Patients with a transabdominal cerclage due to recurrent mid-trimester losses are not at higher risk of foetal growth restriction: a retrospective study.

Foetal growth restriction (FGR) is associated with neonatal morbidity, suboptimal neurodevelopmental outcomes and chronic diseases. Successful pregnancies of women with recurrent mid-trimester pregnancy losses may still be at risk of FGR and small for gestational age (SGA) outcomes. This study aimed to investigate whether patients with recurrent mid-trimester pregnancy losses who undergo transabdominal cerclage (TAC) are at an increased risk of FGR.

Combined therapeutic use of umbilical cord blood serum and amniotic membrane in diabetic wounds.

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.

Posttraumatic stress disorder is characterized by functional dysregulation of dermal fibroblasts.

Incidence of mental health disorders are rising in modernity, with psychological stress linked to a propensity for developing various chronic diseases due to a relative inability of the body to counter the allostatic load on cellular level. Despite these high rates of comorbidities associated with posttraumatic stress disorder (PTSD), there is still a lack of understanding in terms of the peripheral effects of PTSD on tissue level. Therefore, the purpose of this study was to profile basal dermal fibroblast functional status in PTSD using a wide range of markers involved in the cell-to-cell communication facilitated by fibroblasts.

Counteracting diabetes-induced adipose tissue derived-stromal cell senescence.

Adipose tissue stromal cells (ADSCs) are prone to functional decline and senescence during metabolic disturbances. In diabetes mellitus (DM), the pathogenic microenvironment induces oxidative stress causing ADSCs to senesce. The senescence associated secretory phenotype (SASP) in turn drives disease progression.

Pregnancy and diabetic ketoacidosis: fetal jeopardy and windows of opportunity.

Background: Diabetic ketoacidosis (DKA) during pregnancy poses significant risks to both the mother and fetus, with an increased risk of fetal demise. Although more prevalent in women with Type I diabetes (T1D); those with Type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) can also develop DKA. A lack of information about DKA during pregnancy exists worldwide, including in South Africa.

Rectus sheath catheters reduce opiate use in pancreaticoduodenectomy: a pre- and postintervention cohort study.

Background: Pancreaticoduodenectomy is the only curative option for patients with pancreatic cancer; however, pain remains a considerable problem postoperatively. With many centres moving away from using epidural analgesia, there is the need to evaluate alternative opiate sparing techniques for postoperative analgesia. We sought to determine if rectus sheath catheters (RSCs) had an opiate sparing and analgesic effect compared with standard care alone (opiate analgesia).

Nutritional deficiency in South African adults scheduled for bariatric surgery.

Background: Globally, there is a rising trend in obesity, known to increase morbidity and mortality. Metabolic surgery and adequate weight loss decrease mortality but may worsen pre-existing nutrient deficiencies. Most data on pre-existing nutritional deficiencies in the population undergoing metabolic surgery is from the developed world, where an extensive micronutrient assessment is achievable.

Early postpartum HbA1c after hyperglycemia first detected in pregnancy-Imperfect but not without value.

Background: South African women of childbearing age are disproportionally affected by obesity and at significant risk of Type 2 Diabetes Mellitus (T2DM). Unless pregnant, they do not readily undergo screening for T2DM. With a local focus on improved antenatal care, hyperglycemia is often first detected in pregnancy (HFDP).

Immunology of chronic low-grade inflammation: relationship with metabolic function.

Inflammation is part of the body's innate immune response and is an essential process that not only defends against harmful bacteria and pathogens but also plays a key role in the maintenance and repair of tissues. Under pathological conditions, there is bilateral crosstalk between immune regulation and aberrant metabolism resulting in persistent inflammation in the absence of infection. This phenomenon is referred to as sterile metabolic inflammation (metainflammation) and occurs if the initiating stimulus is not removed or if the resolution process is disrupted.

Evaluating the Influence of IV Ketamine on Postoperative Opioid Use for Surgical Patients at a Tertiary Care Centre.

Background: Subanesthetic doses of ketamine have been shown to improve the efficacy of opioids, increase pain control, and exemplify opioid-sparing effects when used as postoperative analgesia for adults.

Objectives: To determine, for surgical patients, the impact of IV ketamine infusions on opioid use in hospital, overall and within 24 h before discharge, as well as pain scores.

Methods: A retrospective matched cohort study was conducted, in which surgical patients exposed to ketamine were compared with those not exposed to ketamine, among admissions from January 1, 2018, to February 28, 2020.

A qualitative evaluation of the process of creating and implementing an interprofessional care pathway for patients treated with oral anticancer drugs.

Purpose: To investigate factors affecting the co-creation and implementation of care pathways for patients treated with oral anticancer drugs.

Methods: An explorative qualitative process evaluation was performed at four Belgian hospitals, co-creating and implementing a care pathway for patients on oral anticancer drugs. Semistructured interviews and focus groups were performed by a) local coordinators leading an interprofessional project team during the co-creation and implementation stage, b) external implementation coaches, and c) teams of healthcare professionals with a role in the care pathway.

Establishment of fibroblast and myofibroblast phenotypes for use in in vitro co-culture models.

Fibroblasts function to secrete and modify components of the extracellular matrix. During wound healing, fibroblasts migrate to the site of injury and differentiate into contractile myofibroblasts; this differentiation is characterised by an increased contractile capacity. Fully differentiated myofibroblasts can be distinguished from fibroblasts via the higher expression of α-smooth muscle actin as well as a denser cytoskeleton.

