A comprehensive analysis of royal jelly protection against cypermethrin-induced toxicity in the model organism Allium cepa L., employing spectral shift and molecular docking approaches.

In this study, the toxicity of the pesticide cypermethrin and the protective properties of royal jelly against this toxicity were investigated using Allium cepa L., a model organism. Toxicity was evaluated using 6 mg/L cypermethrin, while royal jelly (250 mg/L and 500 mg/L) was used in combination with cypermethrin to test the protective effect. To comprehend toxicity and protective impact, growth, genotoxicity, biochemical, comet assay and anatomical parameters were employed. Royal jelly had no harmful effects when applied alone. On the other hand, following exposure to cypermethrin, there was a reduction in weight increase, root elongation, rooting percentage, mitotic index (MI), and chlorophyll a and b. Cypermethrin elevated the frequencies of micronucleus (MN) and chromosomal aberrations (CAs), levels of proline and malondialdehyde (MDA), and the activity rates of the enzymes catalase (CAT) and superoxide dismutase (SOD). A spectral change in the DNA spectrum indicated that the interaction of cypermethrin with DNA was one of the reasons for its genotoxicity, and molecular docking investigations suggested that tubulins, histones, and topoisomerases might also interact with this pesticide. Cypermethrin also triggered some critical meristematic cell damage in the root tissue. At the same time, DNA tail results obtained from the comet assay revealed that cypermethrin caused DNA fragmentation. When royal jelly was applied together with cypermethrin, all negatively affected parameters due to the toxicity of cypermethrin were substantially restored. However, even at the maximum studied dose of 500 mg/L of royal jelly, this restoration did not reach the levels of the control group. Thus, the toxicity of cypermethrin and the protective function of royal jelly against this toxicity in A. cepa, the model organism studied, were determined by using many different approaches. Royal jelly is a reliable, well-known and easily accessible protective functional food candidate against the harmful effects of hazardous substances such as pesticides.

Reconstruction of finger contracture with an expanded first dorsal metacarpal artery perforator flap: A case report.

Volar finger contractures can be challenging for plastic surgeons. The dorsal metacarpal artery perforator (DMCAP) flap is frequently used to cover bones, tendons, and neurovascular structures in the dorsum of the hand after trauma and burns as an alternative to grafts and free flaps. We aimed to report volar finger defect reconstruction with expanded DMCAP flap. A 9-year-old male patient applied to our clinic with the complaint of inability to open the second finger of the left hand after an electrical burn that caused proximal and distal interphalangeal joints flexion contractures. Reconstruction was planned for the patient with a two-session expanded first DMCAP flap. A 16 mL 5 × 3 cm tissue expander was placed in the prepared area from the vertical incision in the first session. The tissue expander was inflated with 4 mL of isotonic solution. The DMCA area was enlarged 6 weeks later by giving 22 mL of isotonic solution. After the pedicle dissection, the 9 × 3 cm DMCAP flap was elevated by dissection over the paratenon. With 180° of rotation, the left-hand second finger was adapted to the 6 × 2 cm defect area on the volar face. The flap donor site was closed primarily. The operation was terminated by placing the hand on a protective splint. There were no complications in the flap in the postoperative 6 months. The patient was referred to the physical therapy and rehabilitation department. As a result, an expanded DMCAP flap may cover volar tissue defects up to the distal phalanx. This report may present the first case in which volar finger contracture reconstruction was performed with an expanded first DMCAP flap after an electrical burn in a pediatric patient.

The use of mathematically standardized bilobed design perforator flaps for coverage of sacral pressure ulcers.

