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BACKGROUND: Replantation is the ideal treatment in traumatic scalp defects to provide immediate coverage with restoration of hair-bearing skin. However, data are limited to case reports and small case series. Comprehensive analysis of techniques and outcomes is not available. Our aim was to systematically analyze the available literature to better understand management and postoperative outcomes of patients undergoing scalp replantation. METHODS: A systematic review of the PubMed, Cochrane, and EBSCO databases was performed in October 2019. Search terms included "replantation," "replant," "revascularized," "revascularization," "avulsion," and "scalp." Only papers reporting microvascular replantation of completely avulsed scalps, including case reports, were included. Review articles, non-English language articles, articles discussing nonreplant coverage, incomplete scalp avulsions, and articles discussing delayed scalp replantation were excluded. Data extracted included demographics, percent of scalp affected, mechanism, operative technique, and postoperative outcomes. Statistical analysis was performed using Mann-Whitney U tests, Kruskal-Wallis, and chi-squared tests. RESULTS: From a total of 704 initial results, 61 studies were included for analysis comprising 149 scalps. Complete survival was achieved in 54.7%, partial survival in 38.9%, and failure in 6.7%. Total ischemia time greater than 12 hours was associated with complete replant failure. Arterial anastomoses appeared to protect against complete loss. The number of venous repairs, proportion of venous-to-arterial repairs, use of vein grafts, thromboprophylaxis, or intraoperative complications did not affect outcomes. Patients required significant volumes of blood products, which was associated with partial success. Salvage rate after unplanned return to the operating room was 60.0%. Normal hair growth was achieved in all surviving native scalp tissue. CONCLUSION: Scalp replantations, while technically challenging, are the ideal treatment for scalp avulsions. Fortunately, these have high rates of success. And as a focal point of a patient's appearance, this is invaluable in restoration of a sense of normalcy.
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Couro Cabeludo , Tromboembolia Venosa , Anticoagulantes , Humanos , Microcirurgia , Reimplante , Couro Cabeludo/cirurgiaRESUMO
Long noncoding RNAs (lncRNAs) that map to intragenic regions of the human genome with the same (intronic lncRNAs) or opposite orientation (antisense lncRNAs) relative to protein-coding mRNAs have been largely dismissed from biochemical and functional characterization due to the belief that they are mRNA precursors, byproducts of RNA splicing or simply transcriptional noise. In this work, we used a custom microarray to investigate aspects of the biogenesis, processing, stability, evolutionary conservation, and cellular localization of â¼ 6,000 intronic lncRNAs and â¼ 10,000 antisense lncRNAs. Most intronic (2,903 of 3,427, 85%) and antisense lncRNAs (4,945 of 5,214, 95%) expressed in HeLa cells showed evidence of 5' cap modification, compatible with their transcription by RNAP II. Antisense lncRNAs (median t1/2 = 3.9 h) were significantly (p < 0.0001) more stable than mRNAs (median t1/2 = 3.2 h), whereas intronic lncRNAs (median t1/2 = 2.1 h) comprised a more heterogeneous class that included both stable (t1/2 > 3 h) and unstable (t1/2 < 1 h) transcripts. Intragenic lncRNAs display evidence of evolutionary conservation, have little/no coding potential and were ubiquitously detected in the cytoplasm. Notably, a fraction of the intronic and antisense lncRNAs (13 and 15%, respectively) were expressed from loci at which the corresponding host mRNA was not detected. The abundances of a subset of intronic/antisense lncRNAs were correlated (r ≥ |0.8|) with those of genes encoding proteins involved in cell division and DNA replication. Taken together, the findings of this study contribute novel biochemical and genomic information regarding intronic and antisense lncRNAs, supporting the notion that these classes include independently transcribed RNAs with potentials for exerting regulatory functions in the cell.