Transabdominal cerclage during pregnancy: A retrospective single operator series over a quarter century.

Objective: To describe the pregnancy outcomes and complications observed in a series of cases of transabdominal cerclage (TAC), which is reserved for highly selected women with recurrent mid-trimester pregnancy loss, due to cervical insufficiency.

Methods: A retrospective audit covering 25 years (January 1, 1997 to December 31, 2021) was performed at the Obstetric Special Care division, Tygerberg Academic Hospital in Cape Town, South Africa. All 118 pregnancies from 94 procedures, operated and managed by the principal author were included for descriptive analysis.

A regenerative approach to the pharmacological management of hard-to-heal wounds.

A wound is considered hard-to-heal when, despite the appropriate clinical analysis and intervention, the wound area reduces by less than a third at four weeks and complete healing fails to occur within 12 weeks. The most prevalent hard-to-heal wounds are associated with underlying metabolic diseases or vascular insufficiency and include arterial, venous, pressure and diabetic foot ulcers. Their common features include an abnormal immune response and extended inflammatory phase, a subdued proliferation phase due to cellular insufficiencies and finally an almost non-existent remodeling phase.

A regenerative approach to the pharmacological management of hard-to-heal wounds.

A wound is considered hard-to-heal when, despite the appropriate clinical analysis and intervention, the wound area reduces by less than a third at four weeks and complete healing fails to occur within 12 weeks. The most prevalent hard-to-heal wounds are associated with underlying metabolic diseases or vascular insufficiency and include arterial, venous, pressure and diabetic foot ulcers. Their common features include an abnormal immune response and extended inflammatory phase, a subdued proliferation phase due to cellular insufficiencies and finally an almost non-existent remodeling phase.

Ex vivo tolerization and M2 polarization of macrophages dampens both pro- and anti-inflammatory cytokine production in response to diabetic wound fluid stimulation.

Monocytes/macrophages play a prominent role in cutaneous wound healing. Persistent inflammation in diabetic wounds is associated with the inability of monocytic cells to switch from a phagocytic M1 (classically activated) to an anti-inflammatory, pro-regenerative M2 (alternatively activated) phenotype and as consequence, the proliferative phase of healing does not commence. A targeted cell therapy approach could potentially restore the pathological wound microenvironment through paracrine signalling to enable healing.

The paracrine effects of adipocytes on lipid metabolism in doxorubicin-treated triple negative breast cancer cells.

Adipocytes in the breast tumour microenvironment promotes acquired treatment resistance. We used an in vitro adipocyte-conditioned media approach to investigate the direct paracrine effects of adipocyte secretory factors on MDA-MB-231 breast cancer cells treated with doxorubicin to clarify the underlying treatment resistance mechanisms. Cell-viability assays, and Western blots were performed to determine alterations in apoptotic, proliferation and lipid metabolism protein markers.

The Effect of N-Acetylcysteine and Ascorbic Acid-2-Phosphate Supplementation on Mesenchymal Stem Cell Function in B6.C-Lep/J Type 2 Diabetic Mice.

Diabetes is a complex multifactorial disorder associated with hyperglycemia, oxidative stress, and inflammation. The pathological microenvironment impairs mesenchymal stem cell (MSC) viability and dysregulates their proregenerative and immune-modulatory function causing maladaptive tissue damage. Targeting stem cells to protect them against impairment could thus delay the onset of complications and enhance the quality of life in diabetes mellitus patients.

Factors affecting bacteriology of hand sepsis in South Africa.

Background: Hand sepsis is a common cause of morbidity. The study was conducted in the KwaZulu-Natal province of South Africa, investigating the bacteriological profile and aetiology of hand sepsis, aiming at optimising empiric antibiotic therapy.

Methods: This is a descriptive study of 120 patients who presented to the plastic surgery department of Inkosi Albert Luthuli Central Hospital with hand sepsis, from January 2017 to April 2019, that required surgical drainage.

Herbivory and misidentification of target habitat constrain region-wide restoration success of spekboom () in South African subtropical succulent thicket.

Restoration of degraded subtropical succulent thicket, via the planting of (spekboom) truncheons, is the focus of a public works programme funded by the South African government. The goals of the programme, which started in 2004, are to create jobs, sequester carbon, restore biodiversity, reduce erosion, improve soil water holding capacity and catalyse private sector investment for upscaling of restoration. Here we report on a region-wide experiment to identify factors that can improve project success.

A biome-wide experiment to assess the effects of propagule size and treatment on the survival of Portulacaria afra (spekboom) truncheons planted to restore degraded subtropical thicket of South Africa.

Insights from biome-wide experiments can improve efficacy of landscape-scale ecological restoration projects. Such insights enable implementers to set temporal and geographical benchmarks and to identify key drivers of success during the often decades-long restoration trajectory. Here we report on a biome-wide experiment aimed at informing the ecological restoration of thousands of hectares of degraded subtropical thicket dominated by the succulent shrub, Portulacaria afra (spekboom).

Targeting Stem Cells in Chronic Inflammatory Diseases.

Mesenchymal stem cell (MSC) dysfunction is a serious complication in ageing and age-related inflammatory diseases such as type 2 diabetes mellitus. Inflammation and oxidative stress-induced cellular senescence alter the immunomodulatory ability of MSCs and hamper their pro-regenerative function, which in turn leads to an increase in disease severity, maladaptive tissue damage and the development of comorbidities. Targeting stem/progenitor cells to restore their function and/or protect them against impairment could thus improve healing outcomes and significantly enhance the quality of life for diabetic patients.