared with a previous study of sutureless glueless methodology, the difference in mean surgical time was 11.9 (p < 0.0001). Mean questionnaire scores were as follows: POD1 pain 1.8, FBS 2.3, irritation 1.0, and epiphora 2.6; POW1 pain 1.5, FBS 1.6, irritation 1.6, and epiphora 1.6. Compared to previous studies, this technique showed significantly improved pain at POD1 (p=0.0086, p< 0.0001, p< 0.0001, p< 0.0001) and POW1 (p=0.0002, p=0.0016, p< 0.0001). Significant improvement in irritation and FBS was noted at POD1 and POW1. See Table 1 for full analysis.Conclusion: The sutureless glueless technique using TLDAM is a safe and effective technique compared to current standard methods. There appears to be a significant benefit regarding surgical time and postoperative pain, irritation, epiphora, and FBS compared to previous studies. [ABSTRACT FROM AUTHOR]

Introduction: Acute large traumatic wounds require temporary dressing prior to the definitive soft tissue reconstruction, as the physiological derangement during the immediate postinjury period delays the definitive surgical intervention. Selecting an ideal dressing material from numerous available synthetic dressings and skin substitutes poses a challenge. Although amniotic membrane (AM) scaffold has a definitive role in promoting wound healing in burns and chronic wounds, however, its efficacy in acute large traumatic wound is lacking. The present trial aimed to evaluate the safety and efficacy of AM in wound bed preparation before the definitive soft-tissue reconstruction in acute large traumatic wounds. Methods: Sixty patients with acute large traumatic wounds (>10 cm × 10 cm) were divided into two groups (conventional dressing and AM dressing) using simple mixed block randomization. Wounds were assessed using the Bates Jensen Score at various timelines for the signs of early wound healing. The primary outcome was to evaluate the time taken for the wound bed preparation for definitive soft-tissue reconstruction. The secondary outcome was the pain assessment and complications, if any. Results: There was significant reduction in the wound exudate as well as peripheral tissue edema in the intervention group (P = 0.01). AM dressing was significantly less painful (P = 0.01). The incidence of wound infection and need for debridement was decreased in the intervention group. However, the time interval to definitive soft-tissue coverage was statistically insignificant and comparable in both the groups. No adverse reactions were seen in either group. Conclusion: AM dressings are safe and efficacious with significant reduction in wound exudates and peripheral edema. However, these dressings do not hasten the wound maturation as compared to conventional dressings. AM dressings can be used as a less painful alternative to conventional dressing in the management of large acute posttraumatic wounds. [ABSTRACT FROM AUTHOR]

Purpose: The following is a comparative analysis on the treatment outcomes of corneal perforations using amniotic membrane transplantation (AMT) or penetrating keratoplasty (PK). Methods: This monocentric retrospective study was performed at the Department of Ophthalmology, University Hospital Ulm, Germany. A total of 78 eyes of 78 patients were included. Thirty-nine eyes received an AMT, and 39 patients were treated with a PK. Primary outcome was recurrence of perforation. Secondary outcomes were patient mortality and visual acuity. Results: No statistically significant difference was observed with regard to a recurrence of perforation between the two groups (26% in AMT vs 23% in PK, p > 0.99). The time of recurrences was within the first two years and did not differ statistically (p = 0.97). In addition, a proportional hazards model with cox regression regarding recurrent perforation showed no significant differences (p = 0.5). After AMT, 41% and after KP, 28% of the patients died during follow-up (p = 0.2), respectively. The Charlson Comorbidity Index (p < 0.0001) and the age at the time of surgery (p = 0.0002) were statistically significantly higher in those who were deceased. A mean follow-up of 485 ± 517 days was recorded. Conclusion: Both surgical methods show good results and no statistically significant difference regarding recurrent perforation rate. About a third of the patients died during the follow-up period. The decision regarding the appropriate method should therefore be based on a combination of all factors. [ABSTRACT FROM AUTHOR]

The ocular surface is a complex structure that includes cornea, conjunctiva, limbus, and tear film, and is critical for maintaining visual function. When the ocular-surface integrity is altered by a disease, conventional therapies usually rely on topical drops or tissue replacement with more invasive procedures, such as corneal transplants. However, in the last years, regeneration therapies have emerged as a promising approach to repair the damaged ocular surface by stimulating cell proliferation and restoring the eye homeostasis and function. This article reviews the different strategies employed in ocular-surface regeneration, including cell-based therapies, growth-factor-based therapies, and tissue-engineering approaches. Dry eye and neurotrophic keratopathy diseases can be treated with nerve-growth factors to stimulate the limbal stem-cell proliferation and the corneal nerve regeneration, whereas conjunctival autograft or amniotic membrane are used in subjects with corneal limbus dysfunction, such as limbal stem-cell deficiency or pterygium. Further, new therapies are available for patients with corneal endothelium diseases to promote the expansion and migration of cells without the need of corneal keratoplasty. Finally, gene therapy is a promising new frontier of regeneration medicine that can modify the gene expression and, potentially, restore the corneal transparency by reducing fibrosis and neovascularization, as well as by stimulating stem-cell proliferation and tissue regeneration. [ABSTRACT FROM AUTHOR]

