Impact of injectable chitosan cryogel microspherescaffolds on differentiation and proliferation of adiposederived mesenchymal stem cells into fat cells.

Difficulty in the clinical practice of stem cell therapy is often experienced in achieving desired target tissue cell differentiation and migration of stem cells to other tissue compartments where they are destroyed or die. This study was performed to evaluate if mesenchymal stem cells (MSCs) may differentiate into desired cell types when injected after combined with an injectable cryogel scaffold and to investigate if this scaffold may help in preventing cells from passing into different tissue compartments. MSCs were obtained from fat tissue of the rabbits as autografts and nuclei and cytoplasms of these cells were labeled with BrdU and PKH26. In Group 1, only-scaffold; in Group 2, only-MSCs; and in Group 3, combined stem cell/scaffold were injected to the right malar area of the rabbits. At postoperative 3 weeks, volumes of the injected areas were calculated by computer-tomography scans and histopathological evaluation was performed. The increase in the volume of the right malar areas was more in Group 3. In histopathological evaluation, chitosan cryogel microspheres were observed microscopically within the tissue and the scaffold was only partially degraded. Normal tissue form was seen in Group 2. Cells differentiated morphologically into fat cells were detected in Groups 2 and 3. Injectable chitosan cryogel microspheres were used in vivo for the first time in this study. As it was demonstrated to be useful in carrying MSCs to the reconstructed area, help cell differentiation to desired cells and prevent migration to other tissue compartments, it may be used for reconstructive purposes in the future.

The Association of Frailty With Long-Term Outcomes in Patients With Acute Respiratory Failure Treated With Noninvasive Ventilation.

The objective of this study was to investigate the prevalence and impact of frailty on mortality in patients with acute respiratory failure (ARF) treated with noninvasive ventilation (NIV). This was a single-center, prospective study of patients who developed ARF (irrespective of etiology) and were treated with NIV support. Frailty was assessed using the Clinical Frailty Scale (CFS). We modeled the relationship of CFS with one-year mortality using Cox proportional hazards regression, adjusting for other clinical and demographic characteristics. Of the 166 patients enrolled, 48% had moderate to severe frailty. These patients were more likely to be female (67% versus 33%) and on oxygen therapy at home (46% versus 28%). The median CFS score was 5 (interquartile range (IQR): 5-6). Moderate to severe frailty was associated with a 60% higher risk of one-year mortality (hazard ratio (HR): 1.63, 95% confidence interval (CI): 1.15-2.31). Frailty assessment may identify patients in need of ventilatory support who are at increased risk of mortality and may be an important factor to consider when discussing goals of care in this vulnerable population.

Comparison of Dorsal Intercostal Artery Perforator Propeller Flaps and Bilateral Rotation Flaps in Reconstruction of Myelomeningocele Defects.

AIM: To compare the complications and surgical outcomes between bilateral rotation flaps and dorsal intercostal artery perforator (DICAP) flaps in the soft tissue reconstruction of myelomeningocele defects. MATERIAL AND METHODS: Between January 2005 and February 2017, we studied 47 patients who underwent reconstruction of myelomeningocele defects. Patient demographics, operative data, and postoperative data were reviewed retrospectively and are included in the study. RESULTS: We found no statistically significant differences in patient demographics and surgical complications between these two groups; this may be due to small sample size. With regard to complications-partial flap necrosis, cerebrospinal fluid (CSF) leakage, necessity for reoperation, and wound infection-DICAP propeller flaps were clinically superior to rotation flaps. Partial flap necrosis was associated with CSF leakage and wound infection, and CSF leakage was associated with wound dehiscence. CONCLUSION: Although surgical outcomes obtained with DICAP propeller flaps were clinically superior to those obtained with rotation flaps, there was no statistically significant difference between the two patient groups. A well-designed comparative study with adequate sample size is needed. Nonetheless, we suggest using DICAP propeller flaps for reconstruction of large myelomeningocele defects.

Effects of insulin-like growth factor-1 on random pattern skin flap survival in rats.

