Regenerative reconstruction offers hope and fuller lives to amputees

Photo: Daniel Odame/Unsplash
by Matt Sheehan
OSF Healthcare

PEORIA - There’s a new hope for people facing amputations, and it’s in a mix of fascinating, perhaps unexpected methods.

Roughly 465,000 amputations take place in the United States each year, with 83% of them being lower limb amputations like toes and legs, according to the Amputee Coalition.

Eric Martin, DO, the chief of Vascular Surgery at OSF HealthCare Saint Francis Medical Center in Peoria, Illinois, has crafted a predictable and consistent method that provides reliable outcomes for heroic limb salvage. He does it through procedures referred to as regenerative reconstruction, a treatment currently reserved for the most serious of cases like severe bacterial infection, traumatic crushed limbs, and lower limb ulcers that have become infected and spread throughout the body. These procedures normally accompany a lower limb revascularization with either a bypass procedure or angioplasty and stenting.

“We're here to treat people who have a lot of disadvantaged anatomy and protoplasm (living part of cells) with many medical comorbidities, who otherwise would not be able to heal. Through regenerative reconstruction, we're able to accelerate wound healing and accelerate healing of other diseases processes much quicker,” Dr. Martin says. “In the past, amputation or death was the end point. Now we're able to save lives, have a much more robust limb salvage program here at OSF HealthCare which also makes a difference in terms of affecting mortality in certain patients."

OSF Saint Francis is the only location in Illinois performing advanced regenerative reconstruction procedures at this high of a level.

"We like to pride ourselves on being at the tip of the spear at regenerative reconstruction in the state of Illinois," Dr. Martin says. “We've built that up by having good relationships with companies and getting our hands on the latest and greatest products on the market. We’re always trying to optimize our arsenal of regenerative medicine to provide the best results for our patients. Not only to help with the regenerative reconstruction phase, but also to help address chronic biofilm (bacteria) in the inflammatory phase of wound healing.”

Fish skin, pig intestine, pig bladder and more!
Dr. Martin’s algorithm is built by a group of surprising products made up of animal tissue (xenografts) and human tissue (allografts). This includes fish skin, pig intestine, pig bladder, cow tendon and tissue from human umbilical cords that come from planned procedures with women who have planned, elective C-sections.

Photo provided
Dr. Eric Martin
"The healing capabilities of the fish skin have been quite remarkable," Dr. Martin says. “One of the big reasons is that it's very homologous (same make up) to human skin. The characteristics and composition of the fish skin are nearly identical to what you'd see with human skin. If you'd take a slice of human skin and a slice of fish skin and put it under an electron microscope and look at it, it'd almost look identical.”

The fish skin manufactured by Kerecis, a company in Iceland, spurs on new blood vessel growth and collagen deposition, and eventually helps encourage growth of the outer layer of skin. The fish are caught from the northern Atlantic Ocean near Iceland, and are then skinned and manufactured in plants located in Ísafjörður, Iceland. Dr. Martin started using the fish skin products in August 2023.

Smith calls regenerative reconstruction “medical miracles

Joe Smith, executive vice president of Research and Development and Product Life Cycle at Kerecis, traveled with other researchers to Peoria to learn more about Dr. Martin’s case studies. He says through these techniques, the world is going to see patients healed in ways we never have before.

“We harvest the fish skin right out of the ocean, take the scales off, and put it through a very gentle process,” Smith says. “What comes out is a medical device, homologous to human tissue, and totally absorbs in the body in seven days.”

Smith calls regenerative reconstruction “medical miracles,” and says with the combination of talented surgeons and top tier products these life-saving procedures can be done more and more.

"We also use pig bladder and pig intestine. One company (Organogenesis) has been able to take pig intestine and cross link it to increase its structural integrity and combine it with type 1 collagen. They then add PHMB (Polyhexamethylene biguanide) which is a very powerful antimicrobial agent. When this tissue is put into the human body, it's very good at killing recalcitrant bacteria that are resistant to antibiotics taken by mouth or through the veins," Dr. Martin says.

