Two-Port Laparoscopic Removal of Large Ovarian Cystadenoma.

An ovarian mucinous cystadenoma is a common benign tumour of the ovary that tends to reach very large sizes. Although traditional morcellation in the abdominal cavity is largely avoided in gynaecologic surgery, several authors have proposed other systems and techniques for the removal of large masses without resorting to laparotomy. We proposed an extremely minimally invasive technique to remove a large mass with a very low suspicion of malignancy, and created a video demonstration of the procedure. In this short film we illustrate our novel technique using only 2 laparoscopic ports, which maximizes both cosmesis and speed of recovery. The technique is not a completely closed system, therefore the potential for spreading an undiagnosed malignancy still exists. Accordingly, the authors do not suggest this technique for masses with a high potential for malignancy. However, in properly consented patients where there is very little suspicion for malignancy, our technique may be a reasonable option to promote fast recovery and provide excellent cosmesis.

Recent Advances on Immune Targeted Therapy of Colorectal Cancer Using bi-Specific Antibodies and Therapeutic Vaccines.

Colorectal cancer (CRC) is a universal heterogeneous disease that is characterized by genetic and epigenetic alterations. Immunotherapy using monoclonal antibodies (mAb) and cancer vaccines are substitute strategies for CRC treatment. When cancer immunotherapy is combined with chemotherapy, surgery, and radiotherapy, the CRC treatment would become excessively efficient. One of the compelling immunotherapy approaches to increase the efficiency of CRC therapy is the deployment of therapeutic mAbs, nanobodies, bi-specific antibodies and cancer vaccines, which improve clinical outcomes in patients. Also, among the possible therapeutic approaches for CRC patients, gene vaccines in combination with antibodies are recently introduced as a new perspective. Here, we aimed to present the current progress in CRC immunotherapy, especially using Bi-specific antibodies and dendritic cells mRNA vaccines. For this aim, all data were extracted from Google Scholar, PubMed, Scopus, and Elsevier, using keywords cancer vaccines; CRC immunotherapy and CRC mRNA vaccines. About 97 articles were selected and investigated completely based on the latest developments and novelties on bi-specific antibodies, mRNA vaccines, nanobodies, and MGD007.

Salpingectomy vs tubal ligation for sterilization: a systematic review and meta-analysis.

OBJECTIVE: After strong evidence and major organizations recommending salpingectomy over tubal ligation, we sought to perform a systematic review and meta-analysis comparing the intraoperative attributes and complication rates associated with these 2 procedures. DATA SOURCES: We searched PubMed, the Cochrane Library, Embase, and clinical trials registries without time or language restrictions. The search was conducted in February 2020. Database searches revealed 74 potential studies, of which 11 were examined at the full-text level. Of these, 6 studies were included in the qualitative analysis and 5 studies were included in the meta-analysis. STUDY ELIGIBILITY CRITERIA: We included randomized controlled trials comparing salpingectomy with tubal ligation in women seeking sterilization. We included studies that also had at least 1 outcome listed in the population/patient problem, intervention, comparison, outcome, and time. Articles were excluded if they did not meet the inclusion criteria or if data were not reported and the authors did not respond to inquiries. STUDY APPRAISAL AND SYNTHESIS METHODS: Abstracts and full-text articles were assessed by 2 authors independently using the blinded coding assignment function or EPPI-Reviewer 4. Conflicting selections were resolved by consensus. The quality of included studies was determined using the Cochrane Collaboration tool for assessing the risk of bias in randomized trials. Two authors independently assessed the risk of bias for each study; disagreements were resolved by consensus. RESULTS: There were few differences between the procedures, with no differences in most important clinical outcomes (antimüllerian hormone, blood loss, length of hospital stay, pre- or postoperative complications, or wound infections). A single study reported a reduced rate of pregnancies with salpingectomy (risk ratio, 0.22; 95% confidence interval, 0.05-1.02), but this did not reach statistical significance (P=.05). CONCLUSION: We conclude from these data that salpingectomy is as safe and efficacious as tubal ligation for sterilization and may be preferred, where appropriate, to reduce the risk of ovarian cancer.

Complications of Laparoscopic and Transabdominal Cerclage in Patients with Cervical Insufficiency: A Systematic Review and Meta-analysis.

