Skeletal stability and complications in transantral maxillary distraction in patients with cleft lip and palate.

The current prospective study aimed at assessing skeletal stability and complications arising from transantral maxillary distraction adopted for advancements of less than 12 mm in patients with cleft lip, alveolus, and palate malformations.The recruited patients with cleft lip, alveolus, and palate were followed up for 12 months. Lateral skull radiographs were obtained before surgery (T0), at the end of the activation period of the distractors (T1), and after completion of the follow-up interval (T2). Length and height of the maxilla were assessed at the different points of time. The relapse rate of maxillary advancement was calculated. Complications such as infections, distractor breakage and loosening, nonunions, and the need for reoperation were documented.Seven patients were included in this study (mean [SD] age, 19.5 [2.6] y). The length of the maxilla significantly increased by 6.4 ± 1.1 mm at T1 (P = 0.018) but showed a significant relapse by 7.5% at T2 (P = 0.018). As a complication, a case of infection of the cheek occurred during the consolidation period, which could be treated conservatively. In an additional patient, there was a loosening of a distractor at the end of the distraction period, which required reoperation with conventional fixation of the maxilla in the intended position. At the time of removal of the distractors and the conventional osteosynthesis plates, no cases of nonunion could be identified.It seems that the low horizontal relapse rate of transantral maxillary distraction in patients with cleft lip and palate outweighs the possible complications of this procedure in cases of limited distances of advancement of less than 12 mm.

A recipe for change: Analyzing the climate and ecosystem impacts of the Brazilian diet shift.

Diet shift is an opportunity to mitigate the impacts of food systems, which are responsible for about a third of greenhouse gas (GHG) emissions globally and exert various environmental pressures on ecosystems. This study evaluates the mitigation potential of both global and local environmental impacts through dietary changes within the Brazilian context. Furthermore, the study aims to identify the potential benefits and trade-offs that may arise from these dietary transitions, thus providing a comprehensive analysis of the overall environmental implications. To this end, a life cycle assessment (LCA) was performed to evaluate the environmental impacts of a conventional diet in Brazil and seven alternatives, namely adjusted-EAT-Lancet, pescatarian, vegetarian, entomophagic (insect-based food), mycoprotein (microbial-based food), and synthetic (cell-based food) diets. Results indicate a substantial mitigation potential for GHG emissions (4-9 kg CO2e/cap/day) (39 % to 86 %) and land use (4-9 m2/cap/day) (38 % to 82 %) through a diet shift from a conventional diet to any of the seven alternative diets. However, certain trade-offs exist. A diet shift demonstrates no mitigation potential of soil acidification, and opportunities to reduce water eutrophication (0.02-0.2 g Pe/cap/day) (2 % to 24 %) and water consumption (0.2-0.5 m3/cap/day) (7 % to 14 %) were only found by completely substituting animal products for insect-based food, microbial-based food, and cell-based food. This study highlights the considerable potential of dietary changes to mitigate global environmental impacts associated with food systems. By revealing opportunities and challenges, this study supports science-based decision-making and guides efforts toward sustainable and environmentally friendly food consumption patterns.

Polypropylene meshes coated with a polysaccharide based bioadhesive for intra-abdominal mesh fixation in a rabbit model.

BACKGROUND: In this study, we evaluate a new bioadhesive for intra-abdominal onlay mesh fixation of a polypropylene-polyvinylchloride graft. METHODS: Three pieces of a commercially available polypropylene/polyvinylfluoride mesh, each 3 × 3 cm in size, and three pieces of the same mesh coated with a polysaccharide bioadhesive were fixated to the surface of the anterior abdominal wall of 30 New Zealand white rabbits. The fixation was performed either by using four transabdominal Prolene(®) 4/0 sutures, four spiral tacks (Protack 5 mm Tyco), or cyanoacrylate glue (Glubran(®) GEM, Viareggio, Italy). Each mesh position and the according kind of fixation were randomized before implantation. The animals were sacrificed 12 weeks postoperatively. After determining the extent of intra-abdominal adhesions, the meshes were excised en bloc with the anterior abdominal wall for tensile strength measurements and histological analysis. RESULTS: All meshes coated with the bioadhesive adhered to the intact peritoneum without extra fixation. Irrespective of the fixation technique coated meshes led to more and stronger adhesions. Mesh shrinkage by scarring was increased in coated meshes fixed with glue and low in uncoated meshes fixed with tacks. Testing the tensile strength, coated meshes fixed with transfascial sutures achieved the best results (16.14 ± 6.1 N), whereas coated meshes fixed with glue showed the lowest strength (10.39 ± 4.81 N). The foreign body reaction was considerably more distinctive using coated mesh. The mesh ingrowth was not influenced by this reaction. CONCLUSIONS: All meshes coated with the new bioadhesive were self-adhesive in that way; they stayed in position when attached to the peritoneum. Although this may facilitate intra-operative mesh fixation, the bioadhesive displayed several disadvantages, such as stronger adhesions and an increased shrinkage of the implant. The tensile strength was not influenced by the use of the bioadhesive. At present, we see no major advantage for polysaccharide bioadhesive applied in this study.

