Comparison between Single Versus Twice Application of Topical 85% Trichloroacetic Acid in the Treatment of Cervical Intraepithelial Neoplasia; A Randomized Clinical Trial on Efficacy and Tolerability.

PURPOSE: To compare the efficacy and safety of up to two-time administration of 85% TCA, as a promising alternative therapy to conservative and surgical management of grade one to three CINs. METHODS: In this two-armed randomized clinical trial, a total of 53 patients with biopsy-proven CIN lesions were allocated to two groups of TCA treatment. The first group (n=26) received a single dose of local therapy with 85% TCA while the second group (n=27) was treated on two separate occasions with a two-week interval. Two participants (one in each group) were lost to follow-up. At the two-month follow-up after TCA application, a colposcopy-guided biopsy was performed for all patients and the pathological specimens were studied by a single experienced pathologist to determine the post-intervention grading of CIN. RESULTS: Two groups were comparable in terms of age and base-line lesion grading, as CIN 1 lesions comprised the majority of cases (54%), followed by CIN 2(37%). While our sample was a poor representative of CIN3 lesions (7%), no significant difference was noticed between the single and twice TCA treated groups with a response rate of 52% and 54% respectively (either complete remission to normal histology or regression to any low-grade lesion). Either separate analysis (with respect to the base-line grading within each treatment group) or combined analysis (regardless of CIN sub-group) could not generate any statistical significance. The second dose of TCA did not increase the frequency of reported adverse events. CONCLUSION: The second dose of topical 85% TCA does not seem to increase the CIN response rate more so than its single dose. However, further controlled clinical trials with larger samples are warranted to verify current findings. The use of TCA was not limited by any major side effect, therefore, the potential to achieve an increased efficacy with more frequent TCA applications is appealing.

Bone Allograft: An Option for Total Mandibular Reconstruction.

Total mandibular reconstruction is one of the most challenging modalities in maxillofacial surgery. In this article, we try to introduce a method of total mandible reconstruction. We report a 25-year-old male patient with complete involvement of the mandible by Langerhans cell tumor. The patient underwent total mandibulectomy and reconstruction with bone allograft harvested from a donor who had died the day before. The patient has good functional and aesthetic results in a long time. It seems that bone allograft can be a good alternative to other methods in total mandibular reconstruction.

The Extract of Lycium depressum Stocks Enhances Wound Healing in Streptozotocin-Induced Diabetic Rats.

In diabetes, impaired wound healing and other tissue abnormalities are considered major concerns. The aim of the present study was to assess the wound-healing activity of methanolic extracts of the extract of Lycium depressum leaves. A total of 60 healthy male Wistar diabetic rats weighing approximately 160 to 180 g and 7 weeks of age were randomized into 10 groups for incision and excision wound models: sham surgery group (SHAM), including creation of wounds and no treatment; base formulation group (FG) with creation of wounds and application of base formulation ointment; treatment group 1 (TG1) with 1 g of powder extract of the plant material in ointment; treatment group 2 (TG2) with 2 g; and treatment group 4 (TG3) with 4 g of powder extract of the plant material in ointment. A wound was induced by an excision- and incision-based wound model in male rats. The mature green leaves of L depressum were collected and authenticated. Extractions of dried leaves were carried out. For wound-healing activity, the extracts were applied topically in the form of ointment and compared with control groups. The healing of the wound was assessed based on excision, incision, hydroxyproline estimation, and biomechanical and biochemical studies. The extract of L depressum leaves enhanced wound contraction, decreased epithelialization time, increased hydroxyproline content, and improved mechanical indices and histological characteristics in treatment groups compared with SHAM and FG ( P < .05). These findings permit the conclusion the extract of L depressum benefits parameters of wound healing in a diabetes induced model.

Immunohistochemical Profile of Uterine Leiomyoma With Bizarre Nuclei; Comparison With Conventional Leiomyoma, Smooth Muscle Tumors of Uncertain Malignant Potential and Leiomyosarcoma.

