Mucosal Defect Research Articles

Externally Applied "Through-the-Scope" Clip Closure During Endorobotic Submucosal Dissection.

Endorobotic submucosal dissection (ERSD) is a recent, novel technique combining submucosal dissection and robotic transanal approach. We strongly believe that ERSD increases precise dissection and dexterity, improves visuality, and enables the dissection to be completed in the submucosal plane. However, during these procedures, adverted defects and bleeding can occur. These complications can be managed by suturing and/or coagulation using the da Vinci SP® surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Closing defects with sutures can be time-consuming and technically more demanding. Nevertheless, through-the-scope (TTS) clips can manage these complications faster and potentially more cost-effectively. This prevents using additional robotic instruments (needle driver) and barbed sutures. This video aims to show using externally applied TTS clips for defect closure with robotic assistance following ERSD. TTS clips are flexible endoscopic clips in the market. They are designed for hemostasis, endoscopic marking, and defect closure in endoscopic procedures. The TTS clips are sent to the surgical field through the GelPOINT® Path transanal platform (Applied Medical, Rancho Santa Margarita, CA, USA), and it can be controlled with a robotic instrument indirectly. The TTS clips were used in 3 patients who underwent ERSD due to rectal lesion, and informed consents were obtained. The first patient was a 49-year-old woman referred with a rectal lesion at 12 cm from the anal verge found on screening colonoscopy. After submucosal injection, dissection was started, and the lesion was removed successfully. The mucosal defect in the upper rectum was successfully closed with a single externally placed TTS clip. The second patient was a 39-year-old man with a 40-mm recurrent polyp extending from 6 to 10 cm of the anal verge. Due to submucosal fibrosis, a larger defect area was left at the end of the tissue resection, and two TTS clips were used to approximate this defect. The last patient was a 53-year-old woman with a 35 mm lesion at 11 cm from the anal verge. Some bleeding was observed during the excision, and multiple TTS clips were used to prevent post-procedure bleeding. TTS clips were placed successfully in all cases. All 3 patients were discharged home the same day without complication. Histopathology revealed benign lesions with free deep and radial margins. No morbidity was detected after the procedures. Our video demonstrates the successful application of externally applied TTS clips for defect closure and hemostasis following ERSD in varying cases. The externally applied clip management is a viable alternative for accelerated, reliable, and inexpensive defect closures after ERSD. See Video Vignette.

Risk of stricture after endoscopic submucosal dissection in the cervical esophagus and efficacy of local steroid injection for stricture prevention (with video)

There is a high incidence of stricture after endoscopic submucosal dissection (ESD) for cervical esophageal cancer. We aimed to elucidate the risk factors for stricture and to evaluate the efficacy of steroid injection for stricture prevention in the cervical esophagus. We retrospectively analyzed 100 patients who underwent ESD for cervical esophageal cancer to (1) identify the factors associated with stricture among patients who did not receive steroid injection, and (2) compare the incidence of stricture between patients with and without steroid injection. Among 48 patients who did not receive steroid injection, there were significant differences in tumor size (P= .026), resection time (P= .028), and circumferential extent of the mucosal defect (P= .005) between patients with stricture (n= 5) and without stricture (n= 43). Compared with patients without steroid injection, patients with steroid injection had a significantly lower incidence of stricture when the post-ESD mucosal defect was<3/4 and≥1/2 (40% versus 8%; P= .039). For the patients with a post-ESD mucosal defect of≥3/4 (n= 13), local steroid injection was performed for all of them, and 6 (46%) developed stricture. Patients who underwent≥1/2 circumferential resection were at high risk of cervical esophageal stricture. Steroid injection had a stricture prevention effect in patients with<3/4 and≥1/2 circumferential resection, but seemed to be insufficient in preventing stricture in patients with≥3/4 circumferential resection.

Successful closure of large mucosal defect with novel anchor-pronged clip after gastric endoscopic submucosal dissection.

Successful closure of large mucosal defect with novel anchor-pronged clip after gastric endoscopic submucosal dissection.

Endoscopic hand suturing of small intestine and colon: complete suturing of a post-endoscopic submucosal dissection mucosal defect at the anastomosis after right hemicolectomy.

Endoscopic hand suturing of small intestine and colon: complete suturing of a post-endoscopic submucosal dissection mucosal defect at the anastomosis after right hemicolectomy.