OBJECTIVE: Cervical insufficiency is a defect of the cervix that leads to failure to preserve a full-term intrauterine pregnancy. Laparoscopic cerclage and open transabdominal cerclage (TAC) are effective ways to manage patients with cervical insufficiency. We performed this systematic review and meta-analysis to investigate the complications of laparoscopic cerclage and open TAC in the management of cervical insufficiency. DATA SOURCES: We searched PubMed, Cochrane, Scopus, and Web of Science using our search strategy and screened the results for our criteria. We extracted the results reported and analyzed them using Open Meta-Analyst (OpenMeta[Analyst], Brown School of Public Health, Providence, RI) and Review Manager (Cochrane Collaboration, London, United Kingdom) software. METHODS OF STUDY SELECTION: We included all randomized controlled and observational trials performed on patients with cervical insufficiency undergoing open TAC or laparoscopic cerclage that matched our search strategy. We excluded letters to the editor, reviews, meetings/conference abstracts, non-English or nonhuman studies, and instances where the full text was not available. TABULATION, INTEGRATION, AND RESULTS: We included a total of 33 trials. Both interventions of laparoscopic cerclage and open TAC were associated with significantly less total fetal loss (laparoscopic cerclage, relative risk [RR] 0.03; 95% confidence interval [CI], 0.01-0.08; p <.001, and open TAC, RR 0.19; 95% CI, 0.07-0.51; p <.009). The overall blood loss in open TAC was 110.589 mL (95% CI, 93.737-127.44; p <.001), and in laparoscopic cerclage, it was 24.549 mL (95% CI, 9.892-39.205; p = .001). In addition, open TAC had a positive effect regarding incidence of hemorrhage >400 mL (RR 0.077; 95% CI, 0.033-0.122; p <.001). Preterm premature rupture of membranes was significant in the open TAC (RR 0.037; 95% CI, 0.019-0.055; p <.001) and laparoscopic cerclage groups (RR 0.031; 95% CI, 0.009-0.053; p = .006). CONCLUSION: Laparoscopic cerclage may be safer than open TAC in the management of cervical insufficiency because we found a statistically significant lower incidence of fetal loss, blood loss, and rate of hemorrhage in the laparoscopic cerclage group. Clinically, this evidence may help support favoring a laparoscopic approach over an open one in appropriate patients, although it is unclear whether this benefit is limited to cerclages placed either before pregnancy or placed in the first-trimester or both.

Design and Implementation of an 11mm Improvised Laparoscopic System for Performing a Single-Port Laparoscopic Hysterectomy through the Smallest Incision Ever Reported.

As a major institute in the field of minimally invasive gynecologic surgery, we constantly endeavor to develop and perform the least-invasive surgeries possible. In laparoscopy and robot-assisted laparoscopy, we should expect that complex surgeries that are currently undertaken with the use of many ports of a given diameter will eventually be accomplished with smaller incisions and fewer ports. There will always be clinical scenarios that require a more invasive approach, either because of adhesive tissues or a complex pathology. However, many routine cases will yield themselves to extremely minimally invasive techniques. In this report, we explain how we designed and ultimately used an improvised 11mm laparoscopic single-port system to perform a single-port hysterectomy through a bluntly created 11mm incision. The system was completely devised using currently available and easily obtainable surgical equipment approved in the United States, to maximize the reproducibility of the surgery. The surgery includes the creation of a working incision using an 11mm blunt laparoscopic trocar, to consistently produce a repeatedly small footprint. The surgery was performed successfully and without complication. To the best of our knowledge, this is the smallest reported single-incision hysterectomy.

Comparison of Mechanical Characteristics of Commonly Used Vaginal Packing Materials.