BACKGROUND: Sacral pressure ulcer reconstruction is frequently applied in plastic surgery practice. Although perforator flaps are frequently used, recurrence is not uncommon in patients. For this reason, using the as little area as possible during the reconstruction is vital. Therefore, we aimed to describe a mathematically standardized bilobed perforator flap design for sacral pressure ulcer reconstruction with a certain proportion and angle relation between limbs. METHODS: A total of 17 patients (5 female/12 male)were included in this report. The mean age of the patients was 50.4 years (Ranging from 32 to 79 years). The patients with grade 3-4 sacral pressure ulcers were included in the report. The patients have grade 1-2 sacral ulcers or the other areas of pressure ulcer excluded. The size of the defects ranged from 8 × 14 cm to 5 x 16 cm. For ulcers in the sacral region, we used bilobed flaps that we mathematically standardized. The length of the first limb of the flap was planned 90° vertically oriented according to the distance between the perforator zone to the distal lateral border of the defect. The width of the first limb was kept equal to the length of the defect. The orientation of the second limb of the flap was designed 90 degrees horizontally according to the first limb. Therefore, the lengths of second limbs were calculated as half of the first limb's width, and the widths of second limbs were calculated as ¾ width of the first limb's width. RESULTS: A total of 10 flaps were elevated based on superior gluteal artery perforators, and seven flaps were nourished by inferior gluteal artery perforators. The mean size of the first limb of the flaps was 14.7 × 7.2 cm (Ranging from 8 to 20 × 6 to 13 cm). The mean size of the second limb of the flaps was 6.7 × 5.3 cm (Ranging from 5 to 12 × 4 to 8 cm). The mean size of defects was 10.5 × 7.3 cm (Ranging from 8 to 14 × 5 to 16). The mean rotation angle was 91.7° (ranging from 90 to 100). In the early postoperative period, the hematoma was detected in three patients and evacuated in one patient, resulting in wound separation. Tip necrosis was seen in a patient that was healed by wound care. No total flap loss was encountered. No late-term recurrence was seen during the follow-up. The mean follow-up time was 13.1 months (Ranging from 4 to 24 months). CONCLUSION: Unilateral standardized bilobed perforator can reliably be preferred in medium to large size sacral pressure ulcer defects.

Near-total gluteal defect reconstruction with bilateral delayed giant lumbar artery perforator flaps: A case report.

The reconstruction of the near-total or total gluteal defects is challenging. Reconstructive options were restricted when the gluteal flaps were sacrificed. The lumbar artery perforator flap (LAPF) has been recently popularized as an alternative option for sacral and gluteal pressure ulcers. Extension of flap size may be needed in extensive defects. We aim to use the delay phenomenon to increase lumbar artery perforator flap territory to reconstruct near total gluteal defect. A 36-year-old woman was referred to our clinic with defect sizes of 23 × 23 cm and 25 × 17 cm for the right and left gluteal regions. She had a history of multiple surgeries for her paraplegia-related sacrogluteal pressure sores. The reconstruction was started on the left side with delaying incisions to the flap borders. Seven days later, the left gluteal defect was reconstructed with 27 × 19 cm LAPF based on a second lumbar artery perforator. At the same session, the delaying incision was performed to the borders of the right LAPF. On day 14, the right gluteal defect was closed with a 25 × 25 cm-sized right LAPF. No flap loss and early complications were seen. The patient was discharged without complication after 10 days after the last operation. The patient was followed up for 1 year. A right ischial pressure ulcer due to wheelchair use was encountered, which was managed with conservative wound care in the 8th month. Giant-sized lumbar artery perforator flaps may be obtained by delay phenomenon to reconstruct near-total or total gluteal pressure sores.

Evaluation of Tear Stability and Ocular Surface in Patients Undergoing External Endonasal Dacryocystorhinostomy (EE-DCR) for Primary Acquired Nasolacrimal Duct Occlusion (PANDO).

The aim of our study was to show the changes in ocular surface and tear film parameters of patients who underwent external endonasal dacryocystorhinostomy (EE-DCR). For this purpose, tear film break-up time, corneal staining score, ocular surface disease index (OSDI), and Schirmer I test were performed preoperatively and postoperatively. The data obtained were compared with healthy controls. In the preoperative period, ocular surface disease index scores and corneal staining scores were higher, and Schirmer 1 and tear film break-up time were lower in group 1 compared with group 2. The ocular surface parameters were similar between the groups in the first and third postoperative months. External endonasal dacryocystorhinostomy is an important method for the restoration of deteriorated tear stability. Restoration of these disorders may be an important determinant of patient satisfaction and visual quality after surgery.

Novel Scalp Flap Elevation With Balloon Trocar Dissection Device.