Managing complexity with chimerism: ALT-AMT flaps for complex head and neck reconstruction

BackgroundHead and neck cancer is the most common cancer in males and fifth most common in females in India. Inadequate screening programs and non-availability of local healthcare resources leads to late diagnosis and most cases present at an advanced stage. Surgical extirpation often results in complex, large defects. The concept of chimerism is useful in dealing with such extensive defects.MethodsBetween July 2013 and May 2017, all patients who underwent primary reconstruction of head and neck defects following cancer extirpative surgery, with ALT-AMT chimera flap at a tertiary care cancer centre were included in this study. The patient data of age, sex, etiology, defect size, flap size, perforator configuration, anastomotic details, donor site closure, and complications was retrospectively collected as per the designated proforma from the hospital electronic record, departmental case record forms and the first author’s personal logs, and analyzed.ResultsChimeric flaps based on the lateral circumflex femoral artery i.e. ALT plus AMT provide the desired qualities to address the complex defects. All thirteen patients had a large intraoral mucosal defect. Nine cases had a large extra oral skin defect. The average size of ALT was (112.5 cm2 area) and of AMT was (94.9 cm2 area). The combined area of ALT AMT was 28.5 X 9 = 256.5 cm2. All AMT pedicles were joining the ALT pedicle. 1 AMT was lost and all donor sites needed skin grafting.ConclusionChimeric ALT + AMT is a valuable option when complex, large, multidimensional and multicomponent defects need to be reconstructed. The advantage of utilising a single donor site and two independent flaps with a single microvascular anastomosis.Level of Evidence: Level IV, therapeutic study

Successful removal of a duodenal lesion in difficult location using "a sandwich method".

A 69-year-old woman was diagnosed with a duodenal adenoma near major duodenal papilla during cancer screening examination (Figure 1A). Therefore, endoscopic mucosal resection (EMR) was proposed to remove the duodenal lesion. Unfortunately, satisfactory visualization of the duodenal lesion was not obtained during gastroscopic operation. Unexpectedly, duodenoscopy provided optimal visualization of the duodenal lesion. Consequently, the "sandwich method" using duodenoscopy-gastroscopy-duodenoscopy was successfully performed to remove the challenging duodenal lesion. Firstly, the duodenoscopy was used to create a submucosal bleb through injecting saline containing 0.3 % indigo carmine. Subsequently, the gastroscopy with a transparent capwas used to remove the duodenal lesion with en bloc resection. Then, the duodenoscopy was reused to close the mucosal defect. Finally, pathologic examination showed a tubule-villous adenoma. The patient was recovered uneventfully, and discharged 2 days later.

Recombinant Platelet-Derived Growth Factor-BB (rhPDGF-BB) Augmented Collagen Grafting for Oral Mucosal Defect Reconstruction

Abstract Objective To assess the suitability of collagen grafting and compare the outcomes between rhPDGF-BB (recombinant human platelet-derived growth factor-BB) augmented collagen grafting and collagen alone grafting for oral mucosal defect reconstruction. Method A total of 30 patients, who were planned for surgical excision of various intraoral lesions, participated in the study. These participants were then randomly assigned into two groups. Group I underwent reconstruction with collagen sheet with rhPDGF-BB, while group II underwent reconstruction with collagen sheet alone. Post-operatively, haemostasis, pain, granulation, epithelialisation and healing contracture were assessed. Results The lesions that were treated included leucoplakia, erythroplakia, oral submucous fibrosis and verrucous carcinoma. Use of collagen was associated with good haemostasis, pain relief, granulation tissue formation and epithelialisation. Group I was found to develop slightly better granulation tissue, epithelisation and lesser degree of tissue contracture compared to group II, although these results were not significant statistically (p value = 0.464, 0.705 and 1.000 respectively). Conclusion This study shows that use of collagen graft augmented with rhPDGF-BB could be beneficial in oral cavity reconstruction following resection of small lesions, although further research with larger sample size is proposed to confirm the benefit.

Suturing with muscle layer grasping and pulling technique for mucosal defect of colorectal endoscopic submucosal dissection.

Watch a video of this article.