INTRODUCTION: Clinically, vaginal packing provides the benefit of hemostasis and is designed to prevent the formation of postoperative hematomas. Despite the common use of vaginal packing in pelvic surgery, there is limited data to indicate which material has the ideal characteristics for vaginal packing. MATERIALS AND METHODS: Three packing materials were used: DeRoyal® Fluftex™ (DeRoyal Industries, Inc., Powell, Tennessee), NHP Surgi-Pak™ vaginal packing (NHP Industries, Inc., City of Industry, California), and Curad® Plain Packing Strips (Medline Industries, Inc., Northfield, Illinois). A fluid with similar viscosity to human blood, defibrinated sheep's blood (Remel Laboratories, Nenexa Kansas) was used to saturate the materials. The primary outcome was the amount of fluid absorbance of each product in both the handpacked and unpacked state. The number of drops used to saturate each material were counted and converted to mL/g. Each product was tested three times and the results were measured by counting the number of drops needed to saturate the material in each experiment. Experiment: Three materials were obtained and conducted into two different experiments to test absorbance. The packed trial consisted of 0.1g of material and was compacted in a 146mm standard Pasteur pipette (Sigma-Aldrich Corp., St. Louis, Missouri). Droplets of sheep's blood were dispensed until each material had reached its capacity, which was determined by counting the last sequential drop received onto the respective material before the first of the fluid fell from the material into the collecting container. Trials were conducted three times per material and an average of the three trials was calculated. The second experiment tested 1g of each material unpacked and folded into eight layers. Droplets of blood were placed onto the material until each material leaked, which was defined again as the first fluid to fall from the material into the collecting container that it was suspended above. The number of drops needed to produce this effect was recorded. All droplets were counted and converted to mL/g. Standard deviation was calculated for each material in both experiments and an analysis of variance (ANOVA) single factor test was done. RESULTS: Three trials were conducted per material and there was a difference in absorbance between each packing material (p=0.02 packed, p=0.001 unpacked). Additionally, the plain packing strip absorbed the least amount of blood product in the packed and unpacked state compared to DeRoyal® Fluftex™ and NHP Surgi-Pak™ vaginal packing. The average absorbance of the packed materials was 7.7mL/g for DeRoyal® Fluftex™, 9.8mL/g for NHP Surgi-Pak™ vaginal packing, and 7.5mL/g for the Curad® Plain Packing Strips. There was a standard deviation of 2.08 drops for DeRoyal® Fluftex™, 3.51 drops for NHP Surgi-Pak™ vaginal packing, and 1.73 drops for Curad® Plain Packing Strips. Absorbance for DeRoyal® Fluftex™ unpacked was 8.2mL/g, NHP Surgi-Pak™ vaginal packing unpacked was 7.00mL/g, and Curad® Plain Packing Strips was 4.8mL/g. The standard deviation for the unpacked experiment was 29.02 drops for DeRoyal® Fluftex™, 13.61 drops for NHP Surgi-Pak™ vaginal packing, and 15.59 drops for Curad® Plain Packing Strips. A p-value of less than .05 in a confidence interval of 95% was determined. CONCLUSION: Even though there are studies showing the clinical benefits of vaginal packing after a variety of gynecological surgeries, there is less known about the characteristics of the ideal material. Minimal foreign body reaction, decreased adherence to surgical scars, X-ray visualization, low cost, and easy availability are among the ideal characteristics of the presumed ideal material used for vaginal packing. In this study, we compared the absorbance between three commonly used materials and did not find any statistical differences. Further studies are needed to show the clinical benefits and mechanical characteristics of material used for vaginal packing. Due to the lack of a statistically significant difference in absorbance between the materials, evaluation of mechanical characteristics may be beneficial in determining an ideal vaginal packing product.

Polypropylene Mesh Sling for Stress Urinary Incontinence: Does Memory Shaping of the Polypropylene Mesh Matter?

We report a case of a mid-urethral sling (Advantage Fit™, Boston Scientific Corporation, Marlborough, Massachusetts) freshly removed from its original package. Upon removal from the packaging, the sling was noted to have a deformation in positioning at the midpoint, with curvature opposite the natural curve of the sling in the body. The images show the comparison to a sling with the desired positioning. Mid-urethral slings are commonly made from polypropylene mesh which has memory properties. It is important that manufacturers ensure that any steps in the processing or packaging of slings do not result in changes in the shape of the sling that may have unknown impacts on its clinical outcome.

Robotic Burch colposuspension: a surgical case and instructional video.