BACKGROUND: Balloon trocar devices have been utilized in several surgical cases to reach a difficult-to-access location, achieve hemostasis, and obtain safe, efficient surgery. OBJECTIVE: Highlight the balloon trocar dissection device in a novel technique of scalp flap elevation for tissue expander placement. METHODS: The pocket for the tissue expander was determined at the scalp. A 2 cm vertical incision was made. A 12 mm balloon trocar is then introduced and insufflated. Through the trocar, endoscopic light is then inserted. Scalp flap elevation was performed with the device. The exact location of the pocket was seen with the lumination of endoscopic light. RESULTS: The balloon trocar dissection device provides easy scalp flap elevation and bleeding control. With the help of endoscopic light, the pocket for the expander was created precisely. CONCLUSION: The balloon trocar device is simple, effective, low-cost equipment for tissue expander placement in the scalp.

Tumi Flap: A Novel Modification to Frontal Flap for Orbital Exenteration Defects.

Orbital exenteration remains a significant disfigurement in the face. Many reconstructive options were reported for one stage covering the defects. Local flaps are used primarily in elderly patients who are not candidates for microvascular procedures. Local flaps generally close the gap without achieving 3-dimensional adjustment perioperatively. Secondary procedures or shrinking by time are needed for better orbital adaptation. In this case report, we describe a novel frontal flap design influenced by a Tumi knife, an ancient Peruvian trepanation instrument. The design helps us to create a conic shape that can resurface the orbital cavity at the time of the operation.

The effect of hydrochlorothiazide on the recurrence of nonmelanoma skin cancer: a 7-year retrospective study comprising 300 patients.

BACKGROUND: Hydrochlorothiazide (HCTZ) possesses well-described photosensitizing properties, and a causal association with nonmelanoma skin cancer (NMSC) was recently shown. However, previous studies have not shown whether HCTZ use is associated with the risk of recurrence of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). This study aims to investigate the association between HCTZ use and recurrence in patients with NMSC. METHODS: We identified cases with NMSC from our hospital archives during the period between 2013 and 2019. Patients were divided into groups according to the pathological diagnosis, HCTZ use, and recurrence. Multivariable analysis was performed to determine factors associated with recurrence in BCC and SCC. RESULTS: Recurrences of BCC were significantly higher in HCTZ users with ORs of 4.839221 (95% confidence interval [CI], 1.22-19.12).In HCTZ users, NMSC cases were associated with increased age (p < 0.001 for both BCC and SCC). BCC recurrences were statistically significant with age, longer follow-up, and positive margins after excision in HCTZ users (p = 0.048, 0.020, and, 0.003, respectively). SCC recurrences were not significantly associated with HCTZ use. DISCUSSION: HCTZ use is significantly associated with BCC recurrences. Especially in the elderly population, cases with a positive margin should be followed closely.

Effects of Systemic Diseases on Graft Preparation in Descemet Membrane Endothelial Keratoplasty.

OBJECTIVES: To evaluate the effects of the systemic diseases and drugs of the donor on Descemet membrane (DM) graft preparation. METHODS: Seventy-eight corneas of 58 donors, of whom the DM grafts were used in Descemet membrane endothelial keratoplasty (DMEK) surgery, between January 2018 and January 2020, were enrolled in this retrospective study. The hospital records of the donors were analyzed. Age, sex, blood type, systemic diseases, and drugs; complete blood count; biochemistry panel for liver and kidney functions in the past 48 hours; and the drugs used in the hospital, if any, in the past 24 hours were recorded. The grafts with tears that occurred while preparation were included in group 1, and the successful grafts with no tears were included in group 2. RESULTS: There were no statistically significant differences in the characteristics of the donors between groups. However, breast cancer and the use of sevelamer were found to be significantly higher in group 1 ( P =0.010, P =0.033, respectively). No statistically significant difference in the use of other drugs was found between groups. CONCLUSION: Although diabetic donors have been reported to be inappropriate candidates for the preparation of DM grafts for DMEK, most of the donors with several systemic diseases including diabetes can be used in DMEK surgery, with the right technique in DM graft preparation.

Two distinct promoter architectures centered on dynamic nucleosomes control ribosomal protein gene transcription.