When Dr. Martin’s patients arrive at the hospital, their wound’s cross-sectional area can cover an entire lower leg or foot, depending on where the infection is. But the wounds don’t start that way. Even a quarter size ulcer on the bottom of someone’s foot, if left untreated, can grow substantially.

Pyoderma gangrenosum cure
A recent case is the first of its kind in the world of medicine. Dr. Martin and his team were able to cure a patient with a rare autoimmune disease called pyoderma gangrenosum. Traditionally, this disease did not have a cure and was treated with corticosteroids and immunosuppressive agents only. These medications had many unwanted side effects for patients.

“This is the first surgical cure in the history of medicine, where we were able to eradicate the ulcers that formed in his leg and were present for over a decade through the use of surgery and regenerative medicine," Dr. Martin says. "It was really the regenerative medicine that helped provide immunomodulation and benefit to him to help suppress his body's own immune system and allow him to heal and recover so nicely.”

Many people get amputations because after undergoing treatment time and time again, their wounds just won’t heal

Who could benefit from this treatment?
Dr. Martin says in the past, medication was offered to patients, but oftentimes the medicine would have side effects with it.

“So now by avoiding long-term use of medicine with many deleterious side effects, the surgery was curative for this patient, and he's done very, very well,” Dr. Martin says.

Most of his patients have diabetes and a history of compromised circulation or have peripheral artery disease. Most are people who smoke and have high levels of cholesterol and blood pressure as well. These people often go on to develop non-healing ulcers in their lower limbs that are arterial, venous or neuropathic in origin.

“Others are patients who have venous stasis disease where vein valves are not working properly, and they go on to develop a venous ulcer,” Dr. Martin adds. “You must first treat the reflux disease and ablate the incompetent vein, before going on to treat the ulcer. The treatment for this is either radio frequency ablation (RFA) or using glue, in the form of VenaSeal.

Many people get amputations because after undergoing treatment time and time again, their wounds just won’t heal. Dr. Martin calls these “chronic wounds.” He says they’re much more difficult to treat than acute wounds because the biofilm (bacteria) doesn’t respond to treatment like antibiotics.

The biofilm fixes in on one place, and something called quorum sensing takes place. Dr. Martin calls this a “bacterial forcefield,” which causes the medical team to be much more aggressive in treatment. Biofilm develops an extracellular polymeric substance (EPS) consisting of lipopolysaccharide (LPS). This substance made by biofilm, makes it much more resistant to degradation with standard antimicrobial therapy.

This calls for debridement to clear away the damaged tissue, normally from a saline jet system called VERSAJET, which aims to reduce the bacterial bioburden in wound beds. Then through a bottled wound lavage solution called Irrisept (chlorhexidine gluconate), Dr. Martin’s team can irrigate the area. In addition to sharp debridement with a scalpel, Dr. Martin’s team has other adjunctive means to address the biofilm.

Now it’s time to aggressively treat the area with human allograft tissue, fish skin and mammalian-based skin products.

Story straight from the operating room
While operating on a patient at OSF Saint Francis, Dr. Martin discussed his process. The patient’s Achilles’ heel was eroded because of the infection from her chronic wound that had grown for over a year. After debridement, Dr. Martin found a healthy part of the Achilles’ tendon sheet and was ready to treat the area.

“We’re going to be able to regenerate the tendon sheet by using an umbilical cord graft and a piece of fish skin called SurgiBind designed to help reconstruct tendon and cover bone,” Dr. Martin says. “This fish skin tends to be very homologous to human tissue, including similarities in the extracellular matrix (ECM) like laminin, fibronectin, glycosaminoglycan, hyaluronic acid, proteoglycans, collagen and elastin.” Dr. Martin remarks these characteristics are all important for the health of human tissue.

It’s easy to amputate, that would be the simple solution to this problem. This is the harder course and the road less traveled

Jessica Collins, a medical device representative and surgical specialist with Kerecis has seen the success stories from regenerative reconstruction.