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Perfilação da Expressão Gênica/métodos , Genoma Humano/genética , Íntrons/genética , RNA Antissenso/genética , RNA Longo não Codificante/genética , Alfa-Amanitina/farmacologia , Azacitidina/análogos & derivados , Azacitidina/farmacologia , Linhagem Celular Tumoral , Metilases de Modificação do DNA/antagonistas & inibidores , Metilases de Modificação do DNA/metabolismo , Dactinomicina/farmacologia , Decitabina , Células HeLa , Humanos , Células MCF-7 , Inibidores da Síntese de Ácido Nucleico , Análise de Sequência com Séries de Oligonucleotídeos/métodos , RNA Polimerase II/antagonistas & inibidores , RNA Polimerase II/metabolismo , Estabilidade de RNA , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Introduction: Melanoma, a highly aggressive skin cancer originating in melanocytes, poses a significant threat due to its metastatic potential. While progress has been made in treating melanoma with targeted therapies and immunotherapies, challenges persist. Crotoxin (CTX), the principal toxin in Crotalus durissus terrificus snake venom, exhibits various biological activities, including anti-tumoral effects across multiple cancers. However, its clinical use is limited by toxicity. Thus, exploring alternatives to mitigate adverse effects is crucial. Methods and Results: This study investigates the antitumoral potential of CTX in its native and in a detoxified form, in melanoma cells. Firstly, we demonstrated that detoxified CTX presented reduced phospholipase activity. Both forms proved to be more cytotoxic to SK-MEL-28 and MeWo melanoma cells than non-tumoral cells. In SK-MEL-28 cells, where cytotoxic effects were more pronounced, native and detoxified CTX induced increased necrosis and apoptosis rates. We also confirmed the apoptosis death demonstrated by the activation of caspase-3 and 7, and the formation of apoptotic bodies. Furthermore, both CTX caused cell cycle arrest at the G2/M phase, interfering with melanoma cell proliferation. Cell migration and invasion were also suppressed by both CTX. These results confirm the antitumoral potential of CTX. Discussion: The maintenance of the antiproliferative effects in the detoxified version, with reduced enzymatic activity often liked to harm effects, supports further studies to identify active parts of the molecule responsible for the interesting effects without causing substantial toxic events, contributing to the future use of CTX-derived drugs with safety and efficacy.
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BACKGROUND: Operating rooms (ORs) generate 70% of hospital waste, leading to increased costs for the hospital, patient, and the environment. The lack of cost awareness among physicians has been well documented; however, there is little information on anesthesiologists or ancillary OR staff. This study aimed to evaluate the cost awareness of commonly used items at an academic medical center among OR personnel. METHODS: Anonymous surveys were distributed to OR personnel (nurses, surgical technicians (STs), nurse anesthetists, anesthesiologists, surgeons, and residents), asking for the estimated costs of ten commonly used items. These costs were then compared against actual costs to evaluate the accuracy of participants' estimates. Responders were clustered by job, highest level of education, and years of experience for comparison. RESULTS: 167 surveys were collected, and overall only 16.4% of estimates were accurate within 50% of actual price. No significant differences in accuracy between groups were identified overall (P = .2), but both surgical and anesthesia attendings had significantly higher rates of correct responses than their respective residents. No difference was seen in accuracy when all attendings (surgeons and anesthesiologists) were compared with either nurses or STs. Linear regression demonstrated no correlation between number of years at current position or years at institution and number of correct responses (R2 = .0025 and R2 = .005, respectively). DISCUSSION: Addressing the knowledge deficit around item costs via global education of all OR personnel (surgeons, anesthesia providers, and ancillary staff) could be a viable pathway to reduce waste, and thus cost, for our healthcare system.
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Anestesia , Anestesiologia , Cirurgiões , Humanos , Salas Cirúrgicas , Inquéritos e QuestionáriosRESUMO
We determined the phytochemical composition, anti-inflammatory mechanism of action, ROS/RNS scavenging capacity and systemic toxicity of a purified subfraction (S8) of Eugenia selloi. The composition of S8 was assessed by LC-ESI-QTOF-MS; the anti-inflammatory activity in RAW264.7 macrophages through NF-κB activation and biomarkers by multiplex in THP-1 cells; neutrophil migration, intravital microscopy and ICAM-1 expression in mice; NETs formation and CD11b expression; S8 scavenging capacity of ROS/RNS; toxicity in Galleria mellonella larvae model. Coumaric acid, quercetrin and vanillic acid were identified. S8 decreased NF-κB activation, IL-1ß, IL-6, IL-10, MDC and MCP-1 levels, reduced neutrophil migration and ICAM-1 expression in mice; S8 did not interfere NET formation and CD11b expression, exhibited high antioxidant and showed negligible toxicity. E. selloi proved to be a promising, yet underexplored source of bioactive compounds, which can be useful employed in agribusiness and in the pharmaceutical and food industry to develop new products or human health supplies.
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Tracheocutaneous fistula (TCF) is a common complication that occurs after decannulation of a long-term tracheostomy. Numerous studies have demonstrated the incidence of TCF formation to positively correlate with an increasing duration of cannulation, specifically in children. Treatment of a persistent TCF in a child has been well described in the literature, with good response to local measures such as curettage and silver nitrate. When this fails, fistulectomy followed by primary closure of the skin or secondary intention yields good results. However, there is a lack of knowledge on TCF formation in pediatric burn-injured patients, where a persistent TCF is a particularly challenging problem to correct given the paucity of supple tissue in the neck and potential for contractures after a large burn injury; effectively making the surgical repairs and management algorithms described in the available literature largely not applicable to this patient population. In this manuscript, we describe a series of pediatric burn patients with persistent TCF, successfully treated with a multilayered closure involving local tissue rearrangement in the form of medial mobilization of the strap muscles of the neck.