Characterisation of a new bioadhesive system based on polysaccharides with the potential to be used as bone glue.

Although gluing bone is in theory a very attractive alternative to classical fracture treatment, this method is not yet clinically established due to the lack of an adhesive which would meet all the necessary requirements. We therefore developed a novel two-component bioadhesive system with the potential to be used as a bone adhesive based on biocompatible and degradable biopolymers (chitosan, oxidised dextran or starch). After mixing in water, the two components covalently cross-link by forming a Schiff's base. By the same mechanism, the glue binds to any other exposed amino group such as for example those exposed in fractured bone, even in the presence of water. Modified chitosan was synthesised from commercially available chitosan by deacetylation and was then reduced in molecular weight by heating in acid. The amount of free amino groups was analysed by IR. The molecular weight was determined by viscosimetry. Starch or dextran were oxidised with periodic acid to generate aldehyde groups, which were quantified by titration. l-Dopa was conjugated to oxidised dextran or starch in analogy to the gluing mechanism of mussels. Biomechanical studies revealed that the new glue is superior to fibrin glue, but has less adhesive strength than cyanoacrylates. In vitro cell testing demonstrated excellent biocompatibility, rendering this glue a potential candidate for clinical use.

A role for E2F6 in the restriction of male-germ-cell-specific gene expression.

E2F transcription factors play a pivotal role in the regulation of cellular proliferation and can be subdivided into activating and repressing family members [1]. Like other E2Fs, E2F6 binds to E2F consensus sites, but in contrast to E2F1-5, it lacks an Rb binding domain and functions as an Rb-independent transcriptional repressor [2, 3, 4 and 5]. Instead, E2F6 has been shown to complex with Polycomb (PcG) group proteins [6 and 7], which have a well-established role in gene silencing. Here, we show that E2F6 plays an unexpected and essential role in the tissue specificity of gene expression. E2F6-deficient mice ubiquitously express the alpha-tubulin 3 and 7 genes, which are expressed strictly testis-specifically in control mice. Like an additional E2F6 target gene, Tex12, that we identified, tubulin 3 and 7 are normally expressed in male germ cells only. The promoters of the alpha-tubulin and Tex12 genes share a perfectly conserved E2F site, which E2F6 binds to. Mechanistically, E2F6-mediated repression involves CpG hypermethylation locking target promoters in an inactive state. Thus, E2F6 is essential for the long-term somatic silencing of certain male-germ-cell-specific genes, but it is dispensable for cell-cycle regulation.

Toll-like receptor interference in myeloid dendritic cells through head and neck cancer.

BACKGROUND: In head and neck squamous cell carcinoma (HNSCC) the secretion of various immunosuppressive mediators contributes to large-scale effects on the immune functions. The influence of HNSCC on the Toll-like receptor (TLR) expression profiles of human myeloid dendritic cells (MDCs), which have been identified in human solid tumor tissue of the head and neck, was analysed. MATERIALS AND METHODS: MDCs were isolated from peripheral blood by 'magnetic bead separation' and subsequently incubated with supernatants of HNSCC permanent cell lines. TLR expression profiles were investigated using Af cytometry and SDS-PAGE. RESULTS: Human MDC from peripheral blood were found to express all human TLRs except TLR4 and TLR9. Incubation of MDC with supernatants of HNSCC resulted in an increased expression of TLR7. CONCLUSION: The data suggest an interference of TLR7 expression through HNSCC and provide novel evidence of TLR alterations as a potential tumor promoting event in head and neck cancer.