“The massive amount of technology and products that Dr. Martin has figured out how they all work together synergistically and uses on these patients to help them save body parts, is remarkable,” Collins says.

This patient was suffering from a rare, serious disease called calciphylaxis in both of her legs. She had gone on to develop end stage renal disease (ESRD) with stage 5 chronic kidney disease and was in dire need of a kidney transplant. However, the calciphylaxis in her legs kept her from being eligible for a kidney transplant. In addition, the patient presented in septic shock to the emergency room because the area of skin ulcerations in her lower legs had become secondarily infected with an aggressive fungal infection and polymicrobial bacterial organizations. Because of this, Dr. Martin was consulted to help treat the patient, and the course of action became regenerative reconstruction. Her other option was bilateral above knee amputations (AKAs).

“It’s easy to amputate, that would be the simple solution to this problem. This is the harder course and the road less traveled,” Dr. Martin said during the regenerative reconstruction procedure.

Dr. Martin calls the start of his procedure a “triple stack” of different tissue products.

“We’ve put down the amniotic membrane grafts, we’ve selectively placed umbilical cord grafts and then I’ve wrapped the leg with Kerecis fish skin,” Dr. Martin says. “Why I’m doing this is because the amniotic membrane grafts will incorporate (attach) within three to five days. They contain an abundance of growth factors that are involved in cell signaling and cellular recruitment. The umbilical cord grafts tend to incorporate within 10-14 days, and they contain the progenitor stem cells that help to signal other stem cells to migrate to the wound bed. The fish skin takes more like 14 to 18 days to incorporate, and it contains many components of the extracellular matrix and collagen. It’s a sequential absorption of these grafts into the tissue which helps to build up the granulation tissue from the bottom up and to make this wound more superficial.”

After wrapping the leg, Dr. Martin injects a porcine (pig-derived) bladder xenograft around the wound. He says it addresses the “zone of injury” and will recruit cells to improve cell signaling, pulling healthy cells from the area around the wound bed into it. This pig bladder contains four types of collagens that help with cellular recruitment. He says this maneuver will help skin regenerate within a month in that area, starting to close the wound from the outside in.

“I’ve been doing this for about 10 years in over 350 patients. I’ve never had an adverse reaction, complications, or side effects from doing this,” Dr. Martin says. “Every time, I get a fairly consistent result of helping wounds shrink in size.”

The next step is to cover the wound with a layer of collagen-based product stemming from bovine tendon made by Integra Lifesciences.

“The tendon has two layers. An outer silicon layer that serves as a protection from the environment, similar to what the epidermis would do,” Dr. Martin says. “On the inside, it contains type 1 collagen and chondroitin sulfate from shark cartilage. This helps to generate cell migration into the wound bed.” This process benefits the healing process for patients, Dr. Martin continues, adding that it also protects the grafts underneath.

While the regenerative reconstruction is a very in-depth procedure, it actually decreases the amount of time someone is being treated and lessens long-term morbidity.

The bovine layer will then be stapled to the outer skin surrounding the wound bed. Before finalizing the wrapping of the bovine tendon, Dr. Martin places additional powdered fish skin in between the fenestrations of the fish skin product already sewn in place. This helps to promote granulation tissue, which develops during the process of healing. The bovine layer will be left in place for about 22-25 days.

Goals of regenerative reconstruction
The hope of the regenerative reconstruction is to heal wounds from the outside in. In other words, “shrink the wound.” Some of Dr. Martin’s patients had wounds for over a decade before they came in, and by that time their wounds are exponentially worse off.

“I definitely think if patients are able to get to us at a much earlier stage, and not so late because now they're facing sepsis as a result from their wounds becoming infected, now they have a blood stream infection, their blood pressure is low, their heart rate is elevated, and certain organ systems are beginning to fail (kidneys, lungs, liver, heart). A lot more goes into having to resuscitate them and keeping them alive in addition to treating their wounds,” Dr. Martin says. “So definitely before they get to the end stage of full-blown septic shock, it would be nice if patients could get to us at an earlier stage of their clinical presentation so we could treat them more aggressively and get them healed much quicker.”

