Involvement of mast cells by the malignant process in patients with Philadelphia chromosome negative myeloproliferative neoplasms.

The Philadelphia chromosome negative myeloproliferative neoplasms (MPNs) are clonal hematologic malignancies frequently characterized by a mutation in JAK2 (JAK2V617F). Peripheral blood (PB) CD34(+) cells from patients with polycythemia vera (PV) and primary myelofibrosis (PMF) generated in vitro significantly fewer mast cells (MCs) than normal PB CD34(+) cells. The numbers of MC progenitors assayed from MPN CD34(+) cells were, however, similar to that assayed from normal CD34(+) cells. A higher percentage of the cultured MPN MCs expressed FcvarepsilonRIalpha, CD63 and CD69 than normal MCs, suggesting that cultured MPN MCs are associated with an increased state of MC activation. Further analysis showed that a higher proportion of cultured PV and PMF MCs underwent apoptosis in vitro. By using JAK2V617F, MplW515L and chromosomal abnormalities as clonality markers, we showed that the malignant process involved MPN MCs. JAK2V617F-positive MC colonies were assayable from the PB CD34(+) cells of each of the 17 JAK2V617F positive MPN patients studied. Furthermore, erlotinib, a JAK2 inhibitor, was able to inhibit JAK2V617F-positive PV MC progenitor cells, indicating that malignant MC progenitor cells are a potential cellular target for such JAK2 inhibitor-directed therapy.

T cells from patients with polycythemia vera elaborate growth factors which contribute to endogenous erythroid and megakaryocyte colony formation.

In the present study, we report that media conditioned by polycythemia vera (PV) CD3+ cells promote BFU-E and CFU-Mk colony formation by both cord blood and PV peripheral blood CD34+ cells in the absence of exogenous cytokines and promoting megakaryocyte proplatelet formation. CD3+ cells constitutively produce elevated levels of IL-11, while stimulation with the addition of phytohemagglutinin (PHA) increased GM-CSF levels in most of the patients with PV. Anti-IL-11-neutralizing antibody partially inhibited the formation of BFU-E and CFU-Mk colonies promoted by PV CD3+ cell-conditioned media. Although IL-11 is not produced by normal T cells, real-time PCR and flow cytometric analysis showed that IL-11 was upregulated in the CD3+ cells of most PV patients as compared to normal CD3+ cells. In addition, a greater percentage of BFU-E colonies formed by PV CD34+ cells in the presence of PV CD3+ cell-conditioned media alone were JAK2V617F-positive as compared with that induced by EPO. We conclude that dysregulated production of soluble growth factor(s), including IL-11 and GM-CSF by PV T cells, contributes to the in vitro formation of erythroid colonies in the absence of exogenous cytokines by PV CD34+ cells and likely plays a role in sustaining hematopoiesis in PV.

Brow suspension, a minimally invasive technique in facial rejuvenation.

People tend to prefer noninvasive or minimally invasive methods of facial rejuvenation, especially when it involves their face, which is the hallmark of a person's identity and impossible to hide. It is widely known that brow ptosis gives the face a "tired look" and also accentuates deformities of the upper eyelid. Most people who are interested in facial rejuvenation may not accept even a minor surgery, such as an endoscopic surgery. The senior author has developed a minimally invasive method of suspending the brow at a higher position. In this technique, there is neither surgical dissection nor a surgical incision except for four stab incisions and suture insertion, which is why we refer to it as a nonsurgical brow suspension. It is done under local anesthesia, and the brows are fixed in the position that they assume when the patient is supine. In the past 6 years, we performed 387 brow suspensions on 324 female and 63 male patients. The youngest patient was 19 years old, and the oldest was 74 years old. A retrospective chart review was done. These 387 cases were reviewed by comparison of preoperative and postoperative photographs. This approach was not only used for patients who were not interested in surgical rejuvenation but was also combined with lipofilling, laser resurfacing, and/or upper blepharoplasty. This technique is useful for correcting postsurgical brow asymmetry. We present this technique as an adjunct to the established techniques of facial rejuvenation. Despite the high patient acceptance and technical ease, it is not a replacement for the established techniques of facial rejuvenation.

