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TMS Basics > Data Statistics > Flashcards

Data Statistics Flashcards

1
Q

In the article “Aseptically processed placenta Improves Diabetic Foot Ulcers” what percent of wounds were healed at 6 weeks and 12 weeks with dHACA compared to SOC?

A

In a multicentered RCT, 70% of DFUs treated with amniotic membrane were healed at the 6 week mark compared to 15% in the SOC group.

At the 12 week mark, 85% of DFUs treated with amniotic membrane compared to 25% in the SOC group were healed with a clinically significant p value.

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2
Q

What is the general take away from the “Aseptically processed placenta Improves Diabetic Foot Ulcers” article?

A

Diabetic foot ulcers treated with amniotic membrane healed over 4 times faster at the 6 week marker than those treated with SOC and over 3 times faster at the 12 week mark.

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3
Q

In the article “Aseptically processed placenta Improves Diabetic Foot Ulcers” what was the number needed to treat?

A

NNT= 1.7

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4
Q

What does number needed to treat (NNT) mean and what is an ideal NNT?

A

Number needed to treat is the average number of patients who need to be treated to prevent one additional bad outcome (e.g. the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial).

Ideal NNT= 1

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5
Q

In the article ““Aseptically processed placenta Improves Diabetic Foot Ulcers” what was the number of applications of AM used compared to SOC? What does this imply?

A

3 applications with AM versus 6 to 12 applications with SOC. This means that there is long term cost savings with treatment of AM compared to SOC.

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6
Q

Amniotic fluid contains Lamin. What does Lamin protein play a role in?

A

Cellular differentiation, cell shape, cell migration and tissue regeneration

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7
Q

Regarding germ layers, what is the unique characteristic of amniotic fluid and membrane derived cells?

A

AF and AM contain subpopulation of cells with stem cell characteristics that can be maintained in an undifferentiated state, but are capable of differentiating into all three germ layers.

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8
Q

Has AM or AF stem cells been known to cause Teratomas?

A

No

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9
Q

What are the properties of amniotic fluid?

A

Metabolically active filter, allowing transport of water soluble materials, production of growth factors, proteins, lipids, carbohydrates, amino acids, enzymes, hormones, cytokines and biologically active molecules.

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10
Q

What are the 4 important wound healing properties of amniotic technology?

A

Immunoprivelaged, anti-inflammatory, anti-scaring, anti-bacterial

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11
Q

When implanted into a site of injury, what does amniotic fluid cells trigger?

A

AF triggers existing cells to secrete and attract cells, growth factors, cytokines, proteins an stem cells.

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12
Q

What molecules around found the basement membrane of the amniotic membrane that play a role in cell proliferation?

A

Collagen I, II, IV, V, VII
Lamin 1 and 5
Fibronectin

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13
Q

According to the article “Clinical Application of Human Amnion in plastic surgery” there are 11 indications for use of amniotic technology. Name all 11 indications.

A
  1. Burns
  2. Chronic Vascular Ulcers
  3. Diabetic Ulcers
  4. Dural Defects
  5. Intraabdominal adhesions
  6. Peritoneal reconstruction
  7. Tendon/Ligament/Nerve Repair
  8. Microvascular grafts
  9. Corneal Transplants
  10. ENT reconstruction
  11. Joint Arthroplasty (ie. Hip)
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14
Q

What is amniotic membrane devoid of?

A

Nerves, Muscles, Lympahtic tissue

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15
Q

According to the article “Clinical Application of Human Amnion in plastic surgery”, applying AM to a wound bed will help prevent these 3 things:

A

Wound Desiccation
Excessive Fluid Loss
Cover Exposed nerve endings from environment to create an analgesic response

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16
Q

What does AM lack, which makes it immunoprivelaged?

A

Lacks HLA antigens

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17
Q

What are the 3 most important growth factors that promote epithelialization?

A

EGF, TGF, bFGF

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18
Q

What does EGF stand for and what does it do?

A

Epidermal growth factor. EGF is a common mitogenic factor that stimulates the proliferation of different types of cells, especially fibroblasts and epithelial cells after binding to its receptor to initiate an intracellular cascade/signaling.

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19
Q

What does TGF stand for and what is it responsible for?

A

Transforming growth factor. Responsible for the synthesis and deposition of ECM proteins

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20
Q

What does bFGF stand for and what is it responsible for?

A

Basic fibroblast growth factor. Is a proangiogenic factor that plays a role in tissue granulation through fibroblast proliferation.

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21
Q

What is the most important anti-inflammatory factor found in AM?

A

IL-10

22
Q

What is IL-10 responsible for?

A

IL-10 enhances B cell survival (WBC), enhances proliferation, enhances antibody production shown to inhibit pro inflammatory cytokines.

23
Q

What are the major two cell types that give AM its antibacterial properties?

A

Lysozymes and immunoglobulins, which help reduce bacterial colonization (both group A and B bacteria).

24
Q

What is angiogenesis?

A

Growth of Blood vessels.

25
Q

What is fibronectin?

A

Fibronectin is an ECM protein which helps signal guide cells and acts as an adhesion cell, helping attach molecules to collagen.

26
Q

In the article “A Multicentered RCT evaluating the efficacy of dHAM/chorion allograft for treatment of venous leg ulcers” what percent of patients were healed with DHAM+Compression at 12 weeks compared to SOC+Compression?

A

In the multicentered RCT, 60% of patients with venous leg ulcers (VLUs) treated with dHAM+compression demonstrated wound healing compared to 35% of patients treated with SOC+compression at the 12 week follow up.

