Amnion Chorion Membrane Research Articles

EVALUATION OF THE EFFICACY OF AMNIOTIC CHORION MEMBRANE IN MANAGEMENT OF GRADE II FURCATION DEFECTS (CLINICAL STUDY)

INTRODUCTION: Treatment of molar furcation defects remains a considerable challenge in clinical practice. Furcation defects treatment can vary according to the type and location of the defects. Regenerative procedures are one of the treatment modalities in furcation involvement. In this study Amnion Chorion membrane(ACM) was used with an alloplast to manage grade II furcation defects. OBJECTIVES The aim of this study was to evaluate clinically and radiographically the effect of ACM augmented with alloplast bone graft in management of grade II furcation involvement. MATERIALS AND METHODS: This study was conducted clinically on fourteen patients with fourteen grade II furcation defects. Patients were divided into two groups: test group: included seven furcation defects that were treated by alloplast bone graft covered by ACM, and control group: including seven furcation defects treated with alloplast bone graft covered by a resorbable collagen membrane. Probing depth (P D), clinical attachment loss(CAL)were measured at baseline,3, and 6 months. Cone beam computed tomography(CBCT)was performed at baseline,6, and9months to evaluate bonefill in the furcation defect. RESULTS: ACM has shown reduction in probing depth and clinical attachment loss, and enhanced bone formation when compared to control group treated with resorbable collagen membrane. CONCLUSIONS: ACM is an effective, easy to handle, safe, and time saving membrane that can be used in periodontal regeneration.

Persistent amnion-chorion membrane separation.

Fetal membranes are composed of the amnion and chorion, which fuse during the early second trimester. Persistent separation confers increased risk of adverse perinatal outcomes. This study characterizes sonographic and placental findings associated with persistent amnion-chorion (AC) membrane separation. This is a case series of 23 patients carrying singleton pregnancies with persistent AC membrane separation after 16 weeks' gestation diagnosed by ultrasound from 2010 to 2016 at our institution. Twenty placentas were available for analysis. Obstetrical complications occurred in 13 (56.5%) cases; two (8.7%) cases resulted in intrauterine fetal demise. Fetal malformations were reported in eight (34.8%) cases. Four (17.4%) neonates were small-for-gestational age (SGA; <10th percentile). Placental size measured ≤10th percentile for gestational age in eight (40%) cases. Placental cord insertion was marginal or velamentous in eight (34.8%) cases. Maternal and/or fetal placental perfusion abnormalities occurred in 11 (55%) cases. AC membrane separation is associated with adverse obstetrical outcomes, placental abnormalities, including marginal and velamentous cord insertion, placental growth restriction and placental perfusion defects. This membrane complication is associated with increased incidence of fetal malformations in the absence of identifiable genetic etiologies.

Skin Integrity and Infection Prevention Las Vegas: don't bust on biofilm, bet on dHACM.

The 4th International Skin Integrity and Infection Prevention conference, hosted by the Journal of Wound Care and the University of Huddersfield, was held earlier this year in Las Vegas. A key theme was the impact of biofilm on wound healing. In the second of our sponsored symposia reports, the manner in which delayed healing can be reversed through effective biofilm management, and the introduction of regulatory proteins found in dehydrated human amnion chorion membrane allograft were explained.

PD173: Comparison of amnion chorion membrane and subepithelial connective tissue graft in management of gingival recession: a randomized controlled clinical trial

PD173: Comparison of amnion chorion membrane and subepithelial connective tissue graft in management of gingival recession: a randomized controlled clinical trial

SOFT TISSUE HEALING AROUND IMMEDIATELY PLACED DENTAL IMPLANTS AUGMENTED WITH AMNIOTIC CHORION MEMBRANE VERSUS CONNECTIVE TISSUE GRAFT (A CLINICAL AND HISTOLOGICAL STUDY)

INTRODUCTION: The Amnion Chorion Membrane (ACM) has favorable regenerative properties which facilitates its use for coveringimmediate dental implants.OBJECTIVES: To evaluate clinically and histologically the effect of Amnion Chorion membrane in augmenting immediately placed dentalimplants compared to connective tissue graft (CTG)MATERIALS AND METHODS: This study was conducted clinically on eighteen upper hopeless anterior/premolar teeth scheduled forextraction and immediate implant placement. Patients were divided into two groups: in the first group, nine immediate implants were coveredwith ACM, and in the second group nine immediate implants were covered with CTG. Keratinized mucosal width (KMW), keratinized mucosalthickness (KMT) and healing score were recorded for both groups at 7 , 14 , 30 and 90 daysRESULTS: The KMT showed an increase by 26% in the test group while in the control group it decreased by 6.5% by the end of the studyperiod. Regarding the healing scores both groups showed marked improvement throughout the study, lower values of healing scores were notedin the test group. Clinical results were confirmed by histological examination which revealed that oral mucosa of both groups showedparakeratinized gingival epithelium. The connective tissue of the test group showed more regularly arranged ,thick bundles.CONCLUSIONS Both treatment modalities were satisfactory but the ACM offered more positive results concerning the mucosal thicknessand healing scores.KEYWORDS: Immediate implants, ACM, Connective tissue graft, Soft tissue

