Beneficial Effects of Amnion-Chorion Stem Cell Grafting in the Long Term Management of Nonuremic Calciphylaxis Wounds

Calciphylaxis is a poorly understood disease with high morbidity and mortality. The current primary literature on treatment is lacking; however, disease management often involves a multifaceted approach with a primary focus on consistent wound care. This report describes a case outlining the long-term management of nonuremic calciphylaxis wounds in a patient with severe malnutrition with the use of human amniotic membrane grafts, aggressive surgical debridement, nutritional therapy, and advanced wound healing techniques. A 38-year-old African American female with a history of non-uremic calciphylaxis presented from a transitional facility with numerous non-healing wounds in the setting of severe malnutrition secondary to bariatric surgery. Biweekly wound debridement was initiated utilizing an amniotic stem cell skin graft, dry applicable absorbent dressing, high-frequency ultrasonic ablation, and wound vacuum-assisted closure (VAC) over the course of approximately nine months. Nutritional supplementation was given in the form of jejunostomy tube feed due to a gastric bypass and a perforated viscus. At the current date, the patient demonstrates significant improvement in pain and wound healing. The patient is also able to ambulate with care and has begun steps towards independent management of wounds. Future goals of care include independent bedside wound management, placement of allograft, and discharge to a long-term care facility. Most patients with refractory pain, widespread necrotic wounds, and dangerous comorbidities will inevitably be referred to palliative care. This case creates a framework for the long term management of medically complex patients with nonuremic calciphylaxis using human amniotic membrane stem cell grafts and appropriate advanced wound care techniques

Goldfish Pyramidal and Stellate Neurons Respond Differently to Anoxia

With oxygen deprivation the mammalian brain undergoes excito-toxic cell death but this does not occur in the anoxia tolerant goldfish. Since GABA is the major inhibitory neurotransmitter in the brain, I investigated its potential role in preventing hyper-excitability in goldfish telencephalon neurons. Utilizing patch-clamp technique, the electrical activities of both excitatory (pyramidal) and inhibitory (stellate) neurons were recorded. With anoxia, membrane potential depolarized in both cell types. While pyramidal cells remained mostly quiescent, action-potential frequency of the stellate neurons increased. Further, the GABAA receptor reversal potential (EÂŹGABA) was depolarizing in both cell types. Inhibition of GABAA receptors reversed the anoxic response, while GABAB receptor inhibition did not induce a response. Co-antagonism of both GABAA/B receptors generated seizure-like neuronal activity. I conclude that GABA is vital for the anoxic survival of the goldfish and that the increased stellate neuron activity likely results in inhibition of pyramidal neuron activity with anoxia.M.Sc

Goldfish Pyramidal and Stellate Neurons Respond Differently to Anoxia

With oxygen deprivation the mammalian brain undergoes excito-toxic cell death but this does not occur in the anoxia tolerant goldfish. Since GABA is the major inhibitory neurotransmitter in the brain, I investigated its potential role in preventing hyper-excitability in goldfish telencephalon neurons. Utilizing patch-clamp technique, the electrical activities of both excitatory (pyramidal) and inhibitory (stellate) neurons were recorded. With anoxia, membrane potential depolarized in both cell types. While pyramidal cells remained mostly quiescent, action-potential frequency of the stellate neurons increased. Further, the GABAA receptor reversal potential (EÂŹGABA) was depolarizing in both cell types. Inhibition of GABAA receptors reversed the anoxic response, while GABAB receptor inhibition did not induce a response. Co-antagonism of both GABAA/B receptors generated seizure-like neuronal activity. I conclude that GABA is vital for the anoxic survival of the goldfish and that the increased stellate neuron activity likely results in inhibition of pyramidal neuron activity with anoxia.M.Sc

GABA receptor inhibition and severe hypoxia induce a paroxysmal depolarization shift in goldfish neurons

This work shows that the combination of anoxia and inhibition of GABA receptors induces seizure-like activities in goldfish telencephalic pyramidal and stellate neurons. Importantly, to prevent seizure-like activity, an intact GABA-mediated inhibitory pathway is required. </jats:p