INTRODUCTION AND HYPOTHESIS: The Burch colposuspension is a well-studied and proven surgical treatment for stress urinary incontinence without intrinsic sphincter deficiency. The advent of the minimally invasive mid-urethral sling has given rise to diminished surgical experience in performing the Burch. Recent anti-mesh media and FDA notifications have caused patients to demand mesh-free surgery, resulting in an opportunity for the resurgence of the Burch procedure. The objective of this video is to demonstrate surgical technique and instruction for a robotic Burch colposuspension as well as recommendations for successful completion of the procedure. Additionally, the video reviews and illustrates pertinent surgical anatomy regardless of approach. METHODS: The patient is a 53-year-old woman who presented with symptoms of vaginal pressure, urinary incontinence, and constipation. She had symptoms and urodynamics consistent with mixed urinary incontinence without intrinsic sphincter deficiency and had been treated with antimuscarinics for overactive bladder. On examination she was found to have stage II prolapse. She desired surgical management of both her prolapse and stress incontinence. CONCLUSION: Robotic Burch colposuspension can be completed in a safe and effective manner and should be considered as an option for patients in whom an anti-incontinence procedure is indicated and who are already undergoing robotic surgery.

Correlation of patient age with CT-measured aorta-sacral promontory distance.

INTRODUCTION AND HYPOTHESIS: Pelvic floor disorders are becoming more prevalent in the elderly population. Since more patients are seeking definitive management for their prolapse, the number of elderly patients undergoing sacral colpopexies will likely increase. During sacral colpopexies, the surgeon must carefully dissect in the presacral space and avoid vital structures. In elderly patients the aorta potentially elongates and the vertebral body height decreases. Consequently, there is a potential for anatomical change of distance from the bifurcation of the aorta to the sacral promontory. This study aimed to correlate the aorta-sacral promontory distance with age. METHODS: From 1 January 2013 to 31 January 2014 computed tomography (CT) images of 241 patients were reviewed in this retrospective study. Radiologists measured the aorta-sacral promontory distance on sagittal acquisition. The corresponding demographic information of age, body mass index, and comorbidities was evaluated using univariate analysis and univariate linear regression. RESULTS: The mean age was 56.6 years, and BMI was 27.6. The mean aorta-sacral promontory measurement based on the CT scan was 63.11 mm. Univariate analysis using a t test and ANOVA demonstrated an inverse correlation with age (p < 0.0001) and hypertension (p = 0.0034) and a positive correlation with BMI categories (p < 0.0017) Under univariate linear regression, the weight of the patient in kilograms demonstrated positive correlation (p = 0.0413). CONCLUSIONS: Based on CT measurements, the aorta-sacral promontory distance is decreased in elderly and hypertensive patients. Heavier patients have an increased aorta-sacral promontory distance. These potential anatomical variants should be considered before operating in the presacral space.

Surface and boney landmarks for sacral neuromodulation: a cadaveric study.

INTRODUCTION AND HYPOTHESIS: Standard external landmarks have been suggested as a guide for in-office percutaneous nerve evaluation (PNE), but validity of these landmarks has not been assessed. Our objective was to determine whether the standard 9 cm from the tip of the coccyx indicates the position of the S3 sacral foramen and whether other boney landmarks and measurements improved positioning. METHODS: Measurements and distances between external boney landmarks were obtained in 22 embalmed cadavers. Spinal needles were placed 9 cm superior to the coccyx and 2 cm lateral to midline bilaterally. After dissection, internal measurements relating to sacral length, position of S3, and location of the needle in relation to S3 were recorded. Correlations among measured variables were assessed using descriptive statistics. RESULTS: Mean distance from the tip of coccyx to S3 was 9.26 cm (±0.84), from S3 to midline 2.30 cm (±0.2); from needle to S3 1.25 cm, and needle placement was as likely to be placed above or below S3; and S2-S3 and S3-S4 interforamenal distance 1.48 cm (±0.30) and 1.48 cm (±0.24), respectively. Mean distance from S3 to sacroiliac joint (SIJ) was shorter than S2 to SIJ. All associations between external measurements and length from tip of coccyx to S3 were not significant. CONCLUSION: A distance 9 cm from the tip of the coccyx is a reasonable starting landmark for in-office blind PNE. However, given the variability in coccyx length, caution should be taken; also, sensory-motor response is necessary to confirm proper placement.

Correlation of Computed Tomography Measured Presacral Thickness with Body Mass Index.