While the regenerative reconstruction is a very in-depth procedure, it actually decreases the amount of time someone is being treated and lessens long-term morbidity. Someone’s life expectancy after a major amputation is normally around five years, Smith says.

While the cost of surgery can be a lot up front, Dr. Martin says by healing the wound quicker, it will decrease the cost in the long run for both patients and the hospital system. He adds the products used at OSF are all covered by the major health insurances as well.

Dr. Martin was invited to Iceland this June by Kerecis and was the 2024 grand prize winner for the most outstanding regenerative reconstruction in the United States and Europe for one of his cases. He’s slowly becoming one of the country’s foremost leading authorities in regenerative reconstruction, speaking to many research scientists around the country about his work.

Now his goal is to train other doctors around the world, using his techniques in regenerative reconstruction and offer patients new hope and a promise for a better tomorrow.

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The new Covid vaccine has been approved, why you might not want to rush out to get it yet

by Arthur Allen and Eliza Fawcett, Healthbeat
Rebecca Grapevine, Healthbeat
Because viruses evolve as they infect people, the CDC has recommended updated covid vaccines each year.

The FDA has approved an updated covid shot for everyone 6 months old and up, which renews a now-annual quandary for Americans: Get the shot now, with the latest covid outbreak sweeping the country, or hold it in reserve for the winter wave?

The new vaccine should provide some protection to everyone. But many healthy people who have already been vaccinated or have immunity because they’ve been exposed to covid enough times may want to wait a few months.

Covid has become commonplace. For some, it’s a minor illness with few symptoms. Others are laid up with fever, cough, and fatigue for days or weeks. A much smaller group — mostly older or chronically ill people — suffer hospitalization or death.

It’s important for those in high-risk groups to get vaccinated, but vaccine protection wanes after a few months. Those who run to get the new vaccine may be more likely to fall ill this winter when the next wave hits, said William Schaffner, an infectious disease professor at Vanderbilt University School of Medicine and a spokesperson for the National Foundation for Infectious Diseases.

On the other hand, by late fall the major variants may have changed, rendering the vaccine less effective, said Peter Marks, the FDA’s top vaccine official, at a briefing Aug. 23. He urged everyone eligible to get immunized, noting that the risk of long covid is greater in the un- and undervaccinated.

Of course, if last year’s covid vaccine rollout is any guide, few Americans will heed his advice, even though this summer’s surge has been unusually intense, with levels of the covid virus in wastewater suggesting infections are as widespread as they were in the winter.

The Centers for Disease Control and Prevention now looks to wastewater as fewer people are reporting test results to health authorities. The wastewater data shows the epidemic is worst in Western and Southern states. In New York, for example, levels are considered “high” — compared with “very high” in Georgia.

Hospitalizations and deaths due to covid have trended up, too. But unlike infections, these rates are nowhere near those seen in winter surges, or in summers past. More than 2,000 people died of covid in July — a high number but a small fraction of the at least 25,700 covid deaths in July 2020.

Partial immunity built up through vaccines and prior infections deserves credit for this relief. A new study suggests that current variants may be less virulent — in the study, one of the recent variants did not kill mice exposed to it, unlike most earlier covid variants.

Covid rapid tests will no longer be free

Alexandra Koch/Pixabay

Public health officials note that even with more cases this summer, people seem to be managing their sickness at home. “We did see a little rise in the number of cases, but it didn’t have a significant impact in terms of hospitalizations and emergency room visits,” said Manisha Juthani, public health commissioner of Connecticut, at a news briefing Aug. 21.

Unlike influenza or traditional cold viruses, covid seems to thrive outside the cold months, when germy schoolkids, dry air, and indoor activities are thought to enable the spread of air- and saliva-borne viruses. No one is exactly sure why.

“Covid is still very transmissible, very new, and people congregate inside in air-conditioned rooms during the summer,” said John Moore, a virologist and professor at Cornell University’s Weill Cornell Medicine College.