In yeast, ribosome production is controlled transcriptionally by tight coregulation of the 138 ribosomal protein genes (RPGs). RPG promoters display limited sequence homology, and the molecular basis for their coregulation remains largely unknown. Here we identify two prevalent RPG promoter types, both characterized by upstream binding of the general transcription factor (TF) Rap1 followed by the RPG-specific Fhl1/Ifh1 pair, with one type also binding the HMG-B protein Hmo1. We show that the regulatory properties of the two promoter types are remarkably similar, suggesting that they are determined to a large extent by Rap1 and the Fhl1/Ifh1 pair. Rapid depletion experiments allowed us to define a hierarchy of TF binding in which Rap1 acts as a pioneer factor required for binding of all other TFs. We also uncovered unexpected features underlying recruitment of Fhl1, whose forkhead DNA-binding domain is not required for binding at most promoters, and Hmo1, whose binding is supported by repeated motifs. Finally, we describe unusually micrococcal nuclease (MNase)-sensitive nucleosomes at all RPG promoters, located between the canonical +1 and -1 nucleosomes, which coincide with sites of Fhl1/Ifh1 and Hmo1 binding. We speculate that these "fragile" nucleosomes play an important role in regulating RPG transcriptional output.

Reno-protective effects of Phosphodiesterase 5 inhibitors.

The kidneys are vital organs that play an important role in removing waste materials from the blood, electrolyte balance, blood pressure regulation, and red blood cell genesis. Kidney disease can be caused by various factors, including diabetes, ischemia/reperfusion injury, and nephrotoxic agents. Inflammation and oxidative stress play a key role in the progression and pathogenesis of kidney diseases. Acute kidney injury (AKI) and chronic kidney disease (CKD) are important health problems worldwide, as they are associated with a long-term hospital stay, and increased morbidity and mortality in high-risk patients. Current standard therapeutic options are not sufficient to delay or stop the loss of kidney function. Therefore, it is necessary to develop new therapeutic options. Phosphodiesterase 5 inhibitors (PDE5Is) are a currently available class of drugs that are used to treat erectile dysfunction and pulmonary hypertension in humans. However, recent evidence suggests that PDE5Is have beneficial renoprotective effects via a variety of mechanisms. In this review, the benefits of PDE5 inhibitors in clinical conditions associated with kidney disease, such as diabetic nephropathy, ischemia-reperfusion injury, and acute and chronic kidney injury, are summarized.

Reconstruction of lower lip defects with free super-thin anterolateral thigh flap.

BACKGROUND: Lower lip is a vital organ with important functions as well as aesthetic importance. It is critical to provide an aesthetically appealing lower facial subunit with maintenance of understandable speech and oral competence. Achieving these targets is very difficult especially in total lower lip defects. This report presents a technique using super-thin anterolateral thigh (ALT) flaps with fascia graft for reconstruction of large, complex oral sphincter defects. PATIENTS AND METHODS: Six patients with squamous cell carcinoma (SCC) and one patient with a gunshot injury were presented in this report. All of them had full-thickness defects including skin, orbicularis muscle and oral mucosa. The mean age was 58 (range, 32-85) years. Defects of the lower lip were reconstructed with a super-thin ALT flap. Super-thin flaps were obtained by planning as close to the knee as possible and elevating at the level of superficial fascia. The fascia graft was used for achieving lip suspension. RESULTS: Overall flap survival was 100%. The flap size ranged from 8 × 6 cm to 14 × 10 cm. The follow-up periods ranged from 6 to 14 months. All the patients achieved acceptable oral competence, both in the resting condition and during speaking and eating, except for one patient who had a drooping lower lip developed in the post-operative 3rd month and underwent a secondary tightening procedure. Another patient needed liposuction due to bulky appearance. CONCLUSION: Super-thin ALT flaps seem to be a useful option for functional and aesthetic reconstruction of extensive lip defects.

The Effects of Adipose Derived Stromal Vascular Fraction and Platelet-Rich Plasma on Bone Healing of a Rat Model With Chronic Kidney Disease.