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Queimaduras/complicações , Fístula Cutânea/cirurgia , Doenças da Traqueia/cirurgia , Traqueostomia/efeitos adversos , Criança , Fístula Cutânea/etiologia , Humanos , Músculos do Pescoço/cirurgia , Doenças da Traqueia/etiologiaRESUMO
Adult hippocampal neurogenesis (AHN) is suppressed by high-fat (HF) diet and metabolic disease, including obesity and type 2 diabetes. Deficits in AHN may contribute to cognitive decline and increased risk of dementia and mood disorders, which have higher prevalence in women. However, sex differences in the effects of HF diet/metabolic disease on AHN have yet to be thoroughly investigated. Herein, male and female C57BL/6J mice were fed an HF or control (CON) diet from â¼2 to 6 months of age. After 3 months on the diet, mice were injected with 5-ethynyl-2'-deoxyuridine (EdU) then killed 4 weeks later. Cell proliferation, differentiation/maturation, and survival of new neurons in the dentate gyrus were assessed with immunofluorescence for EdU, Ki67, doublecortin (DCX), and NeuN. CON females had more proliferating cells (Ki67+) and neuroblasts/immature neurons (DCX+) compared with CON males; however, HF diet reduced these cells in females to the levels of males. Diet did not affect neurogenesis in males. Further, the numbers of proliferating cells and immature neurons were inversely correlated with both weight gain and glucose intolerance in females only. These effects were robust in the dorsal hippocampus, which supports cognitive processes. Assessment of microglia in the dentate gyrus using immunofluorescence for Iba1 and CD68 uncovered sex-specific effects of diet, which may contribute to observed differences in neurogenesis. These findings demonstrate sex-specific effects of HF diet/metabolic disease on AHN, and highlight the potential for targeting neurogenic deficits to treat cognitive decline and reduce the risk of dementia associated with these conditions, particularly in females.
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Diabetes Mellitus Tipo 2 , Dieta Hiperlipídica , Animais , Giro Denteado , Dieta Hiperlipídica/efeitos adversos , Proteína Duplacortina , Feminino , Hipocampo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Neurogênese , ObesidadeRESUMO
OBJECTIVE: Given their involvement in pathological and physiological angiogenesis, there has been growing interest in understanding and manipulating endothelial progenitor cells (EPC) for therapeutic purposes. However, detailed molecular analysis of EPC before and during endothelial differentiation is lacking and is the subject of the present study. MATERIALS AND METHODS: We report a detailed microarray gene-expression profile of freshly isolated (day 0) human cord blood (CB)-derived EPC (CD133+KDR+ or CD34+KDR+), and at different time points during in vitro differentiation (early: day 13; late: day 27). RESULTS: Data obtained reflect an EPC transcriptome enriched in genes related to stem/progenitor cells properties (chromatin remodeling, self-renewal, signaling, cytoskeleton organization and biogenesis, recruitment, and adhesion). Using a complementary DNA microarray enriched in intronic transcribed sequences, we observed, as well, that naturally transcribed intronic noncoding RNAs were specifically expressed at the EPC stage. CONCLUSION: Taken together, we have defined the global gene-expression profile of CB-derived EPC during the process of endothelial differentiation, which can be used to identify genes involved in different vascular pathologies.