PURPOSE: To investigate the effects of pharmacological delay with insulin-like growth factor-1 (IGF-1) on skin flap survival. METHODS: Thirty Sprague-Dawley rats were submitted to dorsal skin flap (3x9 cm). Seven days before the surgery, the animals were subdivided into three groups of 10 rats. In group 1 (controls), no injection was done. Seven days before the elevation, saline had been injected to the marked skin flap area in group 2 (sham group), and group 3 (experimental group) underwent a pharmacological delay with subcutaneous IGF-1 injections. On the seventh postoperative day, flap area was analyzed for survival. Tissue samples were obtained for histological and biochemical evaluations. RESULTS: Survival rates were 43.55 ± 16%, 21.40 ± 8%, and 43.12 ± 14% in groups 1, 2, and 3, respectively. Differences between group 2 and other groups were statistically significant. No significant difference was detected between all three groups for tissue or plasma vascular endothelial growth factor (VEGF) levels. There was no significant histological difference between groups. CONCLUSION: Although a single injection of insulin-like growth factor-1 (IGF-1) did not significantly increase flap survival, its wound healing features are still encouraging and further meticulously planned studies, especially with repeated applications or controlled-release methods, and combinations with binding protein are required.

Effects of insulin-like growth factor-1 on random pattern skin flap survival in rats

ABSTRACT PURPOSE: To investigate the effects of pharmacological delay with insulin-like growth factor-1 (IGF-1) on skin flap survival. METHODS: Thirty Sprague-Dawley rats were submitted to dorsal skin flap (3x9 cm). Seven days before the surgery, the animals were subdivided into three groups of 10 rats. In group 1 (controls), no injection was done. Seven days before the elevation, saline had been injected to the marked skin flap area in group 2 (sham group), and group 3 (experimental group) underwent a pharmacological delay with subcutaneous IGF-1 injections. On the seventh postoperative day, flap area was analyzed for survival. Tissue samples were obtained for histological and biochemical evaluations. RESULTS: Survival rates were 43.55 ± 16%, 21.40 ± 8%, and 43.12 ± 14% in groups 1, 2, and 3, respectively. Differences between group 2 and other groups were statistically significant. No significant difference was detected between all three groups for tissue or plasma vascular endothelial growth factor (VEGF) levels. There was no significant histological difference between groups. CONCLUSION: Although a single injection of insulin-like growth factor-1 (IGF-1) did not significantly increase flap survival, its wound healing features are still encouraging and further meticulously planned studies, especially with repeated applications or controlled-release methods, and combinations with binding protein are required.

Modulation of alternative oxidase to enhance tolerance against cold stress of chickpea by chemical treatments.

The alternative oxidase (AOX) is the enzyme responsible for the alternative respiratory pathway. This experiment was conducted to examine the influence on cold tolerance ability of chickpea (Cicer aurentium cv. Müfitbey) seedlings of AOX activator (pyruvate), AOX inhibitor (salicylhydroxamic acid (SHAM)) and an inhibitor of the cytochrome pathway of respiration (antimycin A) treatments. 5mM pyruvate, 2µM antimycin A and 4mM SHAM solutions were exogenously applied to thirteen-day-old chickpea leaves and then the seedlings were transferred to a different plant growth chamber arranged to 10/5°C (day/night) for 48h. Cold stress markedly increased the activities of antioxidant enzymes compared to controls. Pyruvate and antimycin A significantly increased the cold-induced increase in antioxidant activity but SHAM decreased it. Cold-induced increases in superoxide anion, hydrogen peroxide, and lipid peroxidation levels were significantly reduced by pyruvate and antimycin A, but increased by SHAM treatment. Pyruvate and antimycin A application increased both the activity and protein expression of AOX in comparison to cold stress alone. However, SHAM significantly decreased activity of AOX but did not affect its expression. Total cellular respiration values (TCRV) supported the changes in activity and expression of AOX. While TCRV were increased by cold and pyruvate, they were significantly reduced by SHAM and especially antimycin A. These results indicate that pyruvate and antimycin A applications were effective in reducing oxidative stress by activating the alternative respiratory pathway as well as antioxidant activity. Furthermore, direct activation of AOX, rather than inhibition of the cytochrome pathway, was the most effective way to mitigate cold stress.