Sacral colpopexy is often chosen as a reliable approach that effectively resolves vaginal vault prolapse. Advancements in minimally invasive technology, robotic and laparoscopic surgery, have helped facilitate surgical dissection and operation when performing this procedure. An increased presacral thickness can potentially present a surgical challenge when operating in the presacral space. We hypothesize that there is a correlation between body mass index and presacral thickness. Computed Tomography (CT) images of 241 patients were reviewed in this retrospective study. The presacral thickness was measured by taking the cross sectional distance from the sacral promontory to the upper aspect of the iliac arteries. The corresponding demographic information of age, body mass index (BMI), and comorbidities were evaluated using univariate analysis, linear regression, and multiple regression analysis. The mean age was 56.6 years, and BMI was 27.6. The mean presacral thickness measurement based on the CT scan was 21.08 mm. Univariate linear regression models demonstrated a positive correlation between presacral thickness and BMI and a negative correlation with age. When adjusting for both age and BMI on multivariate analysis, a positive correlation with hypertension was found. The surgeon should be aware of this potential change in anatomy when operating in the presacral space.

Morphologic Evaluation of Post-implanted Monofilament Polypropylene Mesh Utilizing a Novel Technique with Scanning Electron Microscopy Quantification.

Polypropylene mesh has been shown to shrink up to 50%; however, little is known about other changes that may occur while it is implanted. It is unclear whether such changes have clinical impact; nonetheless, knowledge of such can ultimately affect the technique of implantation and may affect outcomes. The objective of this study was to evaluate surgically explanted mesh after two years implantation for evidence of change in morphology using scanning electron microscopy (SEM). Secondly, we describe a novel technique for quantifying such changes with intentions for future validation. SEM imaging was conducted and mesh changes were visualized. SEM images revealed deep surface cracks both transverse and longitudinal, flaking and peeling of fibers, as well as fibrosis. Microstructural quantification of cracks was also completed. The fraction of transverse cracked area to whole surface area was 24.2%. Average crack length range was 0.58 to 71.46 µm and average crack thickness range was 0.99 to 25.46 µm. Polypropylene mesh is subject to structural changes after surgical implantation. It is important to investigate how these processes impact clinical outcomes. Validated techniques of quantifying such changes can prove useful in future research and aid in development of the ideal graft.

To mesh or not to mesh with polypropylene: does carcinogenesis in animals matter?

Polypropylene in sheets has been been found to be carcinogenic in some laboratory animals. Although no human carcinogenicity has been reported, long-term follow-up in humans implanted with polypropylene mesh will be important.

Evaluation of surgical instrument handling on polypropylene mesh using scanning electron microscopy.

INTRODUCTION AND HYPOTHESIS: To evaluate the effect of surgical instruments handling on polypropylene mesh using scanning electron microscopy (SEM). METHODS: We applied different surgical instruments, including a few robotic ones, to pieces of polypropylene mesh. SEM was used to evaluate the morphological changes with this intervention. RESULTS: Straight hemostat, laparoscopic atraumatic grasper, laparoscopic needle driver, and robotic instruments (Bipolar forceps, Cadiere forceps, PK dissecting forceps and SutureCut) were applied to the mesh. SEM images of tool-affected mesh regions in specimens handled by different instruments along with the images of intact mesh were obtained. Average mesh fiber diameters, as well as the average parameters characterizing instrument-affected regions, were measured. There was substantial widening of the fibers in specimens handled by hemostat or a needle holder. An elliptical but much longer and narrower tool marking with more surface roughness was observed in mesh handled by a grasper. A ∼25-µm-wide and ∼200-µm-long strap was split on one side from the core of the fiber caused by Cadiere. CONCLUSIONS: There are morphological changes to polypropylene mesh caused by instrument handling. These changes are different depending on the instrument used. These alterations vary from changes in the surface creating roughness of the fiber, compression of the mesh with narrowing of the fiber in at least one direction or actual splitting or pitting of the fiber. Since there are no data regarding the effect of these morphological changes to the ultimate functioning of the mesh, surgeons should minimize mesh handling by instruments.

Intracranial meningioma at the site of a previous cranial penetrating trauma due to shrapnel.

Meningiomas are common and mostly benign intracranial tumors, which originate from arachnoid cells of the meninges, and account for approximately 25% of all primary intracranial tumors. Many external etiological factors have been described as etiology of meningioma in the literature, one of which is head trauma. However, trauma as a cause of meningioma remains a controversial subject. Here, a case of a patient with posttraumatic meningioma, who was wounded 25 years before, is presented. The assessment of the clinical characteristics of the patient and those reported in the literature seem to confirm that, in some cases, head trauma may be a factor contributing to the development of meningioma.