27
Q

In the article “A Multicentered RCT evaluating the efficacy of dHAM/chorion allograft for treatment of venous leg ulcers” what percent of patients were healed with DHAM+Compression at 16 weeks compared to SOC+Compression?

A

In the multicentered RCT, 71% of patients with VLUs treated with dHAM+compression demonstrated wound healing compared to 44% of patients treated with SOC+compression at the 16 week follow up.

28
Q

What are two factors that prolong disability and increased need for care for patients with venous leg ulcers?

A

slow rates of healing and frequent recurrence

29
Q

Name 3 symptoms that patient with venous leg ulcers experience that lead to risk of infection?

A

Itching, Edema, Exudate (pus)

30
Q

In the article “A Multicentered RCT evaluating the efficacy of dHAM/chorion allograft for treatment of venous leg ulcers” what is the standard of care considered?

A

SOC is considered to be graduated compression therapy and leg elevation to increase blood flow and decrease edema.

31
Q

What is considered comprehensive treatment of VLUs?

A

Compression therapy, local wound debridement, controlling bioburden, and wound moisture balance with topical dressings

32
Q

What is VEGF and what is it responsible for?

A

Vascular endothelial growth factor (VEGF), is a signal protein produced by cells that stimulates the formation of blood vessels (ie. promotes revascularization and tissue healing)

33
Q

In the article “A Multicentered RCT evaluating the efficacy of dHAM/chorion allograft for treatment of venous leg ulcers” what was the mean percentage of reduction in wound area with dHAM+compression compared to SOC+compression at 12 weeks?

A

At 12 weeks, the mean percent reduction in wound area was 66% with dHAM+compression versus 40% with SOC+compression.

34
Q

In the article “A Multicentered RCT evaluating the efficacy of dHAM/chorion allograft for treatment of venous leg ulcers” what was the mean percentage of reduction in wound area with dHAM+compression compared to SOC+compression at 16 weeks?

A

At 16 weeks, the mean percent reduction in wound area was 72% with dHAM+compression versus 39% with SOC+compression.

35
Q

According to the article “A Multicentered RCT evaluating the efficacy of dHAM/chorion allograft for treatment of venous leg ulcers” how many times greater do patient’s treated with dHAM+compression heal compared to SOC?

A

Patient’s with VLUs treated with dHAM+compression healed 2.26X faster than standard of care.

36
Q

In the Serene et al study in 2014, what percentage of patients treated with dHAM experienced wound closure (of at least 40%) at the 4 week mark than those treated with SOC?

A

At the 4 week mark, 62% versus 32% of wounds treated with dHAM experienced wound closure (over 40%) with a p value of 0.005

37
Q

In the Serene et al study in 2014, what percentage of patients treated with dHAM experienced wound closure (of at least 40%) at the 12 week mark than those treated with SOC?

A

At the 12 week mark, 71% versus 40% of wounds treated with dHAM experienced wound closure (over 40%) with a p value of 0.005

38
Q

What is the benefit of us AM as a nerve wrapping?

A

AM used as a nerve wrapping has been shown to decrease the # of adhesions that would cause long tract injury via tethering or ischemia, prevent perineurial scar formation, and increase nerve diameter size, all of which lead to earlier return of function

39
Q

What is a fibroblast and what does it do in regards to proliferation?

A

A fibroblast is a type of cell that synthesizes the extracellular matrix and collagen, the structural framework (stroma) for animal tissues, and plays a critical role in wound healing.

40
Q

What is the main function of fibroblasts?

A

Fibroblasts main function is to maintain the structural integrity of the connective tissue by continuously secreting extracellular matrix proteins like collagens, glycosaminoglycans, and glycoproteins.

41
Q

Before scar formation, what is the alignment of collagen fibers?

A

Collagen fibers are cross linked in a random basketweave pattern.

42
Q

After scar formation, what is the alignment of collagen fibers?

A

In fibrosis the collagen cross-links and forms a pronounced alignment in a single direction.

43
Q

According to the Burn study by Mohammadi et al, what percentage of grafts were successful in the 7 day period?

A

The mean graft success rate was 97% with a mean graft take duration at about 7 days.

44
Q

According to the Burn study by Mohammadi et al, what the 5 important properties of amniotic membrane?

A
  1. Decreased bacterial count/colonization
  2. Rapid adherence to wound bed
  3. Inhibition of protease activity and PMN filtration (decrease WBC count in wound site)
  4. Increased angiogenesis
  5. Rapid re-epithelialization and wound healing
45
Q

What is the main reason flaps fail?

A

Flaps fail due to inadequate blood supply for a graft to take.

46
Q

According to the Burn study by Mohammadi et al, what percent of grafts were successful after debridement of infected granulated tissue when treated with amniotic technology?

A

For patients who underwent wound debridement of infected granulated tissue, 90.13% of grafts were successful when treated with amnio compared to 65.61% of those in the control group.

47
Q

What are the functional characteristics of IL-29?

A

cytokines with antiviral, antitumor and immunomodulatory activities.

48
Q

What are the functional characteristics of Alpha-defensive?

A

Potent anti microbial peptides with activity against bacteria, viruses and fungi.

49
Q

What are the functional characteristics of PGE2?

A

Immunimodulatory properties that inhibit pro-inflammatory cytokines.

50
Q

What are the functional characteristics of Lactoferrin?

A

increased bone formation with antimicrobial properties (bacterial, viral, fungi)

51
Q

What are the functional characteristics of Laminin?

A

mediates cell ECM interaction, migration and tissue organization.

TMS Basics (3 decks)

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