Or “maybe covid is more tolerant of humidity or other environmental conditions in the summer,” said Caitlin Rivers, an epidemiologist at Johns Hopkins University.

Because viruses evolve as they infect people, the CDC has recommended updated covid vaccines each year. Last fall’s booster was designed to target the omicron variant circulating in 2023. This year, mRNA vaccines made by Moderna and Pfizer and the protein-based vaccine from Novavax — which has yet to be approved by the FDA — target a more recent omicron variant, JN.1.

The FDA determined that the mRNA vaccines strongly protected people from severe disease and death — and would do so even though earlier variants of JN.1 are now being overtaken by others.

Public interest in covid vaccines has waned, with only 1 in 5 adults getting vaccinated since last September, compared with about 80% who got the first dose. New Yorkers have been slightly above the national vaccination rate, while in Georgia only about 17% got the latest shot.

Vaccine uptake is lower in states where the majority voted for Donald Trump in 2020 and among those who have less money and education, less health care access, or less time off from work. These groups are also more likely to be hospitalized or die of the disease, according to a 2023 study in The Lancet.

While the newly formulated vaccines are better targeted at the circulating covid variants, uninsured and underinsured Americans may have to rush if they hope to get one for free. A CDC program that provided boosters to 1.5 million people over the last year ran out of money and is ending Aug. 31.

The agency drummed up $62 million in unspent funds to pay state and local health departments to provide the new shots to those not covered by insurance. But “that may not go very far” if the vaccine costs the agency around $86 a dose, as it did last year, said Kelly Moore, CEO of Immunize.org, which advocates for vaccination.

People who pay out-of-pocket at pharmacies face higher prices: CVS plans to sell the updated vaccine for $201.99, said Amy Thibault, a spokesperson for the company.

“Price can be a barrier, access can be a barrier” to vaccination, said David Scales, an assistant professor of medicine at Weill Cornell Medical College.

Without an access program that provides vaccines to uninsured adults, “we’ll see disparities in health outcomes and disproportionate outbreaks in the working poor, who can ill afford to take off work,” Kelly Moore said.

New York state has about $1 million to fill the gaps when the CDC’s program ends, said Danielle De Souza, a spokesperson for the New York State Department of Health. That will buy around 12,500 doses for uninsured and underinsured adults, she said. There are roughly one million uninsured people in the state.

CDC and FDA experts last year decided to promote annual fall vaccination against covid and influenza along with a one-time respiratory syncytial virus shot for some groups.

It would be impractical for the vaccine-makers to change the covid vaccine’s recipe twice every year, and offering the three vaccines during one or two health care visits appears to be the best way to increase uptake of all of them, said Schaffner, who consults for the CDC’s policy-setting Advisory Committee on Immunization Practices.

At its next meeting, in October, the committee is likely to urge vulnerable people to get a second dose of the same covid vaccine in the spring, for protection against the next summer wave, he said.

If you’re in a vulnerable population and waiting to get vaccinated until closer to the holiday season, Schaffner said, it makes sense to wear a mask and avoid big crowds, and to get a test if you think you have covid. If positive, people in these groups should seek medical attention since the antiviral pill Paxlovid might ameliorate their symptoms and keep them out of the hospital.

As for conscientious others who feel they may be sick and don’t want to spread the covid virus, the best advice is to get a single test and, if positive, try to isolate for a few days and then wear a mask for several days while avoiding crowded rooms. Repeat testing after a positive result is pointless, since viral particles in the nose may remain for days without signifying a risk of infecting others, Schaffner said.

The Health and Human Services Department is making four free covid tests available to anyone who requests them starting in late September through covidtest.gov, said Dawn O’Connell, assistant secretary for preparedness and response, at the Aug. 23 briefing.

The government is focusing its fall vaccine advocacy campaign, which it’s calling “Risk less, live more,” on older people and nursing home residents, said HHS spokesperson Jeff Nesbit.