The anatomical outcome of robotic sacrocolpopexy for treatment of pelvic organ prolapse: a comparison of obese and non-obese patients.

The purpose of this study is to compare the anatomical outcome of robotic sacrocolpopexy for pelvic organ prolapse in women with a body mass index (BMI) of 30 and higher to those with a BMI under 30. This is a retrospective chart review. POP-Q measurements preoperatively and 12 months postoperatively were evaluated using non-parametric statistical analysis. The primary outcome was to compare postoperative POPQ measurements at 12 months following surgery. Secondary outcomes were age at the time of surgery, mesh erosion rate, blood loss, length of hospital stay, and baseline anatomical support. A total of 71 patients were identified: 44 patients had a BMI below 30, and 27 had a BMI equal to or greater than 30. We found no significant relationship between BMI and anatomical support at 12 months post operation. However, obese patients were younger at the time of prolapse surgery (53.6 versus 60.6 years of age, p=0.0022). In regards to the ICS prolapse stage, no difference was found between obese and non-obese patients (2.81 versus 2.95, p=0.17).

The Effect of Lasers on the Healing of Periapical Lesion: A Systematic Review.

Introduction: Endodontic treatment of teeth with periapical lesions presents more clinical difficulty. Various lasers in several methods are used in endodontics, and most of them are utilized as an adjunctive protocol in order to reduce the bacterial load of the root canal system. Improved disinfection plays a crucial role in enhanced and accelerated healing of periapical lesions. This review aims to summarize studies assessing the effect of lasers on periapical lesion healing. Methods: PubMed/MEDLINE, Scopus, Embase, and Web of Science (ISI) online databases were searched, with no publication year or status restriction, for relevant articles on April 2023. Clinical studies evaluating the effect of laser application on the periapical lesion of patients using radiographic assessment were considered eligible for inclusion. Results: Eight studies were included after carefully screening the obtained articles, first by their title and abstract and then by their full texts. Diode (4), Er, Cr: YSGG (3), and Nd: YAG (1) lasers were used with output powers that varied from 0.75 to 2 watts. Photodynamic therapy was employed in two studies, and in other studies, the root canal system was directly irradiated. Irradiation of the root canal system was adjunctive to standard preparation in all studies. The healing of the teeth treated with lasers was not inferior to those conventionally treated. In all of the included studies, laser application outperformed the standard cleaning and shaping protocol; however, this improved or faster healing was not statistically significant in most studies. Conclusion: Lasers might expedite and improve the healing process of periapical lesions. Since lasers enhance the quality of cleaning of the root canal system, it is hard to point out the exact mechanism of it. Further investigations are needed to realize the effectiveness of this treatment modality and to discover the underlying biological concepts.

Effect of simultaneous and sequential use of TGF-ß1 and TGF-ß3 with FGF-2 on teno/ligamentogenic differentiation of periodontal ligament stem cells.

OBJECTIVE: The periodontal ligament is a crucial part of the periodontium, and its regeneration is challenging. This study compares the effect of simultaneous and sequential use of FGF-2 and TGF-ß1 with FGF-2 and TGF-ß3 on the periodontal ligament stem cells (PDLSCs) teno/ligamentogenic differentiation. DESIGN: This study comprises ten different groups. A control group with only PDLSCs; FGF-2 group containing PDLSCs with a medium culture supplemented with FGF-2 (50 ng/mL). In other experimental groups, different concentrations (5 ng/mL or 10 ng/mL) of TGF-ß1&-ß3 simultaneously or sequentially were combined with FGF-2 on the cultured PDLSCs. TGF-ß was added to the medium after day 3 in the sequential groups. Methyl Thiazolyl Tetrazolium (MTT) assay on days 3, 5, and 7 and Quantitative Real-time Polymerase Chain Reaction (RT-qPCR) analysis after day 7 were conducted to investigate PLAP1, SCX, and COL3A1, RUNX2 genes. All experiments were conducted in a triplicate. The One-way and Two-way ANOVA with Tukey post hoc were utilized to analyze the results of the MTT and RT-qPCR tests, respectively. A p-value less than 0.05 is considered significant. RESULTS: The proliferation of cells on days 3, 5, and 7 was not significantly different among different experimental groups (P > 0.05). A higher expression of the PLAP1, SCX, and COL3A1 have been seen in groups with sequential use of growth factors; among these groups, the group using 5 ng/mL of TGF-ß3 led other groups with the most amount of significant upregulation in PLAP1(17.69 ± 1.11 fold; P < 0.0001), SCX (5.71 ± 0.38 fold; P < 0.0001), and COL1A3 (6.35 ± 0.39 fold; P < 0.0001) expression, compared to the control group. The expression of the RUNX2 decreased in all groups compared to the control group; this reduction was more in groups with sequential use of growth factors. CONCLUSION: The sequential use of growth factors can be more effective than simultaneous use in teno/ligamentogenic differentiation of PDLSCs. Moreover, treatment with 5 ng/mL TGF-ß3 after FGF-2 was more effective than TGF-ß1.