Reconstruction of oral mucosal defects with regenerative dermal matrix after T1-T2 squamocellular carcinoma resection

ObjectiveResection of tumors of oral cavity usually causes short- or long-term sequelae such as chewing, speech and swallowing impairment. To preserve this function it is necessary to maintain the lining of the oral cavity, the mobility and sensitivity of the tongue. Reconstructive options for oral mucosal defects resulting from tumor resection included primary closure, mucosal and skin grafts, pedicle and microvascular free flaps, and dermal matrix. Study designRetrospective study on patients undergoing reconstruction of intraoral defects, after removal of T1, T2 malignant tumors, by placement of bilayer dermal matrix. MethodsFrom 2021 to 2022, 47 patients with oral mucosa defects after removal of squamous cell carcinoma were treated. All patients were affected by a T1-T2 squamous cell carcinoma.For each patient, data were collected regarding the site of the disease, the initial staging, the size of the surgical defect, the complications and the outcome months after the operation. ResultsIn all treated cases the surgical defect involved the mucosa of the cheek, the oral floor or the tongue with an average size of 5.45cm2.Patients who underwent this type of reconstruction benefited from excellent healing of intraoral wounds and good restoration of oral function 6 months after surgery. Out of the total number of patients, membrane attachment failure was reported in only two cases. ConclusionAs emerges from the data reported in our study, the dermal matrix represents a valid alternative in oncological reconstructive surgery for small/medium-sized intraoral mucosal defects because it allows re-epithelialization of the wound.

Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2024.

1: ESGE recommends cold snare polypectomy (CSP), to include a clear margin of normal tissue (1-2 mm) surrounding the polyp, for the removal of diminutive polyps (≤ 5 mm).Strong recommendation, high quality of evidence. 2: ESGE recommends against the use of cold biopsy forceps excision because of its high rate of incomplete resection.Strong recommendation, moderate quality of evidence. 3: ESGE recommends CSP, to include a clear margin of normal tissue (1-2 mm) surrounding the polyp, for the removal of small polyps (6-9 mm).Strong recommendation, high quality of evidence. 4: ESGE recommends hot snare polypectomy for the removal of nonpedunculated adenomatous polyps of 10-19 mm in size.Strong recommendation, high quality of evidence. 5: ESGE recommends conventional (diathermy-based) endoscopic mucosal resection (EMR) for large (≥ 20 mm) nonpedunculated adenomatous polyps (LNPCPs).Strong recommendation, high quality of evidence. 6: ESGE suggests that underwater EMR can be considered an alternative to conventional hot EMR for the treatment of adenomatous LNPCPs.Weak recommendation, moderate quality of evidence. 7: Endoscopic submucosal dissection (ESD) may also be suggested as an alternative for removal of LNPCPs of ≥ 20 mm in selected cases and in high-volume centers.Weak recommendation, low quality evidence. 8: ESGE recommends that, after piecemeal EMR of LNPCPs by hot snare, the resection margins should be treated by thermal ablation using snare-tip soft coagulation to prevent adenoma recurrence.Strong recommendation, high quality of evidence. 9: ESGE recommends (piecemeal) cold snare polypectomy or cold EMR for SSLs of all sizes without suspected dysplasia.Strong recommendation, moderate quality of evidence. 10: ESGE recommends prophylactic endoscopic clip closure of the mucosal defect after EMR of LNPCPs in the right colon to reduce to reduce the risk of delayed bleeding.Strong recommendation, high quality of evidence. 11: ESGE recommends that en bloc resection techniques, such as en bloc EMR, ESD, endoscopic intermuscular dissection, endoscopic full-thickness resection, or surgery should be the techniques of choice in cases with suspected superficial invasive carcinoma, which otherwise cannot be removed en bloc by standard polypectomy or EMR.Strong recommendation, moderate quality of evidence.

Introduction to Amniotic Membranes in Maxillofacial Surgery-A Scoping Review.

Background: Amniotic membrane (AM) holds significant promise in various medical fields due to its unique properties and minimal ethical concerns. This study aims to explore the diverse applications of the human amniotic membrane (HAM) in maxillofacial surgery. Methodology: A comprehensive search was conducted on databases, namely Google Scholar, PubMed, and Scopus, from January 1985 to March 2024. Articles in English, Polish, and Spanish were included, focusing on keywords related to amniotic membrane and oral surgery. Results: Various preservation methods for HAM were identified, namely fresh, decellularized, cryopreserved, lyophilized, and air-dried formats. Clinical studies demonstrated the efficacy of HAM in repairing oral mucosal defects, vestibuloplasty, oronasal fistula closure, cleft palate treatment, bone defect repair, and medication-related osteonecrosis of the jaw (MRONJ). Surgeon evaluations highlighted the ease of handling but noted challenges in suturing and stability during application. Conclusions: Amniotic membranes offer a versatile and effective option in maxillofacial surgery, promoting wound healing, reducing inflammation, and providing a scaffold for tissue regeneration. Further research, including randomized trials and comparative studies, is warranted to validate the efficacy and optimize the utilization of HAM in clinical practice.