Not everyone may really need a fall covid booster, but “it’s not wrong to give people options,” John Moore said. “The 20-year-old athlete is less at risk than the 70-year-old overweight dude. It’s as simple as that.”

KFF Health News correspondent Amy Maxmen contributed to this report.

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Can an AI therapist help you through the day?

by Ben Rein

Would you let an AI chatbot be your therapist?

A recent study wanted to know if this would work, so they asked AI about 200 questions from the “Ask the Doctors” page on Reddit. Then they put those answers next to responses from real human doctors and asked healthcare providers to judge which was better, without knowing which one was AI. What do you think happened? They rated the chatbot’s answers as better 78% of the time and found that they were more likely to be empathetic.

But this raises a key point: empathy.

Everybody knows that ChatGPT can’t feel emotions. Therefore, it’s not capable of empathy, because it can’t really understand what you feel. And some scientists think that this is where AI loses: Chatbots will never work as therapists because humans won’t accept or appreciate empathy from a robot.

@dr.brein Can an AI chatbot really be your therapist? ________ This video was supported by the Pulitzer Center through the Truth Decay Grant Initiative, in collaboration with OpenMind Magazine. To read more about this topic, check out the accompanying article on OpenMind’s website, found in my bio 🔗. #PulitzerCenter #neuroscience #AI #therapy #empathy ♬ Mysterious and sad BGM(1120058) - S and N

When a real company, Koko, tried using chatbots, it didn’t work because people knew they were chatbots. The patients didn’t care when the chatbot said, “I understand how you’re feeling” because they knew it was an empty, emotionless statement.

But it makes me wonder, if chatbots continue gaining in use and acceptance, and we come to respect them more, this could change. And I’m curious how you’d feel about that.

If 100 years from now, AI chatbots are considered trained psychiatrists, would this be good or bad for society? It might seem ridiculous, but it’s real life. Right now, we essentially hold that decision in our hands. We are the first humans to coexist with these large language models, and we actively vote as consumers—with our clicks and our wallets—to determine the future of AI. In what capacity will we come to embrace AI? Where do we draw the line? It’s something to think about as we navigate this new virtual world. Thank you for your interest, and please follow for more science.


This story originally appeared on OpenMind, a digital magazine tackling science controversies and deceptions.
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Chemical contaminates found in Illinois rivers threaten food chain

SNS - Scientists tested nine fish species from four northern Illinois rivers for contamination with per- or polyfluoroalkyl substances, synthetic chemicals found in numerous industrial and commercial products and known to be harmful to human health. They found fish contaminated with PFAS in every one of their 15 test sites. Elevated levels of PFOS, one type of PFAS compound, were found in nearly all fish tested.

Study found that there were high levels of PFASs contamination levels in channel catfish found in Illinois waterways.
G.C./Pixabay

The qualities that make PFAS desirable for industrial uses — their durability and stability under stresses such as high heat or exposure to water, for example — also make these chemicals particularly problematic in the environment and hazardous to human and animal health, said Joseph Irudayaraj, a professor of bioengineering at the University of Illinois Urbana-Champaign who led the new study.

The findings are reported in the journal Science of the Total Environment.

Short-chain PFASs (per- and polyfluoroalkyl substances) are widely used as alternatives to long-chain PFASs. Long-chain PFASs become gradually regulated under REACH (EC No. 1907/2006) and other international regulations, due to having persistent, bioaccumulative and toxic properties and/or being toxic for reproduction. The increasingly used short-chain PFASs are assumed to have a lower bioaccumulation potential.

“PFAS contain multiple carbon-fluorine bonds, one of the strongest bonds in organic chemistry,” Irudayaraj said, who is also a professor in the Beckman Institute for Advanced Science and Technology and an affiliate of the Carl R. Woese Institute for Genomic Biology and the Carle Illinois College of Medicine at the U. of I. “Because of this, they are also very hard to break down. They persist for a long time because they are very, very stable.”

Considering such permanent exposure, it is very difficult to estimate long-term adverse effects in organisms. Enriched in edible parts of plants, the accumulation in food chains is unknown.