PURPOSE: To assess the immunohistochemical profile of the atypical nuclei in leiomyoma with bizarre nuclei and compare with benign and malignant counterparts. METHODS: 26 cases of uterine smooth muscle tumors including 12 leiomyosarcoma(LMS), 10 leiomyoma with bizarre nuclei (LBN) and 4 smooth muscle tumor with uncertain malignant potential (STUMP) were selected using whole tissue sections for this study and analysis. Six cases of ordinary leiomyoma were included as benign control group. All representative section were stained for P53, Ki67, estrogen receptor and progestrone receptor. Analysis was carried out using SPSS 16.0 for windows software. RESULTS: Six out of 12 cases of LMS showed strong and diffuse nuclear staining with p53 antibody (50%). In contrast none of STUMPs and only one case of LBN cases showed focal positive reaction with P53. Percentage of positive cells for ki67 in LMS was 14.92 while only 0.85% of cells in LBNs was labeled with Ki67 proliferative marker. (P<0.001). Regarding steroid hormone receptors a significant loosing trend was found in these receptors from benign toward malignant tumors through LBN and STUMP cases. CONCLUSION: Loss of inhibitory function of wild type P53 gene in leiomyosarcoma is an essential event that discriminate frankly malignant tumors from STUMP and atypical leiomyoma.

Chorioamnionitis and diagnostic value of C-reactive protein, erythrocyte sedimentation rate and white blood cell count in its diagnosis among pregnant women with premature rupture of membranes.

Several laboratory parameters have been used in these studies to diagnose chorioamnionitis leading to controversies to some extent. The aim of this study was to assess the diagnostic value of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count in chorioamnionitis among pregnant women with premature rupture of membranes (PROM). In a cross-sectional diagnostic test research, 71 patients presented with PROM before the 37th week of gestation were enrolled. A blood sample was taken from all the patients. Hematologic automatic blood cell counter was used to count the blood cells and their differentiation. ESR and CRP were also measured using the same blood sample at the laboratory. Sensitivity, specificity, correct classification rate and likelihood ratios were calculated. Receiver operating curves were plotted and area under curve was estimated along with its 95% confidence interval. A total of 71 patients were studied. None of the patients had a positive drug history or a history of hypertension before the 20th week of gestation or during her previous pregnancy. Contrary to ESR, WBC count and CRP results didn't provide minimum acceptable diagnostic accuracy measures for diagnosis of chorioamnionitis. The sensitivity and specificity of a positive ESR test at a cutoff value of 52 were 66.7 and 60%, respectively. The area under curve was calculated to be 0.62. The findings of the present study were not supportive of using CRP, WBC as a reliable diagnostic test to identify chorioamnionitis in women with PROM. The results of CRP and WBC were not acceptable but ESR diagnostic value was minimally acceptable.

Effect of Helicobacter pylori infection on pregnancy rates and early pregnancy loss after intracytoplasmic sperm injection.

BACKGROUND: There is a need to elucidate what affects the implantation and early pregnancy course in pregnancies conceived with assisted reproductive technology (ART) so that pregnancy rates and outcomes can be improved. Our aim was to determine the role of maternal Helicobacter pylori infection. MATERIAL AND METHODS: We did a prospective study of 187 infertile couples undergoing intracytoplasmic sperm injection (ICSI) and segregated those according to underlying infertility etiology. We assessed the status of H. pylori IgG antibodies and anti-CagA IgG antibodies by ELISA assay. All pregnancies were followed for early pregnancy loss (EPL, first 12 weeks). RESULTS: The likelihood of H. pylori infection increased with age (1.01, 95% confidence interval [CI]: 1.0-1.13; P = 0.040) but there was no association with EPL. Women infected with CagA-positive strains were more likely to have EPL (19.39, 95% CI: 1.8-208.4; P = 0.014). Women with tubal factor or ovulatory disorder infertility were more likely to abort early (12.95, 95% CI: 1.28-131.11; P = 0.030, 10.84, 95% CI: 1.47-80.03; P = 0.020, respectively). There was no association between EPL and age, number of embryos formed or transferred, or number of oocytes retrieved. CONCLUSION: Our findings suggest that infection with CagA-positive H. pylori strains is linked to an increase in women's potential to abort early (possibly through increased release of inflammatory cytokines). In addition, tubal factor and ovulatory disorder infertility are linked to EPL after ICSI due to unknown mechanisms. Proposals to eradicate H. pylori infection prior to ICSI could lead to a decrease in EPL after ART.