Dehydrated Human Amnion Chorion Membrane in Colorectal Anastomoses: A Retrospective Multi-Center Study

Dehydrated Human Amnion Chorion Membrane in Colorectal Anastomoses: A Retrospective Multi-Center Study

Application of Amniotic Membrane Improves Repair in a Diabetic Animal Model for Delayed Tendon Healing

Category: Basic Sciences/Biologics, Diabetes Introduction/Purpose: Tendon injuries often heal with significant scar formation and compromised biomechanical function. For diabetics, these injuries are further complicated by changes in the extracellular matrix of the tendon, leading to higher incidences of injury and slower healing. Defective or delayed healing is a result of several factors including an impaired ability to form a collagen matrix, compromised angiogenesis, and inadequate production of growth factors. Consequently, complications and re- rupture rates are higher in diabetic patients. Amnion-derived cells resulted in improved tendon healing in an otherwise healthy animal model, in part due to their ability to provide numerous regenerative cytokines to the repair site. The purpose of this study was to evaluate the effect of amniotic tissues on tendon healing in a diabetic model with impaired healing. Methods: For this study BBZDR/WOR animals, an insulin dependent Type II diabetic rodent model, were used. After appropriate anesthesia, a full thickness injury was made through the Achilles tendon; immediately following injury, the tendon was repaired using the modified Kessler method. Repaired tendons were wrapped with a 0.5 × 0.5 cm section of either a fresh hypothermically stored human amniotic membrane (HSAM), a dehydrated human amnion chorion membrane (dHACM), or left unwrapped as a control. Contralateral tendons were used as sham controls, which were exposed then immediately closed. Tendons were retrieved at 14 or 28 days and evaluated using histology, immunohistochemistry, and qPCR. At 28 days, both experimental tendons and contralateral controls from five rats per group were harvested and tested to failure and peak force, stiffness, energy uptake, and displacement at rupture were then determined. Results: At day 14, histological evaluation found significant increases in cellular recruitment at the site of injury in both dHACM and HSAM treated animals (p=0.0001). qPCR and immunofluorescence results confirmed several biomarkers implicated in tendon repair were highly expressed in the treatment groups, but not in untreated controls. In dHACM treated animals, TNF-a, TGFß-1, IL6, FLAP, Tenascin-C, and Scleraxis expression was elevated at 14 days. Control animals with only primary repair resulted in a tendon repair failure rate of 20%; whereas animals treated with HSAM or dHACM had a 6% and 0% failure rate, respectively. dHACM treated tendons also had significant improvements in biomechanical properties compared to controls including increases in the max force, stiffness and strain (47±21%, 146±90%, and 59±35% respectively). Conclusion: Augmentation of tendon repair with placental-derived membranes may improve diabetic tendon repair and reduce re-rupture rates. This study presents compelling data suggesting chorion-containing dHACM is more efficacious than the amnion- only HSAM for tendon repair. The cause for this difference is unclear, we hypothesize that cytokine content, important for tendon healing, within the chorion may be responsible. Components of placental tissue contribute different cytokines, ECM and cell populations—this study highlights that differences in components-delivered and processing techniques may impact outcomes and results may vary for different clinical applications. This study highlights a promising treatment option for a clinically challenging population.

Tips and Tricks to Improve Neurovascular Bundles Preservation During Robot-Assisted Radical Prostatectomy

Objective: We demonstrate various tips and tricks, including latest innovations to improve neurovascular bundles preservation and their outcomes during robot-assisted radical prostatectomy (RARP). Materials and Methods: We have demonstrated our technique of nerve sparing (NS)—athermal, early retrograde release, minimization of tension with identification of landmark artery .We have shown the role of our subjective NS regression model in predicting time to recovery of postoperative erectile function after RARP. We have also shown application of a new innovative technology of near infrared fluorescence (NIRF) using indocyanine green (ICG) in identifying landmark prostatic artery and improving quality of NS. We have also shown the application of an innovative dehydrated human amnion chorion membrane allograft (dHACM) in improving postoperative functional outcomes after RARP. Results: The mean time taken for recovery of postoperative potency was significantly lesser in NS grades 4 and 5 vs grade 0 in subjective NS system. The NIRF with ICG could identify the landmark artery in 17/20 (85%) patients during NS RARP. Fifty-eight patients who were preoperatively potent (Sexual Health Inventory for Men score >19) and continent (no pads) underwent full NS RARP, and dHACM was used. The mean time to continence in dHACM graft group was 1.21 months vs 1.83 months in the nongraft group (p = 0.033). The mean time to potency in dHACM graft group was 1.34 months vs 3.39 months in nongraft group (p = 0.007). Conclusions: The surgeon's experience and volume are the key determinants in NS RARP. The key principles of NS include athermal, minimal traction, and bilateral complete preservation (wherever feasible). The use of these innovations can hasten early return of potency in patients after RARP. No competing financial interests exist. Runtime of video: 6 mins 55 secs

Maxillary Sinus Membrane Repair With Amnion-Chorion Barriers: A Retrospective Case Series.