Clinicopathological and molecular genetic features of Crohn's disease

Objective: To investigate the clinicopathological and molecular genetic characteristics of Crohn's disease (CD). Methods: A retrospective analysis was conducted on 52 CD patients who underwent surgical resection at the First Affiliated Hospital of Nanjing Medical University between January 2014 and June 2023. Clinical presentations and histopathological features were assessed. Whole-genome sequencing was performed on 17 of the samples, followed by sequencing and pathway enrichment analyses. Immunohistochemistry was used to assess the expression of frequently mutated genes. Results: Among the 52 patients, 34 were males and 18 were females, male-to-female ratio was 1.9∶1.0, with a median age of 45 years at surgery and 35 years at diagnosis. According to the Montreal classification, A3 (51.9%,27/52), B2 (61.5%, 32/52), and L3 (50.0%,26/52) subtypes were the most predominant. Abdominal pain and diarrhea were the common symptoms. Histopathological features seen in all 52 patients included transmural inflammation, disruption of cryptal architecture, lymphoplasmacytic infiltration, varying degrees of submucosal fibrosis and thickening, increased enteric nerve fibers and neuronal proliferation. Mucosal defects, fissure ulcers, abscesses, pseudopolyps, and adenomatous proliferation were also observed in 51 (98.1%), 38 (73.1%), 28 (53.8%), 45 (86.5%), and 28 (53.8%) cases, respectively. Thirty-one (59.6%) cases had non-caseating granulomas, and 3 (5.8%) cases had intestinal mucosal glandular epithelial dysplasia. Molecular analysis showed that 12/17 CD patients exhibited mutations in at least one mucin family gene (MUC2, MUC3A, MUC4, MUC6, MUC12, MUC17), and MUC4 was the most frequently mutated in 7/17 of cases. Immunohistochemical stains showed reduced MUC4 expression in epithelial cells, with increased MUC4 expression in the epithelial surface, particularly around areas of inflammatory cell aggregation; and minimal expression in the lower half of the epithelium. Conclusions: CD exhibits diverse clinical and pathological features, necessitating a comprehensive multidimensional analysis for diagnosis. Mutations and expression alterations in mucin family genes, particularly MUC4, may play crucial roles in the pathogenesis of CD.

Potential for expanded application of endoscopic hand suturing: A pilot study of 15 cases.

Endoscopic hand suturing (EHS) was first developed to firmly close a mucosal defect following endoscopic submucosal dissection and has the potential for expanded applications. This study aimed to investigate the feasibility and safety of EHS in various clinical settings. In this single-center pilot study, 15 patients who had diseases with potential indications for EHS were prospectively recruited. Technical success, clinical success after the procedure, and severe EHS-related adverse events (AEs) were evaluated. EHS was applied for defect closure after gastric subepithelial lesion removal under laparoscopic observation (n = 9), defect closure after rectal endoscopic full-thickness resection (EFTR) (n = 2), defect closure after thoracoscopy-assisted esophageal EFTR (n = 1), mucosal closure for gastric ulcer bleeding (n = 1), mucosal closure after peroral endoscopic myotomy (POEM) (n = 1), and postoperative anastomotic leak (n = 1). EHS was completed without severe AEs and the clinical courses were also favorable in 13 patients (87%). The median suturing time was 61 minutes. In patients with POEM and anastomotic leak, EHS was discontinued because of the narrow lumen. In conclusion, EHS appears feasible and safe in situations.