Alterations in antioxidant enzyme activities and proline content in pea leaves under long-term drought stress.

The effects of long-term drought stress on chlorophyll, proline, protein and hydrogen peroxide (H2O2) contents, malondialdehyde (MDA) in terms of lipid peroxidation and on the changes in the activities of antioxidant enzymes such as superoxide dismutase (SOD, EC 1.15.1.1), ascorbate peroxidase (APX, EC 1.11.1.11), catalase (CAT, EC 1.11.1.6) and peroxidase (POX; EC 1.11.1.7) in the leaves of pea (Pisum sativum L.) were studied in field conditions. Chlorophyll and protein contents in leaves decreased significantly with increased drought stress. The proline content increased markedly under water deficit. MDA amounts were elevated as a result of water shortage, whereas H(2)O(2) content changed slightly in pea leaves exposed to drought stress. Drought stress markedly enhanced the activities of SOD, CAT and POX but slightly changed the activity of APX. We conclude that in field conditions, long-term water shortage increased the susceptibility to drought in peas.

The effect of scrotal reconstruction with skin flaps and skin grafts on testicular function.

Due to its unique composition, the reconstruction of scrotal skin defects is a major clinical challenge. This study was designed to evaluate the effects of scrotal reconstruction, using skin grafts and skin flaps, on spermatogenesis. In Group 1, the rats did not undergo surgery and were used as controls. In Group 2, after removal of all of the scrotal skin to expose the testicles, the defect was repaired using a skin flap from the right groin region. In Group 3, the reconstruction was achieved using skin grafts. All the rats were killed at 2 months postoperatively and evaluated. The mean wet weights of the testicles in the control group were significantly higher compared with that of the graft group. The mean height of the germinal epithelium was significantly greater in the control and flap groups compared with that of the graft group. The Johnsen score for spermatogenesis in the control group was higher than that in the graft group. The use of flaps resulted in testicular function that was comparable to that of the control group, whereas the use of grafts resulted in diminished testicular function. Therefore, we suggest that flaps may be the first choice for scrotal reconstruction.

Prevention of web creep using a new frame after synpolydactyly surgery.

The main goal in syndactyly surgery is to create a normal web space; however, it is difficult to achieve the best clinical results in older and complex cases with bony fusions and joint deformities requiring osteotomies. In these complex cases, proper postoperative wound care is difficult to achieve due to the web contractures and deformities. In our report, we introduce a new technique using a frame that we called the "Hittite Sun," which helps in proper wound management to reduce wound healing problems that lead to web creep. Between 2002 and 2006, this frame was used in operations for 46 webs, and the results were compared with those of 30 operated webs in which conventional wound management technique was used. It was found that significantly lower complication rate and lesser web creep formation was seen in these patients, which were managed using the frame, compared with the cases with conventional wound care. The frame was found to be effective for prevention of severe web creep especially in complex synpolydactyly surgery.

Evaluation of amniotic fluid as a skin graft storage media compared with RPMI and saline.

We aimed to assess and compare the histological changes of grafts stored in Roswell Park Memorial Institute-1640 solution (RPMI), amniotic fluid (AF), and saline. Amniotic fluid which has abundant nutrients, proteins, and growth factors, and antimicrobial features may be an easily achievable and cheap alternative for the short term preservation of skin grafts. Discarded surgical skin pieces obtained from 15 trauma patients were divided into three groups as RPMI, AF, and saline. The specimens were evaluated at days 7, 14, 21, and 28 for histological alterations by a 3-point scoring scale. Histological scores in the grafts stored in amniotic fluid and RPMI were found significantly lower than those stored in saline (p<0.01). No significant difference was detected between AF and RPMI stored grafts. AF may be a good alternative for skin graft preservation as demonstrated by histological changes. New studies with multiple AF donators and repeated experiments will be worthwhile. Besides, restrictions of some ethical and legal issues for AF use should be solved.

Effective salt criteria in callus-cultured tomato genotypes.