Schneiderian membrane perforation is the most common complication of maxillary sinus augmentation procedures and has been associated with a variety of post-surgical problems. Multiple techniques to repair perforated Schneiderian membranes with materials such as connective tissue, buccal fat pads, and resorbable collagen membranes have been reported in the dental literature. Although these reparative options have proven successful, they are technique sensitive and time consuming. The aim of this case series is to present a simplified method of Schneiderian membrane perforation repair with amnion-chorion membranes and results obtained from nine cases using this technique. A consecutive retrospective record review was performed of all maxillary sinus augmentation cases performed during the past 5 years by the same board-certified private practice periodontist (DH). Seventy-seven cases were identified, with a total of 104 sinus augmentations, in which nine perforations were noted. None of the perforation cases were aborted midprocedure, and all perforations were repaired with amnion-chorion membranes. All cases were augmented with a combination of allograft and xenograft particulate bone. After an average healing time of 4.9 months, dental implants were placed in the grafted sinuses. This retrospective case series shows nine perforations during 104 lateral window maxillary sinus augmentation procedures. A total of 23 dental implants were placed in the augmented sinuses with perforated Schneiderian membranes, and one failure was noted according the Albrektsson success criteria. A total of 158 dental implants were placed in non-perforated augmented sinuses, with a total of three failures noted.

Maxillary Sinus Membrane Repair With Amnion-Chorion Barriers: A Retrospective Case Series

Background: Schneiderian membrane perforation is the most common complication of maxillary sinus augmentation procedures and has been associated with a variety of post-surgical problems. Multiple techniques to repair perforated Schneiderian membranes with materials such as connective tissue, buccal fat pads, and resorbable collagen membranes have been reported in the dental literature. Although these reparative options have proven successful, they are technique sensitive and time consuming. The aim of this case series is to present a simplified method of Schneiderian membrane perforation repair with amnion–chorion membranes and results obtained from nine cases using this technique.Methods: A consecutive retrospective record review was performed of all maxillary sinus augmentation cases performed during the past 5 years by the same board-certified private practice periodontist (DH).Results: Seventy-seven cases were identified, with a total of 104 sinus augmentations, in which nine perforations were noted. ...

Cell recruitment by amnion chorion grafts promotes neovascularization

BackgroundNonhealing wounds are a significant health burden. Stem and progenitor cells can accelerate wound repair and regeneration. Human amniotic membrane has demonstrated efficacy in promoting wound healing, though the underlying mechanisms remain unknown. A dehydrated human amnion chorion membrane (dHACM) was tested for its ability to recruit hematopoietic progenitor cells to a surgically implanted graft in a murine model of cutaneous ischemia. MethodsdHACM was subcutaneously implanted under elevated skin (ischemic stimulus) in either wild-type mice or mice surgically parabiosed to green fluorescent protein (GFP) + reporter mice. A control acellular dermal matrix, elevated skin without an implant, and normal unwounded skin were used as controls. Wound tissue was harvested and processed for histology and flow cytometric analysis. ResultsImplanted dHACMs recruited significantly more progenitor cells compared with controls (*P < 0.05) and displayed in vivo SDF-1 expression with incorporation of CD34 + progenitor cells within the matrix. Parabiosis modeling confirmed the circulatory origin of recruited cells, which coexpressed progenitor cell markers and were localized to foci of neovascularization within implanted matrices. ConclusionsIn summary, dHACM effectively recruits circulating progenitor cells, likely because of stromal derived factor 1 (SDF-1) expression. The recruited cells express markers of “stemness” and localize to sites of neovascularization, providing a partial mechanism for the clinical efficacy of human amniotic membrane in the treatment of chronic wounds.