What is the impact of previous cholelithiasis on sialolithiasis: A systematic review and meta-analysis.

Introduction: A sialolith is a salivary stone usually presenting with swelling and pain in the affected salivary gland, most commonly the submandibular gland. There have been speculations about the association between this condition and other systemic diseases, especially those forming stones, such as nephrolithiasis and cholelithiasis. This systematic review and meta-analysis aimed to summarize the studies assessing the relationship between cholelithiasis and sialolithiasis. Methods: PubMed/MEDLINE, Scopus, Web of Science, and Embase electronic databases were searched according to the keywords related to both disorders without any publication date or language restriction. Case-control and cohort studies evaluating the relationship between salivary and biliary stones were considered eligible. Quality assessment was performed following Newcastle-Ottawa Scale (NOS) for quality assessment of case-control studies. All meta and statistical analyses were performed with Comprehensive Meta-Analysis software. Results: Two studies fully complied with the defined eligibility criteria and were included, both of which were case-control studies using national-scale databases. In both surveys, the prevalence of previous gallstones in patients with sialolithiasis was compared to that of a control group. Though one of the studies found that there is no relationship between sialolithiasis and cholelithiasis, the meta-analysis revealed that previous cholelithiasis is significantly more prevalent among patients with sialolithiasis (P = 0.000), with an odds ratio of 2.04. Conclusion: It seems that cholelithiasis is significantly associated with an increase in salivary stone formation. Therefore, a thorough salivary examination in all patients declaring current or past cholelithiasis is recommended. However, more studies, especially prospective cohorts, are needed to make firmer conclusions.

Effect of Fibroblast Growth Factor 2 and Low-Level Laser Therapy on the Adhesion and Proliferation of Periodontal Ligament Stem Cells.

Introduction: The adhesion ability of mesenchymal stem cells can significantly affect their viability and is considered a prerequisite for cell therapy. The current study sought to evaluate the effect of fibroblast growth factor 2 (FGF2) and low-level laser therapy (LLLT), either individually or in conjunction, on the adhesion and proliferation of periodontal ligament stem cells (PDLSCs) when applied on the first day of cell seeding. Methods: The experimental groups of this study comprised a control group and different combinations of adjunctive FGF2 (50 ng/mL) and LLLT with an 808 nm diode laser in one (LLLT-1) or two sessions (LLLT-2) of irradiation. The proliferation and adhesion of cells were evaluated by using the methylthiazolyl tetrazolium (MTT) assay and 4',6-diamidino-2-phenylindole (DAPI) staining. All experiments were done in triplicates on the first, third, and fifth days after cell seeding. Two-way ANOVA and post hoc Tukey tests were used to analyze the data of the MTT assay. P<0.05 was considered statistically significant. Results: One-day post-culture, only significant differences were found between the control group and the FGF2 (P=0.04) and FGF2+LLLT-2 application (P=0.04) groups. After three days post-cell culture, only a significantly higher proliferation rate was found in the control group than in the FGF2 group (P=0.01). After five days, the control group and LLLT-2 groups showed significantly higher amounts of proliferation compared to the other groups (P<0.05). DAPI staining qualitatively confirmed the results of the MTT assay. Conclusion: The LLLT can be applied to PDLSCs on the day of seeding without causing a notable decrease in their viability and adhesion. Conversely, the administration of FGF2 should be restricted on the seeding day and postponed to subsequent days as it may have adverse effects on their adhesion and proliferation.