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Diferenciação Celular/fisiologia , Células Endoteliais/metabolismo , Sangue Fetal/metabolismo , Regulação da Expressão Gênica/fisiologia , Células-Tronco/metabolismo , Transcrição Gênica/fisiologia , Antígenos de Diferenciação , Células Cultivadas , Células Endoteliais/citologia , Sangue Fetal/citologia , Perfilação da Expressão Gênica , Humanos , Neovascularização Patológica/genética , Neovascularização Fisiológica/genética , Análise de Sequência com Séries de Oligonucleotídeos , Células-Tronco/citologia , Fatores de TempoRESUMO
Estudos recentes têm revelado que uma fração significativa do transcriptoma de eucariotos é composta por RNAs não codificadores longos (lncRNAs). Este trabalho investigou o padrão de expressão de um conjunto de lncRNAs originados a partir de regiões intrônicas de genes codificadores de proteínas em três linhagens celulares tumorais humanas utilizando microarranjos de DNA customizados. Realizamos uma série de análises in silico com a perspectiva de identificar propriedades globais desses transcritos, tais como a abundância relativa em diferentes tecidos, características evolutivas, estruturais e regulatórias, além de possíveis funções celulares. Avaliamos também a contribuição da metilação do DNA, um mecanismo de silenciamento epigenético da expressão de genes codificadores de proteínas, na regulação da expressão de lncRNAs intrônicos. Observamos que uma fração dos lncRNAs intrônicos detectados nas linhagens estudadas são conservados evolutivamente, tem padrão de expressão tecido específico, e está enriquecida em elementos regulatórios na sua extremidade 5'. Foram identificados subconjuntos de lncRNAs intrônicos possivelmente atuando sobre genes associados a vias regulatórias importantes para o controle do desenvolvimento de organismos e ciclo celular. Comparativamente a mRNAs, uma menor proporção de lncRNAs intrônicos possui ilhas CpGs (CGIs) na vizinhança de seu início de transcrição. Apesar disso, observamos que um subconjunto desses transcritos teve sua expressão sensível ao tratamento com o agente desmetilante de DNA 5-AZA, demonstrando que lncRNAs intrônicos transcritos podem estar sujeitos a regulação transcricional mediada por metilação do DNA. Dentre os lncRNAs intrônicos regulados por metilação do DNA, destaca-se o lncRNA AS-APP, cuja expressão aumentou em 25 a 80 vezes nas linhagens celulares DU-145 e HEK293, respectivamente, após tratamento com 5-AZA. Este lncRNA possui uma CGI metilada e um promotor ativo a cerca de 4 kb de distância do seu início de transcrição conhecido. O aumento da transcrição do lncRNA AS-APP após desmetilação do DNA correlacionou-se a uma diminuição significativa dos níveis de expressão do mRNA do gene APP. Este resultado sugere uma possível ação regulatória em cis do lncRNA AS-APP no locus APP, um importante gene envolvido na doença de Alzheimer e com expressão associada ao prognóstico de alguns tipos de câncer. Os resultados obtidos neste trabalho reforçam a ideia de que lncRNAs intrônicos constituem unidades transcricionais independentes que se encontram sobre controle regulatório nos diferentes tipos celulares. Foi gerado também um catálogo de lncRNAs intrônicos regulados por metilação que permitirá a seleção de candidatos com maior potencial de relevância funcional para caracterização detalhada
Recent studies have revealed that a significant fraction of the eukaryotic transcriptome is composed of long noncoding RNAs (lncRNAs). This work investigated the expression pattern in three human tumor cell lines of a set of lncRNAs originated from intronic regions of protein coding RNAs, using custom DNA oligoarrays. In silico analyses were performed to identify global properties of these transcripts such as relative abundance in different human tissues, regulatory, evolutionary and structural aspects, as well as their possible cellular functions. In addition, we evaluated the contribution of DNA methylation, an important epigenetic mechanism that control the expression of protein coding genes, in the regulation of intronic lncRNAs expression. We found that a fraction of the intronic lncRNAs detected in the cell lines are evolutionarily conserved, show a tissue specific expression pattern, and is enriched in regulatory elements at their 5' end region. Subsets of intronic lncRNAs possibly acting on genes associated to important regulatory pathways controlling organism development and cell cycle were identified. A smaller proportion of intronic lncRNAs relative to mRNAs displayed CpG islands (CGI) in the vicinity of the transcription start site. Notwithstanding, we observed that a subset of these transcripts responded to treatment with the DNA demethylation agent 5-AZA, demonstrating that intronic lncRNAs may be under transcriptional regulation mediated by DNA methylation. Among intronic lncRNAs regulated by DNA demethylation, stands out AS-APP lncRNA, which was up regulated 25 to 80 times in DU-145 and HEK293 cell lines following 5-AZA treatment, respectively,. This lncRNAs has a methylated CGI and an active promoter at 4-kb upstream from its known transcription start site. Increased AS-APP lncRNA transcription following DNA demethylation correlated with a significant decrease of APP gene messenger RNA levels. This finding suggests a possible cis-regulatory action of the lncRNA AS-APP in the APP locus, an important gene involved in Alzheimer disease and whose expression is associated with prognosis of different cancer types. The results obtained in this study reinforce the idea that intronic lncRNAs constitute independent transcriptional units under regulatory control in the different cell types. It was generated a catalog of intronic lncRNAs regulated by DNA methylation that will allow the selection of candidates with higher potential of functional relevance for detailed characterization