Na+, Cl-, K+, Ca2+, and proline contents, the rate of lipid peroxidation level in terms of malondialdehyde (MDA) and chlorophyll content, and the changes in the activity of antioxidant enzymes, such as superoxide dismutase (SOD: EC 1.15.1.1), catalase (CAT: EC 1.11.1.6), ascorbate peroxidase (APX: EC 1.11.1.11), and glutathione reductase (GR: EC 1.6.4.2), in tissues of five tomato cultivars in salt tolerance were investigated in a callus culture. The selection of effective parameters used in these tomato genotypes and to find out the use of in vitro tests in place of in vivo salt tolerance tests were investigated. As a material, five different tomato genotypes during a 10-day time period were used, and 150 mM NaCl was applied at callus plant tissue. The exposure to NaCl induced a significant increase in MDA content in both salt-resistant and salt-sensitive cultivars. But the MDA content was higher in salt-sensitive cultivars. The chlorophyll content was more decreased in salt-sensitive than in salt-resistant ones. The proline amount was more increased in salt-sensitive than in salt-resistant ones. It has been reported that salt-tolerant plants, besides being able to regulate the ion and water movements, also exhibit a strong antioxidative enzyme system for effective removal of ROS. The degree of damage depends on the balance between the formation of ROS and its removal by the antioxidative scavenging system that protects against them. Exclusion or inclusion of Na+, Cl-, K+, and Ca2+, antioxidant enzymes and MDA concentration play a key protective role against stress, and this feature at the callus plant tissue used as an identifier for tolerance to salt proved to be an effective criterion.

Repair of peripheral nerve defects with epineural sheath grafts.

In this study, we investigated the potential of using a detubulized flat epineural sheath for bridging nerve gaps as an alternative to nerve autografting. Nerve gaps were created by removing a 1.2-cm segment of sciatic nerves. Later, the epineurium was incised longitudinally, and after fascicle removal, a flat rectangular epineural sheath was created. Five experimental groups (6 rats each) included: autograft and no treatment controls and epineural sheath groups repaired with 1 strip, 2-strip, and full epineural sheath grafts. Assessments performed at 3, 6, and 12 weeks included functional (pinprick, toe-spread), neurosensory (somatosensory-evoked potentials), and histomorphometric evaluations. The functional results of toe-spread, somatosensory-evoked potentials, and histomorphometric data revealed comparable outcomes between autograft, 2-strip, and full sheath grafts, indicating adequate nerve regeneration. Thus, the new epineural sheath graft technique introduced in this study can be considered as an alternative method to standard nerve autografting technique.

Presence of interferon regulatory factor-1 in aggressive and nonaggressive histological variants of Basal cell carcinoma specimens.

BACKGROUND: Expression of Interferon regulatory factor-1 (IRF-1) has been demonstrated in a variety of cancers previously. To the best of our knowledge, there is only one report about the IRF-1 expression in basal cell carcinoma (BCC) specimens, which has demonstrated increased expression of the IRF-1 gene in BCC versus normal skin. Furthermore, IRF-1 expression has not been compared between aggressive and nonaggressive subtypes of BCC before. AIMS: Our aim is to examine the relation between IRF-1 staining patterns of aggressive and nonaggressive histological subtypes of BCC. MATERIALS AND METHODS: Thirty-seven archival tissue specimens from 33 BCC patients were stained for cytoplasmic and nuclear IRF-1. Twenty-five tumors were grouped as nonaggressive and 12 were grouped as aggressive histological variants, according to the established criteria. RESULTS: IRF-1 was not only expressed in tumor cells, but also in some surrounding inflammatory cells. There was no significant difference between the groups for cytoplasmic or nuclear IRF-1 staining. Aggressive or nonaggressive histological subtypes did not show any statistical difference for gender, relapse, treatment method, or localization. When staining was compared with gender, relapse, treatment method, localization, and tumor grades, no significant difference was found. CONCLUSIONS: Interferon seems to be expressed in BCCs with both aggressive and non aggressive histology. Further studies are needed to elaborate the precise diagnostic and prognostic roles and utility of interferon in the treatment of BCC.

Temperament and character traits of women admitted for breast reduction and comparison with body perception.