Off-Pump Arterial Revascularization Using a New Reusable Device for Coronary Occlusion and Local Stabilization.

Abstract Background: Optimal local stabilization, an unobstructed view, and a free field for operation are of most importance during off-pump surgery to facilitate high-quality anastomoses. We report on a new reusable stabilizing platform for complete off-pump coronary revascularization. Methods: From May 2001 until June 2002, 118 consecutive patients (82 men, 36 women) with coronary artery disease (61 with 1-vessel, 42 with 2-vessel, and 15 with 3-vessel disease) and a mean age of 63. 6 +/- 10. 0 years (range, 41-88 years) were scheduled for complete off-pump arterial revascularization. The mean left ventricular ejection fraction was 56. 5% +/- 12. 5%(range, 25%-85%). Exposure of the coronary vessels was facilitated with deep pericardial slings. The target coronary vessel was snared twice with air-cushioned silicone loops and fixed to the platform, which was connected to a flexible steel arm. The platform is available in 3 versions with different connector angles to accommodate various anatomical conditions. Together with its flat design, the platform provides an unobstructed view and a free field of operation. Results: All operations were performed without any intraoperative complications, and all planned bypasses were carried out. The mean number of bypass grafts was 1. 7 +/- 0. 8 (range, 1-5). There was no early (30 days) mortality. The postoperative course was uneventful in all patients except for 1 reexploration for retrosternal bleeding, 10 patients with temporary atrial fibrillation, and 1 patient with reintubation after early extubation in the operating room because of respiratory insufficiency. Patients were discharged from the hospital in good condition 8. 7 +/- 2. 6 days (range, 5-18 days) after surgery. Conclusions: Our data indicate that complete arterial off-pump revascularization can be performed safely and effectively with a new reusable platform that provides excellent stabilization and an unobstructed view to the target coronary vessels.

A steel band in addition to 8 wire cerclages reduces the risk of sternal dehiscence after median sternotomy.

BACKGROUND: Sternal dehiscence after full median sternotomy may result in wound-healing disorders, including osteomyelitis. The consequences are extended hospitalization, plastic surgery, stress for the patient, and increased costs. Stable closure of the median sternotomy plays a crucial role in the avoidance of sternal dehiscence and osteomyelitis. METHODS: All patients who underwent full sternotomy from January 1999 until December 2001 were investigated with respect to the incidence of sternal dehiscence. Since January 2000, patients supposed to be at risk for sternum dehiscence were more frequently treated with an Ethicon steel band at the third intercostal space in addition to standard osteosynthesis with 8 wire cerclages. RESULTS: Since the introduction of this method, the incidences of sternal dehiscence and sternal wound infections decreased from 2.9% and 0.9 %, respectively, in 1999 to 0.3% and 0.2%, respectively, in 2001. This decline resulted in shorter postoperative hospital stays, less stress for the patients, and substantial reductions in postsurgical costs. CONCLUSIONS: A steel band used in addition to standard osteosynthesis with 8 wire cerclages is a safe and effective procedure resulting in a statistically significant decrease in the frequency of sternal dehiscence.

Cell type-specific aspects in biocompatibility testing: the intercellular contact in vitro as an indicator for endothelial cell compatibility.

Endothelial cells cover the inner surface of blood vessels and form the interface between the blood and the tissues. Endothelial cells are involved in regulating barrier function, which is maintained by the interendothelial cell contacts. These interendothelial cell contacts are established by the interaction of different molecules. The maintenance of the barrier requires an appropriate signalling between these molecules. Thus, a number of different signalling pathways are integrated within interendothelial contacts. Since endothelial cells are important in tissue-implant interactions (especially for stent materials) this study examines the expression pattern of different interendothelial contact molecules to determine the usefulness in the analysis of biocompatibility in vitro. The effects of different pro-inflammatory and toxic stimuli and contact of human microvascular endothelial cells to metallic surfaces were examined for their impact on the pattern of interendothelial contact molecules. Striking modifications in the arrangement of these molecules were induced and the mode of modification was dependent on the tested compound. Thus, examining the pattern of expression of specific interendothelial contact molecules in vitro may be useful for testing the endothelial cell compatibility of biomaterials and their corrosion products.