A comprehensive review on phytochemicals as potential therapeutic agents for stress-induced gastric ulcer

AbstractGastric ulcers are the most common chronic gastrointestinal tract disorders, marked by an inflamed break of the mucus membrane covering the alimentary tract. According to recent research, stress-induced ulcers are widespread in our society. A stress ulcer is a mucosal defect that may become complicated due to upper gastrointestinal tract bleeding. The underlying cause of this condition is pH. Physiological stress leads to severe sickness by triggering the excessive secretion of peptic juices or gastric acid. There is a never-ending quest for safe and affordable medication for this disorder. Nature offers many medicinal plants that can be used to treat a wide range of human ailments. Due to their relatively harmless and comparatively free of harmful effects, health-promoting features, pharmacological practices, and affordability to common people to regulate various diseases, medicinal plants, and herbal preparations are gaining a lot of interest in scientific communities these days. Many studies have recently been performed to classify extracts and their constituents that may have a therapeutic effect on peptic ulcers. Therefore, this review aims to address the molecular mechanisms and pharmacological effects of various phytochemicals related to stress-induced gastric ulcers. Combining phytochemical constituents with modern drugs and treatment methods can lead to the development of therapeutic drugs for gastric ulcers. Gastric ulcers and other related diseases may be treated permanently with this approach.

A multi-centre randomized controlled trial comparing connective tissue graft with collagen matrix to increase soft tissue thickness at the buccal aspect of single implants: 3-Year results.

To compare connective tissue graft (CTG) with collagen matrix (CMX) in terms of increase in buccal soft tissue profile (BSP) when applied at single implant sites. Patients with a single tooth gap in the anterior maxilla and horizontal mucosa defect were enrolled in a multi-centre randomized controlled trial. All were fully healed sites with a bucco-palatal bone dimension of at least 6 mm, and received an immediately restored single implant using a full digital workflow. Patients were randomly allocated to the control (CTG) or test group (CMX: Geistlich Fibro-Gide, Geistlich Pharma AG, Wolhusen, Switzerland) to increase buccal soft tissue thickness. Primary endpoints were increase in BSP at T1 (immediately postop), T2 (3 months), T3 (1 year) and T4 (3 years) based on superimposed digital surface models. Secondary endpoints included patient-reported, clinical and aesthetic outcomes. Thirty patients were included per group (control group: 15 males, 15 females, mean age 50.1 years; test group: 14 males, 16 females, mean age 48.2 years) and 50 could be re-examined at T4. The changes in BSP over time were significantly different between the groups (p < .001). At T4, the estimated mean increase in BSP amounted to 0.83 mm (95% confidence interval [CI]: 0.58-1.08) in the control group and 0.48 mm (95% CI: 0.22-0.73) in the test group. The estimated mean difference of 0.35 mm (95% CI: 0.06-0.65) in favour of the control group was significant (p = .021). No significant differences between the groups could be observed in terms of patients' aesthetic satisfaction (p = .563), probing depth (p = .286), plaque (p = .676), bleeding on probing (p = .732), midfacial recession (p = .667), Pink Esthetic Score (p = .366) and Mucosal Scarring Index (p = .438). However, CMX resulted in significantly more marginal bone loss (-0.43 mm; 95% CI: -0.77 to -0.09; p = .015) than CTG. CTG was more effective in increasing buccal soft tissue profile and resulted in less marginal bone loss than CMX. Therefore, CTG remains the gold standard to increase soft tissue thickness at implant sites. This study was registered in ClinicalTrials.gov (NCT04210596).

The use of a self-assembling peptide gel for stricture prevention in the esophagus after endoscopic submucosal dissection: a U.S. multicenter prospective study (with video)

Background and AimsPost-operative stricture is serious common adverse event following extensive endoscopic submucosal dissection (ESD) in the esophagus. The self-assembling peptide (SA) gel has been shown to promote tissue healing and re-epithelialization. We aimed to evaluate the effect of the SAP gel for esophageal stricture prevention after ESD. MethodsMulticenter prospective study of patients who underwent esophageal ESD followed by SAP gel application between March 2022 to December 2023. Patients were included if ESD mucosal defect involved ≥ 50% of the circumference of the esophagus. High-risk cases were defined as mucosal defects ≥75% of the circumference. Stricture was defined as the inability to pass an endoscope ≥8.9 mm in diameter or a narrow-caliber lumen in a patient with symptoms. ResultsA total of 43 patients (median age 71 years; 81.4% men) underwent ESD (median resected specimen size 50 mm) during the study period. SAP gel (median 3 mL) was successfully applied in all cases (median time 4 minutes). In aggregate, stricture occurred in 20.9% (9/43) of the cases. Stricture developed in 30.8% of the high-risk cases: 80% (4/5) after circumferential ESD and 19% (4/21) in those with defects ≥75% but <100% of the circumference. All cases of stricture resolved with endoscopic treatment. Three cases (6.9%) of postoperative bleeding occurred and were adequately managed endoscopically. ConclusionWe demonstrate that SAP gel application was easy, quick, and associated with a relatively low stricture rate comparable to other prophylactic methods. Additional comparative studies are needed to corroborate these preliminary findings.