There are nearly 15,000 PFAS chemicals, according to the U.S. Environmental Protection Agency. These are classified either as short-chain PFAS, which have less than six carbon-fluorine bonds, and long-chain PFAS, with six or more of these bonds, Irudayaraj said.

Long-chain PFAS were widely used before awareness grew about the hazards of these chemicals. More recently, many industries switched to using short-chain PFAS.

“It was thought that the short-chain PFAS were less toxic, and that they could more easily degrade,” he said. “But surprisingly, that was not the case.”

Now, both types of PFAS are found in groundwater, soil and human tissues.

Short-chain PFASs have a high mobility in soil and water, and final degradation products are extremely persistent. This results in a fast distribution to water resources, and consequently, also to a contamination of drinking water resources. Once emitted, short-chain PFASs remain in the environment. A lack of appropriate water treatment technologies results in everlasting background concentrations in the environment, and thus, organisms are permanently and poorly reversibly exposed. Considering such permanent exposure, it is very difficult to estimate long-term adverse effects in organisms. Enriched in edible parts of plants, the accumulation in food chains is unknown.

“About 99% of people living in the U.S. have PFAS in their system,” Irudayaraj said.

Studies on animals have shown that short-chain PFAS (per- and polyfluoroalkyl substances) are almost completely absorbed when ingested or inhaled but not much through the skin. Both short- and long-chain PFAS don't break down easily in the body due to their strong chemical bonds. Even if these chemicals start off in different forms, they eventually turn into acids through several steps, which can be more toxic than the original chemicals. One such toxic substance, perfluorohexyl ethanoic acid (FHEA), has been found in various tissues from deceased people, according to research published by The Danish Environmental Protection Agency in 2015.

The time it takes for these acids to leave the blood varies depending on the specific chemical, the species, and even the sex of the animal. In general, sulfonates (a type of PFAS) take longer to be eliminated than carboxylates (another type), and longer chains take longer to leave the body than shorter ones. In animals, the time is often shorter for females due to differences in how their bodies process these chemicals. The time these substances stay in the blood can range from a few hours to days in rodents, a bit longer in monkeys, and much longer in humans, sometimes lasting years. However, shorter-chain PFAS tend to leave the body faster, except for PFHxS (a six-carbon chain PFAS), which has a longer half-life in humans than some other PFAS like PFOA and PFOS.

Despite a voluntary phasing out of some PFAS in industry in the U.S. and efforts to reduce PFAS pollution, these chemicals are still found in drinking water, household products, food packaging and agricultural products, he said.

Fish from the Rock River had the highest concentrations of PFAS in their tissues.

The manufacturers of chemical products using PFAS argue that the newer short-chain PFAS is safer than the widely known long-chain contaminants. Despite this assertion, the Auburn study's significant findings challenge these statements. The research indicates that short-chain chemicals are frequently present in drinking water systems and could potentially endanger human and environmental well-being. Additionally, current removal methods are relatively less efficient when it comes to eliminating short-chain PFAS in comparison to long-chain PFAS.

The Auburn study analyzed over 200 individual studies on PFAS finding that the short-chain contaminants may be just as harmful as the long-chain versions, if not more. The short-chain PFAS have been linked to hormonal and reproductive system harm.

The researchers in the U of I study focused on fish in northern Illinois rivers because they are close to urban and industrial areas. Industrial emissions and urban rainwater runoff may further contaminate local waterways with PFAS. Sport fishing is also popular across the state, including in areas inside and near Chicago. More than 666,000 fishing licenses were issued across the state of Illinois in 2020.

The researchers narrowed their research down to the fish in the Pecatonica River, Rock River, Sugar River and Yellow Creek from 2021-22. The team collected dozens of samples from nine species of fish, including bluegill, channel catfish, common carp, northern pike, smallmouth bass and walleye. The fish represented different levels of the food chain, from those that feed only on plants, like bluegill, to those eating other fish, such as channel catfish and northern pike.