The evaluation of long-term effects of cinnamon bark and olive leaf on toxicity induced by streptozotocin administration to rats.

The effects of cinnamon bark and olive leaf have been investigated on streptozotocin-induced tissue injury, and some biochemical and haematological changes in rats. The effects on glycaemia were also evaluated. Long-term administration of olive leaf caused significant improvement in tissue injury induced by streptozotocin treatment; the effect of cinnamon bark was less extent. No effects on blood glucose levels were detected. However, significant decreases in some increased biochemical and haematological parameters of streptozotocin-treated rats were observed. Aspartate aminotransferase, urea and cholesterol levels were significantly decreased by treatment with both plant materials, and alanine aminotransferase by treatment with olive leaf. Cinnamon bark also caused a significant decrease in platelet counts. In addition, any visible toxicity, except decrease in body weight gain, attributable to the long-term use of plant materials was not established in normal rats. The data indicate that long-term use of olive leaf and cinnamon bark may provide benefit against diabetic conditions. Determination of underlying mechanism(s) of beneficial effects, toxicity to other systems and clinical assessments of related plant materials are major topics requiring further studies.

An investigation of household product labels in Turkey.

One hundred ninety-nine household product labels were evaluated for Turkish marking and labeling requirements and the adequacy for management of high dose exposures. Fifty-six percent of the products were proper. The rest had inadequate information or did not have warning instructions, an ingredients list and/or other requirements. The requirements do not provide adequate consumer warning and management of overdose ingestions. Household product labeling standards on Turkey should be reviewed and improved by collaboration with poison centers and manufacturers.

The use of the transverse rectus abdominis musculocutaneous flap after abdominoplasty.

Approximately ten years after abdominoplasty, transverse rectus abdominis musculocutaneous (TRAM) flaps were utilized for breast reconstruction in two patients. Both had considerable excess lower abdominal tissue that they wanted removed. We assumed that a new perforating system had developed that might support the lower abdominal skin even though all the original perforators would have been sacrificed at the time of the abdominoplasty. The two patients had successful breast reconstructions performed utilizing bipedicle TRAM flaps with full survival of the flaps. However, we do not recommend the general use of TRAM flaps after abdominoplasty.

Comparative study between acute intraoperative arterial elongation and the use of the interpositional vein graft for arterial reconstruction.

This study compares the acute intraoperative arterial elongation technique with the interposition vein-graft method for the closure of small arterial gaps that cannot be repaired by undermining alone. Ten conditioned female mongrel dogs were divided into two groups: a vein graft interposition group and an acute expansion-elongation group. In ten cases, a 25-mm segment of the superficial femoral artery was excised. The resultant defect, measuring 45 to 60 mm, was repaired by an interpositional graft of a comparable size segment of the superficial femoral vein. In ten other cases, a same-size defect was repaired by a tension-free end-to-end anastomosis, following acute intraoperative arterial elongation. The animals were explored at various intervals. Overall results revealed a 100 percent patency rate with the acute expansion-elongation group vs. 80 percent with the vein-graft interposition group. The versatility, time saving, and ease of technique, plus previous clinical experience, is encouraging enough to recommend this method for the sound repair of small arterial defects in clinical cases.

Application of the 3M microvascular anastomotic device in non-vascular tubular structures.

In this study, the 3M microvascular anastomotic system was utilized for the first time to perform an end-to-end anastomosis in a non-vascular tubular structure, which was compared to the conventional microvascular suture method. The bicornuate rat uterus was the preferred structure because of its anatomic similarity to the human fallopian tube. Thirty Sprague-Dawley rats underwent 3M and conventional end-to-end anastomoses of their bicornuate uteri. At different intervals, the animals were explored and biopsies were taken for examination under light microscopy. Overall patency rate with the 3M technique was 68 percent vs. 96 percent with the conventional technique. Complication rates were 40 percent with the 3M device and 12 percent with the conventional method. This study concludes that, if this method is to be used on non-vascular tubular structures, further modifications to the system and additional research are mandatory, in order to recommend this technique for clinical application.