The Association Between Crohn’s Disease and Patient Response to Yeast: A Review of the Literature

Inflammatory bowel disease represents a wide range of pathologies and disease states including Crohn’s Disease (CD) and Ulcerative colitis (UC). Despite extensive research, the exact immunopathogenesis of Crohn’s disease remains unclear, but a variety of studies over the years have pointed to yeast as a potential source antigen of uncertain significance. The aim of this review is to summarize the current literature investigating the association between Crohn’s disease patients and their responses to yeast. To do this, we performed a literature review by looking at clinical and translational research regarding the immunopathogenesis of Crohn’s disease, yeast and its associated biomarkers, and overall patient response to dietary yeast published between 1 January 1990 and 1 October 2024 that were indexed on PubMed and Google Scholar with the majority written in English. It was found that antibodies against Saccharomyces cerevisiae (ASCA) have proven to be highly specific for CD during the workup of IBD and may have diagnostic value for the purpose of excluding ulcerative colitis. For CD patients, there appears to be a dysregulated immune response to antigens like yeast that results in abnormal mucosal permeability and thus increases antigen presentation to the immune system. In addition, ASCA and its immunoglobulin modifications have been shown to have significant potential in the prediction of CD onset and disease course. Interestingly, although other abnormally structured antibodies can be found in CD patients’ serum for years preceding diagnosis, there appears to be no relation between ASCA and dietary yeast sensitivity by CD patients. In conclusion, significant research efforts have been made in recent years to explore the role of diet in the disease course and management of patients with Crohn’s disease. The immunological role of antigens including yeast in CD is complex and may represent an important pathogenetic factor in addition to influencing the specific phenotype of the disease. Unfortunately, no single specific diet is superior for the management of IBD, and individualized patient treatment by experts in the field is best for adjunctive therapy. New studies characterizing the microbiome of CD patients and also using immune markers/gene modifications to predict disease outcomes have shown to be quite promising. However, further research is required to investigate the CD yeast response and its role in the pathogenesis, diagnosis and treatment of CD

The Management of Inflammatory Bowel Disease during Reproductive Years: An Updated Narrative Review

Inflammatory bowel disease (IBD) frequently affects women of childbearing age and often coincides with pregnancy. With an increased incidence of IBD, gastroenterologists and obstetricians are more frequently involved in caring for women of reproductive age. While the development of novel therapies has allowed for successful conception and pregnancy outcomes, many patients may hesitate to conceive due to concerns for presumed adverse IBD effects on maternal and fetal health. As such, a noticeable percentage of patients may choose voluntary childlessness. Indeed, active IBD carries a greater risk of adverse pregnancy outcomes, including a loss of pregnancy, preterm delivery, and emergent C-sections. However, those with a quiescent disease tend to have fewer pregnancy complications. Therefore, it is essential to achieve remission prior to conception to optimize pregnancy outcomes. Dedicated IBD and pregnancy clinics can greatly assist in improving patient knowledge and attitudes towards pregnancy; through individualized pre-conception counseling, education, and medication adherence, the risks of poor pregnancy outcomes can be minimized. Furthermore, it is important for healthcare providers to have a sufficient understanding of the medication safety and tools to measure the disease activity, while counseling patients during gestation and breastfeeding periods. This review article aims to provide the most recent evidence-based management methods for IBD during pregnancy

Aseptic Abscess Syndrome: A Case Report of a Rare Extraintestinal Manifestation of Inflammatory Bowel Disease

Introduction: Aseptic hepatic abscesses are a highly uncommon phenomenon and even more rare in the spectrum of extraintestinal manifestations of inflammatory bowel disease. Part of the spectrum of “neutrophilic disease,” both the pathogenesis and the optimal management of these aseptic abscesses remain unclear. In the context of inflammatory bowel disease, sometimes these abscesses appear despite normal endoscopic findings. Case Presentation: We describe a highly uncommon case of aseptic hepatic abscess formation in a patient with inflammatory bowel disease. Conclusion: In doing so, we investigated the concept of “aseptic abscess syndrome” as it relates to similar autoimmune conditions