BACKGROUND: Reduction mammaplasty improves self-esteem and low body perception. Previous reports comprise either retrospective data or sectional analysis in which women were evaluated postoperatively. Furthermore, temperament and character properties of women applying for breast reduction have not been investigated. This study aimed to compare the temperament and character traits of women admitted for breast reduction surgery with those of healthy volunteers and to investigate the interaction of body perception with temperament and character. METHODS: The study enrolled 24 patients admitted for reduction mammaplasty and 24 healthy women. The study participants received the Temperament and Character Inventory (TCI) and the Rosenberg Self-Esteem Scale (RSE) questionnaires. The RSE questionnaire was completed again by the patients 6 months after the operation. RESULTS: Of the temperament scales, the persistence scale was significantly lower for the patients. Only the reward dependence subscale of the temperament scale was significantly higher for the patients. Self-esteem (RSE) was significantly lower for the patients than for the control subjects preoperatively, whereas, it rose significantly after the operation. The RSE showed a negative correlation with self-directedness and its subscales of being responsible and resourceful. A significant negative correlation also was found between RSE and empathy. CONCLUSIONS: Women with large breasts try to develop adaptable character properties against chronic troubles. However, the temperament scale of persistence decreases in this process. Similar temperament and character traits of women with and those without large breasts suggest that patients desire breast reduction for functional rather than cosmetic purposes.

Histological assessment of skin grafts stored in amniotic fluid and saline.

We investigated the efficacy of amniotic fluid as a substance in which to store grafts; it is rich in nutrients, proteins, and growth factors, and has well-known antimicrobial features. We compared it with the widely-used and practical saline. Split-thickness grafts 4 × 4 cm were prepared from the back of 20 rats and divided into four groups (n = 5 each). The rolled grafts were wrapped in gauze dampened with saline or amniotic fluid and placed into refrigerators in sterile containers for storage. On days 7, 14, 21, and 28, histological examinations were made. A semiquantitative evaluation of the histological damage to the skin was made by scoring its degree of severity. Compared with saline, histological scores in the grafts stored in amniotic fluid were found to be significantly lower on the 14th, 21st, and 28th days (p values on days 14, 21, and 28; cell swelling: 0.014, 0.006, and 0.005, respectively; nuclear swelling: 0.003, 0.006, and 0.007, respectively; nuclear pleomorphism: 0.004, 0.005, and 0.003, respectively; nuclear haloes: 0.015, 0.005, and 0.005, respectively; nuclear pyknosis: 0.003, 0.005, and 0.003, respectively; dermo-epidermal clefting: 0.005, 0.003, and 0.003, respectively; eosinophilia and mitosis: 0.003, 0.006, and 0.004, respectively; dermal collagen: 0.003, 0.003, and 0.003, respectively). Amniotic fluid maintained preservation better for skin grafts than saline. Comparison with other modern storage media would be beneficial.

Pilomatricoma: a review of six pediatric cases with nine lesions.

Pilomatricoma, although rare, is the second most frequent benign skin tumor in childhood. It is a hard, painless, slowly progressing subcutaneous tumor that is commonly located in the head-neck region, especially periorbital, and in the upper extremities. Histopathologic characteristics are distinctive. In this study, we performed a retrospective review of the records of our pediatric patients with pilomatricoma. We discuss herein the diagnosis and management of this uncommon skin tumor, and compare our experience with the previous literature. Pilomatricoma should be included in the differential diagnosis of superficial pediatric head and neck masses by any physician involved with pediatric tumors.

The prognostic importance of trauma scoring systems in pediatric patients.