Back in the lab, the scientists analyzed fish tissues for 17 PFAS chemicals. They found PFAS-contaminated fish in every river they tested and in every one of their 15 sampling sites. Fish from the Rock River had the highest concentrations of PFAS in their tissues. Contamination levels were highest in channel catfish, at the top of the food chain, and lowest in the plant eaters.

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Risk of dementia is nearly three times higher the first year after a stroke

DALLAS — Having a stroke may significantly increase the risk of developing dementia. The risk of dementia was the highest in the first year after a stroke and remained elevated over a period of twenty years, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

“Our findings show that stroke survivors are uniquely susceptible to dementia, and the risk can be up to 3 times higher in the first year after a stroke. While the risk decreases over time, it remains elevated over the long-term,” said lead study author Raed Joundi, M.D., D.Phil., an assistant professor at McMaster University in Hamilton, Ontario, Canada, and an investigator at the Population Health Research Institute, a joint institute of McMaster University and Hamilton Health Sciences.

To evaluate dementia risk after stroke, the researchers used databases at the Institute for Clinical Evaluative Sciences (University of Toronto, Canada), which includes more than 15 million people in the Canadian province of Ontario. They identified 180,940 people who had suffered a recent stroke — either an ischemic stroke (clot-caused) or intracerebral hemorrhage (bleeding within the brain) — and matched those stroke survivors to two control groups — people in the general population (who had not had a heart attack or stroke) and those who had had a heart attack and not a stroke. Researchers evaluated the rate of new cases of dementia starting at 90 days after stroke over an average follow-up of 5.5 years. In addition, they analyzed the risk of developing dementia in the first year after the stroke and over time, up to 20 years.

The study found:

  • The risk of dementia was highest in the first year after stroke, with a nearly 3-fold increased risk, then decreasing to a 1.5-fold increased risk by the 5-year mark and remaining elevated 20 years later.
  • Dementia occurred in nearly 19% of stroke survivors over an average follow-up of 5.5 years.
  • The risk of dementia was 80% higher in stroke survivors than in the matched group from the general population. The risk of dementia was also nearly 80% higher in stroke survivors than in the matched control group who had experienced a heart attack.
  • The risk of dementia in people who had an intracerebral hemorrhage (bleeding in the brain) was nearly 150% higher than those in the general population.

“We found that the rate of post-stroke dementia was higher than the rate of recurrent stroke over the same time period,” Joundi said. “Stroke injures the brain including areas critical for cognitive function, which can impact day-to-day functioning. Some people go on to have a recurrent stroke, which increases the risk of dementia even further, and others may experience a progressive cognitive decline similar to a neurodegenerative condition.”

Each year, about 795,000 people experience a new or recurrent stroke. Approximately 610,000 of these are first attacks, and 185,000 are recurrent attacks, according to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update. According to the CDC, of those at least 65 years of age, there is an estimated 7 million adults with dementia in 2014 and projected to be nearly 14 million by 2060.

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“Our study shows there is a large burden of dementia after acute stroke in Canada and identifies it is a common problem that needs to be addressed. Our findings reinforce the importance of monitoring people with stroke for cognitive decline, instituting appropriate treatments to address vascular risk factors and prevent recurrent stroke, and encouraging lifestyle changes, such as smoking cessation and increased physical activity, which have many benefits and may reduce the risk of dementia,” Joundi said. “More research is needed to clarify why some people who have a stroke develop dementia and others do not.”

A 2023 American Heart Association scientific statement, Cognitive Impairment After Ischemic and Hemorrhagic Stroke suggests post-stroke screenings and comprehensive interdisciplinary care to support stroke survivors with cognitive impairment.

A limitation of the study is that administrative data, hospital records and medication dispensary data were used for the analysis. Researchers were not able to perform cognitive assessments or neuroimaging (noninvasive images of the brain) on stroke survivors, therefore, there is no way to confirm the dementia diagnosis or type of dementia. However, the dementia definition was previously validated and shown to be accurate when compared to medical charts.

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