BACKGROUND: Chronic kidney disease (CKD) impairs osteoblast/osteoclast balance and damages bone structure with diminished mineralization and results in bone restoration disorders. In this study, we investigate the effects of adipose-derived stromal vascular fraction and platelet-rich plasma (PRP) on bone healing model in rats with CKD. METHODS: Sprague-Dawley rats were separated into 4 groups. All groups except group I (healthy control) had CKD surgery using 5/6 nephrectomy model. All groups had intramedullary pin fixation after receiving bone fracture using drilling tools. Group II rats were used as control group for CKD. Group III rats received PRP treatment on fracture site. Group IV rats received PRP and stromal vascular fraction treatment on fracture site.Weight loss and blood samples were followed at the time of kidney surgery, third, sixth, and 12th weeks. Bone healing and callus formations were compared, biomechanically, radiologically, histopathologically, and immunohistochemically. Osteoblastic transformation of stem cells was assessed with DiI staining. RESULTS: Negative effects of CKD on bone healing were reduced by increasing mechanical, histological, radiological, and biochemical properties of the bone with stromal vascular fraction and PRP treatments. Although thickness of callus tissue delayed bone healing process, it also enhanced biomechanical features and bone tissue organization. CONCLUSIONS: Platelet-rich plasma and adipose-derived stromal vascular fraction treatments were effective for bone healing in animal model, which can be promising for clinical trials.

A Custom-Made Nostril Retainer for Adult Population.

Nostril retainers are used in cleft lip nose surgery in the post-operative period to maintain alar diameter and resistance against contraction. Various custom made splints were described in the literature to mimic this function when nostril retainers cannot be used for economic or logistic reasons. The authors designed a nostril retainer made by silicone urinary catheter for adult age patients which can be prepared easily. The splint can be used in both unilateral cleft lip nose surgery and operations in the alar wing of the nose.

Securing Posterior Auricular Incision with Button Headbands in Prominent Ear Patients Wearing Surgical Masks for Self-protection in the Pandemic.

In this letter, we describe an attachment on conventional headbands recommended for the postoperative period in prominent ear patients to confidently wear surgical masks without disturbing the posterior auricular incision. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Inhibition of the Notch Pathway Promotes Flap Survival by Inducing Functional Neoangiogenesis.

OBJECTIVE: The Notch pathway seems to function as an antiangiogenic factor, negatively regulating the sprouting effect of vascular endothelial growth factor (VEGF). This function is well defined in embryonic and tumor vasculature. However, little is known about its function in ischemia-induced angiogenesis. In the first part of this study, we investigated the role of Notch in reparative angiogenesis after ischemia. In the second part, we hypothesized that anti-Notch therapy will result in increased angiogenic sprouting. We analyzed the effect of Notch inhibition in the induction of angiogenic sprouting. METHODS: In the first part, we investigated the effect of ischemia on the Notch ligand delta-like ligand 4 (DLL4). Twenty rats were divided equally into 2 groups. In the surgery group, dorsal skin flap was used as model of ischemia. In the control group, no surgical procedure was performed. DLL4 and VEGF gene expressions were assessed. Immunohistochemical staining was used for detection of DLL4 in tissue materials. Plasma levels of VEGF and DLL4 were measured. In the second part, we investigated the effect of Notch inhibition using a gamma-secretase inhibitor (GSI) on inducing neoangiogenesis. Twenty rats were assigned to 2 equal groups. In all animals, dorsal skin flap was raised and sutured back into its bed. Animals in the GSI-treated group received GSI intravenously after surgery for 3 days. Saline was administered in the control group. Necrotic area measurements, microangiography, and histologic evaluations were performed to compare groups. RESULTS: In the first part, VEGF and DLL expressions increased in ischemic tissues (P < 0.01). Immunohistochemical analysis revealed that DLL4 expression was upregulated in capillary endothelial cells after ischemia. Plasma levels for VEGF and DLL4 were higher in the animals that underwent surgery (P < 0.01). In the second part, GSI treatment resulted in higher flap survival rates (P < 0.05). Microscopic analysis exhibited increase in the number of microvascular structures after GSI treatment (P < 0.05). Microangiographic evaluation showed that neovascularization increased in the GSI-applied flaps. CONCLUSIONS: We present an evidence for the importance of the Notch pathway in the regulation of ischemia-induced angiogenesis. Notch inhibition promotes flap survival by creating a neovasculature that has an increase in vascular density.

Bilateral propeller flap closure of large meningomyelocele defects.