Introduction: Amniotic membrane (AM) is a popular treatment for external ocular diseases. First intraocular implantations in other diseases reported promising results. Here, we review three cases of intravitreal epiretinal human AM (iehAM) transplantation as an adjunct treatment for complicated retinal detachment and analyze clinical safety. Possible cellular rejection reactions against the explanted iehAM were evaluated and its influence was assessed on three retinal cell lines in vitro. Methods: Three patients with complicated retinal detachment and implanted iehAM during pars plana vitrectomy are retrospectively presented. After removal of the iehAM at subsequent surgery, tissue-specific cellular responses were studied by light microscopy and immunohistochemical staining. We investigated the influence of AM in vitro on retinal pigment epithelial cells (ARPE-19), Müller cells (Mio-M1), and differentiated retinal neuroblasts (661W). An anti-histone DNA ELISA for cell apoptosis, a BrdU ELISA for cell proliferation, a WST-1 assay for cell viability, and a live/dead assay for cell death were performed. Results: Despite the severity of the retinal detachment, stable clinical outcomes were obtained in all three cases. Immunostaining of the explanted iehAM showed no evidence of cellular immunological rejection. In vitro, there was no statistical significant change in cell death or cell viability nor were proliferative effects detected on ARPE-19, Müller cells, and retinal neuroblasts exposed to AM. Conclusion: iehAM was a viable adjuvant with many potential benefits for treatment of complicated retinal detachment. Our investigations could not detect any signs of rejection reactions or toxicity. Further studies are needed to evaluate this potential in more detail. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to compare the "real-life" effectiveness of amniotic membrane graft (AMG) and conjunctival (CAT) or limbal conjunctival (LCA) autograft in the management of primary pterygium. Methods: Human-based studies on primary pterygium surgery that were published between 1993 and 2022 with at least 3 months of follow-up were identified, and only those that were retrospective were included. The global recurrence rate of pterygium was assessed for each surgical technique separately. Specific recurrence rates taking into consideration the fixation technique (glue versus sutures) were also measured. Results: 35 real-life retrospective subgroups comprising a total of 3747 eyes were included in the final review. The mean global recurrence rates for CAT, LCA and AMG were 7.61%, 5.50% and 9.0%, respectively. Recurrences were less common for patients who received fibrin glue (5.92%, 2.56% and 3.60%) than for those who received sutures (8.99%, 6.03% and 23.0%) for the three groups, respectively. Surgical techniques combining CAT or LCA with AMG yielded an even lower global recurrence rate (1.83%). Conclusion: AMG seems like a reasonable option that could be considered in primary pterygium surgery, especially when glued to the underlying sclera. Combining AMG with other treatment modalities such as CAT or LCA seems to offer an interesting alternative in terms of recurrence. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the efficacy of penile girth enhancement (PGE) using amniotic membrane (AM) as a graft in a rabbit model. Additionally, quantitative histological data of the structure of the penis were obtained by stereological studies. Methods: This study was conducted at the Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. In this study, 20 adult male rabbits of similar age and weight were allocated to two groups: sham surgery and surgery+AM. Both groups underwent surgery in which a longitudinal I-shaped midline incision was made in the tunica albuginea on the dorsal surface of the penis. The surgery+AM group underwent PGE using AM as a graft. The penile length and mid circumference were measured using a vernier caliper before and two months after the surgery. Results: The mean total volume and diameter of the penis significantly increased in the surgery+AM group (P <0.03 and P <0.04, respectively). On stereological evaluation, a significant increase in the mean volumes of the tunica albuginea and corpora cavernosa was observed in the surgery+AM group compared to the sham group (P <0.01 and P <0.03, respectively). Additionally, the mean volume densities of the collagen bundles, muscle fibres, cavernous sinuses, and the total number of fibroblasts and smooth muscle cells increased in the surgery+AM group compared to the sham group (P <0.05 each). No infections, bleeding or other complications were observed. Conclusion: The use of AM as a graft is a method that shows promising results for material use in penile enhancement. Thus, it may be considered for PGE in the future. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to define the antimicrobial peptide (AMP) expression pattern of the equine ocular surface and amniotic membrane using a targeted qPCR approach and 3'Tag‐sequencing. It will serve as a reference for future studies of ocular surface innate immunity and amniotic membrane therapies. Procedures: A targeted qPCR approach was used to investigate the presence of orthologs for three of the most highly expressed beta‐defensins (DEFB1, DEFB4B, and DEFB103A) of the human ocular surface and amniotic membrane in equine corneal epithelium, conjunctiva, and amniotic membrane. 3'Tag‐sequencing was performed on RNA from one sample of corneal epithelium, conjunctiva, and amniotic membrane to further characterize their AMP expression. Results: Equine corneal epithelium, conjunctiva, and amniotic membrane expressed DEFB1, DEFB4B, and DEFB103A. DEFB103A was expressed at the highest amounts in corneal epithelium, while DEFB4B was most highly expressed in conjunctiva and amniotic membrane. 3'Tag‐sequencing from all three tissues confirmed these findings and identified expression of five additional beta‐defensins, 11 alpha‐defensins and two cathelicidins, with the alpha‐defensins showing higher normalized read counts than the beta‐defensins. Conclusions: This study identified AMP expression in the equine cornea and conjunctiva, suggesting that they play a key role in the protection of the equine eye, similar to the human ocular surface. We also determined that equine amniotic membrane expresses a substantial number of AMPs suggesting it could potentiate an antimicrobial effect as a corneal graft material. Future studies will focus on defining the antimicrobial activity of these AMPs and determining their role in microbial keratitis. [ABSTRACT FROM AUTHOR]