PURPOSE: Traumas are among important causes of morbidity and mortality in the pediatric group. Our aim was to evaluate the predicting effects of general trauma scores on mortality and morbidity rates. METHODS: The files of 74 patients, who were admitted to our hospital with trauma between the years 2006 and 2008, were retrospectively investigated. Patients' ages, sex, types of trauma, the time between the trauma and entrance to the hospital, vital and laboratory findings, length of hospital stay, length of intensive care unit (ICU) stay, surgical interventions, the organs affected by the trauma, morbidity, and mortality rates were recorded., glasgow coma scale (GCS), abbreviated injury scale (AIS), trauma score-injury severity score (TRISS), revised trauma score (RTS), injury severity score (ISS), pediatric trauma score (PTS), specific trauma scores for lung, liver, and spleen were calculated using the data in the files. RESULTS: The mean age of patients was 7.0+/-4.34 (1-16) years and 50% of them were men. The types of the trauma were blunt in 66 (89.2%) patients, penetrating in 5 (6.8%) patients and injury due to gun shot in 3 (4.1%) patients. The mean time between the trauma and entrance to the emergency service was 80.40+/-36.67 (10-120) min. Emergency operation and elective surgery was performed in 13 (17%) and 20 (27%) patients, respectively. The mean length of hospitalization was 4.50+/-7.93 (1-35) days.Seven (9.5%) patients needed ICU. The morbidity and mortality rates were 60.8% (n=45) and 2.7% (n=2), respectively. AIS, ISS, TRISS and PTS were independent predictors of morbidity (p<0.05). AIS and ISS were independent predictors of the length of hospital stay (p<0.05). RTS, TRISS, ISS and PTS were independent predictors of the need for ICU (p<0.05). Among laboratory findings, blood glucose, AST and ALT were found to be independent predictors of liver trauma. CONCLUSION: ISS was found to be more valuable than other trauma scoring systems for prognostic evaluation of pediatric trauma patients. On the other hand, blood glucose, AST, and ALT are easily available, cheap, and valuable alternative laboratory findings in prognostic evaluation.

Repair of wide myelomeningocele defects with the bilateral fasciocutaneous flap method.

OBJECTIVE: Five large myelomeningocele defects repaired by bilateral fasciocutaneous flaps are presented in this article. PATIENTS AND METHODS: After the neurological repair, bilateral fasciocutaneous flaps were raised, transposed over the midline, and sutured to each other. RESULTS: All operations lasted shorter than one hour and no major complication was noted in the follow-up. Three of the defects were in the thoracolumbar and two in the lumbosacral regions. The areas of the defects were between 5x6 cm (30 cm2) and 8x10 cm (80 cm2). CONCLUSION: The bilateral fasciocutaneous flap technique offers a shorter operation duration and lower bleeding rate; it is simple to learn and practice and does not abolish alternative operation techniques.

Variations of supraorbital foramina in living subjects evaluated with multidetector computed tomography.

BACKGROUND: We aimed to evaluate the anatomic variations of supraorbital foramina/notches in living subjects using multidetector CT (MDCT) related to age, sex, and side. METHODS: Computer records of 399 patients (207 men and 192 women) referred for high-resolution CT examinations were evaluated for presence, shape, width, and distance from the nasion. RESULTS: The most common presentation was single notch. Presence of double foramen/notch was higher in the right. Bilateral notches were wider in men. Bilateral foramina and left notches were located more lateral in men. Notches were closer to nasion than foramina. Positive correlations were found between right and left sides for the diameters and distances to nasion. Widths of foramina showed negative correlation with the distances to nasion. CONCLUSIONS: This is the first study showing supraorbital foramen/notch variations in living crania. MDCT should be established in anatomical studies and may be used in preoperative evaluation.

Effect of polyamines on glutathione reductase activity in spinach.

The effects of polyamines (putrescine, spermidine and spermine) on glutathione reductase (glutathione: NADP+ oxidoreductase, EC 1.8.1.7; GR) activity of spinach leaves (Spinacia oleracea L. cv. Gladiator) were investigated under in vivo and in vitro conditions. Spinach was grown in sand culture under controlled conditions for 30 d. In in vivo assays 30-day-old plants were sprayed with polyamines once, and leaves were harvested 1, 5, 10 and 15 d after treatment. The three polyamines decreased the GR activity to different degrees, depending on time after application, type of compound and their concentration. In order to study whether or not polyamines can exert a direct effect on GR, the enzyme was partially purified from spinach leaves and incubated with polyamines in the reaction medium. Under these in vitro conditions, GR was inhibited by polyamines in a polyamine type- and concentration-dependent manner. Interestingly, spermine exerted the most intense inhibitory effect in both in vivo and in vitro experiments. It is proposed that the early decrease of glutathione reductase activity in leaves treated with polyamines can be due to a direct interaction of these compounds with the enzyme.