BACKGROUND: Meningomyelocele is a defect of the spinal cord, vertebral spine, and overlying skin and is the most common form of spinal dysraphism. Multiple methods of soft tissue closure for larger myelomeningocele defects have been described, including skin grafting, random fasciocutaneous flaps, skin undermining with relaxing incisions, and musculocutaneous flaps. Most current methods for closure of defects of 8 cm and greater and kyphotic spines usually remains inadequate. In this study, we present our clinical experience with a new surgical procedure, bilateral propeller (BP) flaps based on dorsal intercostal and lumbar artery perforator, for the closure of large thoracolumbar meningomyelocele defects. PATIENTS AND METHOD: Between January 2011 and April 2012, 7 newborns (5 males and 2 females) with thoracolumbar large meningomyelocele were included in the study. Six patients had lumbar kyphosis. Myelomeningocele defects with a mean size of 89.3 cm (range, 58.9-136.8) were closed with BP flaps. RESULTS: All flaps survived; hematoma, seroma, wound dehiscence, flap necrosis, or infection was not observed. No patients required any surgical revisions. The patients had a follow-up of 4 to 16 months with a mean of 10 months, and no long-term complications, including necrosis of flap edges, wound breakdown, or instability, have been apparent in our series. CONCLUSIONS: We believe that the BP flaps represent a useful tool in the management of soft tissue defects associated with especially kyphotic large thoracolumbar and lumbosacral myelomeningoceles.

The management of non-melanocytic skin malignancies of the scalp and calvarium.

BACKGROUND: The management of advanced cutaneous malignancies has been controversial. Thirteen patients with nonmelanoma skin neoplasias that had invaded the bone of the calvarium and scalp were treated in our centre. OBJECTIVE: The purpose of this study was to evaluate our experience in treating these malignancies with scalp resection and full or partial thickness cranium reconstruction. PATIENTS AND METHODS: From June 2008 to March 2012, thirteen patients with locally advanced tumours of the scalp invading the calvarium were treated with wide local excision of the scalp combined with an underlying craniectomy and dural resection if needed. RESULTS: Using histopathological diagnosis eleven patients were diagnosed with basal cell carcinoma and two patients with squamous cell carcinoma. A full thickness cranium resection was performed in seven patients and partial in six patients. CONCLUSION: These large cancers occasionally invade adjacent structures, as well as bone, presenting a challenging surgical problem. In general, giant rotational or island scalp flaps and free tissue transfers are needed to close the area. Finding clean margins are an important part of treating patients with bone involvement and can usually be attained using outer tabula curettage thus preventing unnecessary morbidity.

Investigation of multidirectional toxicity induced by high-dose molybdenum exposure with Allium test.

In this study, the multifaceted toxicity induced by high doses of the essential trace element molybdenum in Allium cepa L. was investigated. Germination, root elongation, weight gain, mitotic index (MI), micronucleus (MN), chromosomal abnormalities (CAs), Comet assay, malondialdehyde (MDA), proline, superoxide dismutase (SOD), catalase (CAT) and anatomical parameters were used as biomarkers of toxicity. In addition, detailed correlation and PCA analyzes were performed for all parameters discussed. On the other hand, this study focused on the development of a two hidden layer deep neural network (DNN) using Matlab. Four experimental groups were designed: control group bulbs were germinated in tap water and application group bulbs were germinated with 1000, 2000 and 4000 mg/L doses of molybdenum for 72 h. After germination, root tips were collected and prepared for analysis. As a result, molybdenum exposure caused a dose-dependent decrease (p < 0.05) in the investigated physiological parameter values, and an increase (p < 0.05) in the cytogenetic (except MI) and biochemical parameter values. Molybdenum exposure induced different types of CAs and various anatomical damages in root meristem cells. Comet assay results showed that the severity of DNA damage increased depending on the increasing molybdenum dose. Detailed correlation and PCA analysis results determined significant positive and negative interactions between the investigated parameters and confirmed the relationships of these parameters with molybdenum doses. It has been found that the DNN model is in close agreement with the actual data showing the accuracy of the predictions. MAE, MAPE, RMSE and R2 were used to evaluate the effectiveness of the DNN model. Collective analysis of these metrics showed that the DNN model performed well. As a result, it has been determined once again that high doses of molybdenum cause multiple toxicity in A. cepa and the Allium test is a reliable universal test for determining this toxicity. Therefore, periodic measurement of molybdenum levels in agricultural soils should be the first priority in preventing molybdenum toxicity.