Purpose: To determine the health economic opportunity cost or gain associated with performing pterygium excision surgery using the TissueTuck technique with cryopreserved amniotic membrane (AM) instead of conjunctival autograft (CAU). Methods: We performed a literature review to determine the average surgical duration of pterygium surgery using CAU with fibrin glue or sutures to calculate the average time saved with the TissueTuck technique. Such time savings was then used to determine the opportunity revenue gain per national average Medicare reimbursement if adjusted to the average surgical duration of cataract surgery. Results: The time savings achieved using the TissueTuck technique over CAU with fibrin glue is 8.9 min per procedure, which can be applied to additional MSICS or phacoemulsification procedures to generate an opportunity revenue gain of $1167 or $762 per 2022 National Average Medicare reimbursement, respectively. After subtracting the current list cost of AmnioGraft (ie, $645), the opportunity gain is $522 or $117 if the time saving is applied to the above procedures, respectively. Alternatively, the time savings achieved by using the TissueTuck technique over CAU with sutures is 23.4 min per procedure, which can be applied to additional MSICS or phacoemulsification procedures to generate an opportunity revenue gain of $3068 and $2004 per TissueTuck procedure or $2423 or $1359 when accounting for the list cost of AmnioGraft, respectively. Conclusion: The TissueTuck surgical technique using cryopreserved AM for pterygium takes less time, has lower recurrence rates, and provides an opportunity gain compared to pterygium excision with CAU. [ABSTRACT FROM AUTHOR]

Unsuccessful wound closure in chronic wounds can be linked to altered keratinocyte activation and their inability to re-epithelize. Suggested mechanisms driving this impairment involve unbalanced cytokine signaling. However, the molecular events leading to these aberrant responses are poorly understood. Among cytokines affecting keratinocyte responses, Transforming Growth Factor-β (TFG-β) is thought to have a great impact. In this study, we have used a previously characterized skin epidermal in vitro model, HaCaT cells continuously exposed to TGF-β1, to study the wound recovery capabilities of chronified/senescent keratinocytes. In this setting, chronified keratinocytes show decreased migration and reduced activation in response to injury. Amniotic membrane (AM) has been used successfully to manage unresponsive complicated wounds. In our in vitro setting, AM treatment of chronified keratinocytes re-enabled migration in the early stages of wound healing, also promoting proliferation at later stages. Interestingly, when checking the gene expression of markers known to be altered in TGF-β chronified cells and involved in cell cycle regulation, early migratory responses, senescence, and chronic inflammation, we discovered that AM treatment seemed to reset back to keratinocyte status. The analysis of the evolution of both the levels of keratinocyte activation marker cytokeratin 17 and the spatial-temporal expression pattern of the proliferation marker Ki-67 in human in vivo biopsy samples suggests that responses to AM recorded in TGF-β chronified HaCaT cells would be homologous to those of resident keratinocytes in chronic wounds. All these results provide further evidence that sustained TGF-β might play a key role in wound chronification and postulate the validity of our TGF-β chronified HaCaT in vitro model for the study of chronic wound physiology. [ABSTRACT FROM AUTHOR]