Amnion–Chorion Allograft Barrier Used for Guided Tissue Regeneration Treatment of Periodontal Intrabony Defects: A Retrospective Observational Report

Introduction: Combination guided tissue regeneration (GTR) for the treatment of periodontal intrabony defects has been an accepted treatment modality for nearly 30 years and has undergone a number of changes during this time, including the use of multiple different barrier membrane materials. Amnion–chorion membrane (ACM) is a placental‐derived tissue that has been used in medicine for &gt;100 years and recently introduced for combination GTR use in dentistry. This retrospective observational report documents use of ACM for combination GTR treatment of periodontal intrabony defects with a minimum of 12‐month post‐surgical observation.Case Series: Review of the practice's electronic database revealed that 114 patients were treated with GTR therapy from March 2010 to October 2011. Of these patients, 64 were treated with ACM combination GTR therapy and had ≥12 months of follow‐up. All patients were diagnosed with localized moderate‐to‐severe chronic periodontitis and exhibited radiographic evidence of ≥1 vertical osseous defect. All patients were treated by thorough degranulation of intrabony periodontal defects and placement of bone allograft covered by ACM. Clinical measurements 12 months after surgery revealed an average probing depth reduction of 5.06 ± 1.37 mm and clinical attachment level improvement of 4.61 ± 1.29 mm.Conclusion: The results of this retrospective observational report are promising and warrant additional controlled, long‐term studies to further evaluate the effectiveness of ACM for combination GTR treatment of periodontal intrabony defects.

Direct analysis reveals an absence of γ-carboxyglutamic acid in cancer procoagulant from human tissues

Additional carboxylation of glutamic acid by vitamin K-dependent gamma-carboxylase is a common posttranslational modification of many proteins, including some of blood clotting factors. Vitamin K-antagonists, such as warfarin, are often included in the therapy of malignant disease, decreasing the blood coagulation potential. Cancer procoagulant, a direct blood coagulation factor X activator from malignant tissue, is considered as a vitamin K-dependent protein, so it could serve as one of possible targets for the therapy with warfarin. However, there is still no experimental data demonstrating directly the presence of gamma-carboxyglutamic acid (Gla) in a cancer procoagulant molecule. The presence of Gla in cancer procoagulant isolated from human amnion-chorion membranes and from human malignant melanoma WM 115 cell line was analyzed directly, using specific anti-Gla monoclonal antibodies. There was no detectable amount of Gla in cancer procoagulant isolated from fetal or malignant tissue. Cancer procoagulant from human tissues does not contain Gla-rich domain. The finding indicates that cancer procoagulant is rather a poor target for warfarin therapy of malignant disease.

Effect of immunisation with cancer procoagulant on the growth of Walker 256 carcinosarcoma cells in rats

The effect of preimmunisation with cancer procoagulant (CP) on the growth of Walker 256 carcinosarcoma cells in Wistar Lew/Han/IMP rats in vivo has been analysed. One group of rats was immunised with CP purified from human amnion-chorion membranes. The rest of the animals (control groups) were injected with 0.9% NaCl in Freund's adjuvant or were not immunised at all. When the presence of polyclonal anti-CP antibody was detected in CP-immunised rats' serum, all (CP-immunised and control) animals were injected i.p. with 4.8 x 10(5) Walker 256 cells per rat. After 5 days ascitic fluid was collected and viable cells were counted. The complete lack of viable Walker 256 carcinosarcoma cells in 24% of the CP-immunised rats was observed. However, the viable neoplastic cells were present in all control (NaCl-injected and nonimmunised) animals. It seems possible that CP plays an important role in tumour progression, so immunisation with CP can reduce the risk of development of malignant disease.

Does uterine wiping influence the rate of post-Cesarean endometritis?

Objective: To compare two methods of uterine cleansing to remove residual amnion-chorion at the time of Cesarean delivery. Methods: All consenting uninfected parturients undergoing a non-emergency Cesarean delivery at the university were enrolled. All patients received antibiotic prophylaxis of a 1-g intravenous bolus of a first-generation cephalosporin immediately after cord clamping. Postpartum endometritis was defined as a temperature of &#83 100.4°F (38°C) on two occasions 6 h apart after the first 24 h with uterine tenderness and/or foul-smelling lochia. Results: Between January 1998 and February 2000 there were 1400 patients enrolled in this investigation. A total of 153 women were determined to have chorioamnionitis present at surgery and 17 women refused participation, leaving 614 women in the uterine wipe group and 616 in the no wipe group. Maternal demographics were similar between patient groups (NS). Intrapartum factors including gestational age at time of Cesarean section, type of anesthesia used for the operative delivery, hours of amnion rupture prior to delivery, use of internal monitoring devices, type of skin incision, method of placental removal, total operative time and estimated blood loss were similar between patient groups (NS). An almost identical number of patients in each arm of the study developed post-Cesarean endometritis (65 out of 614, 10.5%, in the uterine wipe group vs. 66 out of 616, 10.7%, in the no wipe group; p = 1). Conclusions: Both methods of removing residual amnion-chorion membrane tissue and associated debris at surgery were comparably effective, but neither produced a dramatic reduction in the incidence of postoperative endometritis.

Addition of Dehydrated Human Amnion-Chorion Membrane During Scaling and Root Planing

Addition of Dehydrated Human Amnion-Chorion Membrane During Scaling and Root Planing