Assessing peptic ulcer risk with the HAMPROW score in the general Chinese population

The timely identification of individuals at high risk for peptic ulcers (PUs) is vital in preventing gastrointestinal bleeding after antiplatelet therapy. This study was designed to determine PU risk factors and develop a risk assessment model for PU detection in the general Chinese population. In a prospective dataset, clinical data from individuals undergoing gastroscopic evaluation between April 2019 and May 2022 were recorded. PUs were defined as mucosal defects exceeding 5 mm confirmed via gastroscopy. Participants were categorized into development (April 2019 to April 2021) and validation (May 2021 to May 2022) sets based on chronological order. LASSO-derived logistic regression analysis was employed to create a score, which was further validated via temporal validation. A total of 902 patients were ultimately enrolled, 204 (22.6%) of whom had PUs based on endoscopic findings. In the development cohort (n = 631), seven independent risk factors emerged: male sex (OR = 2.35, P = 0.002), white blood cell (WBC) count (OR = 1.16, P = 0.010), red blood cell (RBC) count (OR = 0.49, P < 0.001), globulin level (OR = 0.92, P = 0.004), albumin level (OR = 0.94, P = 0.020), pepsinogen I (PGI) level (OR = 1.01, P < 0.001), and positive Helicobacter pylori (HP) antibody (OR = 2.50, P < 0.001). Using these factors, a nomogram (HAMPROW score [hazard ratio (HP) antibody, albumin, male, PGI, RBC, globulin, and WBC]) was developed for individual PU prediction. The ability of the HAMPROW score to predict survival was confirmed with AUCs of 0.854 (95% CI 0.816–0.891) and 0.833 (95% CI 0.771–0.895) in the development and validation sets, respectively. In conclusion, the HAMPROW score can be used to screen for PUs effectively in the general Chinese population, facilitating personalized early detection of high risk of gastrointestinal bleeding before antiplatelet therapy.

MiR-138-5p ameliorates intestinal barrier disruption caused by acute superior mesenteric vein thrombosis injury by inhibiting the NLRP3/HMGB1 axis.

Acute superior mesenteric venous thrombosis (ASMVT) decreases junction-associated protein expression and intestinal epithelial cell numbers, leading to intestinal epithelial barrier disruption. Pyroptosis has also recently been found to be one of the important causes of mucosal barrier defects. However, the role and mechanism of pyroptosis in ASMVT are not fully understood. Differentially expressed microRNAs (miRNAs) in the intestinal tissues of ASMVT mice were detected by transcriptome sequencing (RNA-Seq). Gene expression levels were determined by RNA extraction and reverse transcription-quantitative PCR (RT-qPCR). Western blot and immunofluorescence staining analysis were used to analyze protein expression. H&E staining was used to observe the intestinal tissue structure. Cell Counting Kit-8 (CCK-8) and fluorescein isothiocyanate/propidine iodide (FITC/PI) were used to detect cell viability and apoptosis, respectively. Dual-luciferase reporter assays prove that miR-138-5p targets NLRP3. miR-138-5p expression was downregulated in ASMVT-induced intestinal tissues. Inhibition of miR-138-5p promoted NLRP3-related pyroptosis and destroyed tight junctions between IEC-6 cells, ameliorating ASMVT injury. miR-138-5p targeted to downregulate NLRP3. Knockdown of NLRP3 reversed the inhibition of proliferation, apoptosis, and pyroptosis and the decrease in tight junction proteins caused by suppression of miR-138-5p; however, this effect was later inhibited by overexpressing HMGB1. miR-138-5p inhibited pyroptosis, promoted intestinal epithelial tight junctions and alleviated ASMVT injury-induced intestinal barrier disruption via the NLRP3/HMGB1 axis.

ЭКСПЕРИМЕНТАЛЬНОЕ ОБОСНОВАНИЕ ПРИМЕНЕНИЯ БИОРЕЗОРБИРУЕМЫХ ПЕРСОНАЛИЗИРОВАННЫХ КОЛЛАГЕНОВЫХ МЕМБРАН ДЛЯ ЗАКРЫТИЯ ДЕФЕКТОВ СЛИЗИСТОЙ ОБОЛОЧКИ РТА

Subject. The subject of the study is the biomechanical properties of a personalized collagen membrane in the area of wound defects of the oral mucosa.&#x0D; Objectives. To increase the effectiveness of treatment of patients with extensive surgical wound defects of the oral mucosa by experimentally substantiating the use of developed collagen membranes from bovine Achilles tendon.&#x0D; Methodology. Based on the Central Vivarium of the First Moscow State Medical University named after I.M. Sechenov (Sechenov University) conducted an experimental study on laboratory animals (rabbits) (n = 12) to create a wound surface in the oral cavity (limited vestibuloplasty according to Clark on the upper jaw) and its closure with collagen membranes with an assessment of the course of the postoperative period and subsequent histological examination of biomaterials: 1st – using a personalized collagen membrane, 2nd – using a collagen membrane with lactoferrin, 3rd – using a Mucograft membrane, 4th group – control.&#x0D; Results. In the postoperative period, on the 3rd day, moderate swelling, and hyperemia in the area of vestibuloplasty were noted in the oral cavity of rabbits: the least pronounced swelling was in animals in the 2nd group of operations (1.5 ± 0.5 points) (p = 0.001), hyperemia – in the 3rd group (1.7 ± 0.4 points) (p = 0.001). On the 5th day in the oral cavity of experimental animals, hyperemia of the mucous membrane of the oral vestibule in the 2nd group was 0.8 ± 0.4 points (p = 0.001), and in the 3rd group – 1.8 ± 0.4 points (p = 0.001). According to the histological research method, a significant difference was noted in the quantity and quality of the formed soft tissues in the area of application of collagen matrices compared to healing by secondary intention (p &lt; 0.05). The results of histological examination showed in group 2 epithelization with acanthosis and proliferation of the basal layer.&#x0D; Conclusion. The effectiveness of the developed collagen membranes from the Achilles tendon has been proven in eliminating extensive wound defects of the oral mucosa.

Comparison of the Effectiveness of a Novel Matrix-Modified Bovine Collagen Membrane With a Conventional Bovine Collagen Membrane for Oral Mucosal Defects: A Single-Center Study.

Background Surgical procedures such asexcision of a growth or lesion lead to soft tissue or oral mucosal defects. These defects require a proper surgical dressing to promote better wound healing and to avoid infection and scarring. A collagen membrane is one of the most commonly used surgical dressings because of its ease of adaptability to defects and its inherent ability to promote epithelialization and inhibition of pain through the indirect mechanism of preventing infection of the surgical site. Collagen also serves as a reservoir of regenerative factors. The regenerative potential increases as porosity decreases. The novel bovine-derived collagen membrane used in this current study has an average porosity of 20 microns which increases the availability of regenerative factors. Objective The aim of this study was to compare the effectiveness between a novel matrix-modified bovine collagen membrane (SurgiColl) and a conventional bovine collagen membrane for promoting wound healing for oral mucosal or soft tissue defects. Materials and methods This clinical trial was conducted in the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital. The sample size of the study was 20, divided into two groups: novel bovine collagen (Surgicoll-Mesh) (Group 1) and conventional bovine collagen (Group 2) with 10 participants in each group. The randomization process was adopted. The parameters assessed were epithelialization, granulation, and wound contraction at the end of two weeks. All the parameters were assessed using a standardized visual assessment scale. Statistical analysis was done usingIBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States), and an independent samplet-test was done at 95% confidence interval. A p-value of less than 0.05 was considered statistically significant. Results The difference in epithelialization between the two groups was statistically significant with a p-value of 0.015 (<0.05). The difference in granulation tissue formation between the two groups was statistically significant with a p-value of 0.015 (<0.05). The difference in wound contraction at the end of two weeks between the two groups was also statistically significant with a p-value of 0.005 (<0.05). Group 1 showed superior results compared to Group 2 for all the outcomes assessed. Conclusion The novel bovine-derived collagen membrane (SurgiColl-Mesh) was superior in its properties of wound healing for oral mucosal or soft tissue defects than the conventional bovine collagen membrane.