Treatment of chronic anal fissure: Is open lateral internal sphincterotomy (LIS) a safe and adequate option?

BACKGROUND: Anal fissure which is defined as a longitudinal tear in anoderm under the dentate line is one of the most common benign diseases of anorectal area, and due to the severe pain during the defecation and emotional stress that it causes may reduce people's quality of life. There are several treatment methods such as medical substances and surgical procedures. In this retrospective study, we aimed to evaluate the safe and adequate option of lateral internal sphincterotomy (LIS) in chronic anal fissure treatment. METHODS: This study is a retrospective study in which 417 patients who were treated for chronic anal fissure were included. RESULTS: Of 417 patients included in the study, 228 (54.7%) were female and the mean ± SD age was 36.1 ± 8.96 years (ranging from 17 to 73 years). Major complaints of patients; pain, bleeding, constipation, pruritus, perianal discharge. Recurrence occurred in 15 patients (3.6%) (12 males, three females) and eight patients (1.9%) developed incontinence (four with gas, four with soiling and seven females, one male). The complaints of all patients with gas incontinence and a patient with fluid incontinence regressed, whereas three patients had permanent fluid incontinence. CONCLUSION: LIS is still the gold standard for the treatment of chronic anal fissure when the physicians would like to avoid recurrence and obtain the best pain relief.

Cytotoxic, apoptotic and cell migration inhibitory effects of atranorin on SPC212 mesothelioma cells

Objective: To investigate the effects of atranorin, a lichen secondary metabolite, on SPC212 malignant mesothelioma cells in vitro. Methods: SPC212 malignant mesothelioma cell line was used. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to evaluate cytotoxic effects of atranorin and cisplatin at 24, 48 and 72 h. Hematoxylin-eosin staining and 4',6-diamidino-2-phenylindole, dihydrochloride staining were used for determining cell and nucleus morphology, respectively. Wound healing assay was used for investigating cell migration. The xCELLigence real-time cell analysis system was used for determining cell proliferation. Results: Atranorin at 5-450 μM decreased cell viability at 24, 48 and 72 h. IC50 values of atranorin were 300.94, 292.6 and 278.02 μM at 24, 48 and 72 h, respectively; meanwhile, the IC50 values of cisplatin were 128.00, 34.37 and 17.05 μM at 24, 48 and 72 h, respectively. Furthermore, atranorin disrupted cell and nuclear morphology with increasing concentrations. Atranorin significantly reduced cell migration by 38%, 37% and 35% at 300, 250 and 200 μM, respectively (P＜0.000). Atranorin at 160-450 μM decreased cell proliferation at 72 h (P＜0.000). Conclusions: Atranorin has cytotoxic, antiproliferative, apoptotic and cell migration inhibitory effects on SPC212 malignant mesothelioma cancer cells.

Diagnostic value of combined serum biomarkers for the evaluation of liver fibrosis in chronic hepatitis C infection: A multicenter, noninterventional, observational study.

BACKGROUND/AIMS: The hepatitis C virus (HCV) infection is important cause of chronic hepatitis. Liver biopsy is considered the gold standard for assessment of fibrosis but this procedure is an invasive procedure. We aimed to evaluate the diagnostic efficiency of non-invasive serum biomarkers, separately and in combinations, on liver fibrosis in treatment-naive chronic hepatitis C (CHC) patients. MATERIALS AND METHODS: Two hundred and sixteen treatment-naive CHC patients were enrolled from 32 locations across Turkey in this open-labelled, non-interventional prospective observational study. FibroTest®, aspartate aminotransferase-to-platelet ratio index(APRI), aspartate aminotransferase and alanine aminotransferase ratio (AAR), fibrosis index based on four factors (FIB-4), Age-platelet(AP) index and Forns index were measured and compared with Metavir scores got from liver biopsies. RESULTS: Data from 182 patients with baseline liver biopsy were suitable for analysis. One hundred and twenty patients (65.9%) had F0-F1 fibrosis and 62 patients (34.1%) had F2-F4 fibrosis. APRI 0.732 area under the curve(AUC) indicated advanced fibrosis with 69% sensitivity and 77% specificity. FIB-4 0.732 AUC and FibroTest 0.715 AUC indicated advanced fibrosis with 69% and 78.4% sensitivity, and 75% and 71.4% specificity, respectively. The combined use of tests also led to an increase in AUC and specificity. Combinations of FibroTest with APRI and/or FIB-4, and FIB-4 with APRI were optimal for the evaluation of liver fibrosis. CONCLUSION: Fibrotest, FIB-4, APRI, AP index and Forns index exhibit good diagnostic performance for determining liver fibrosis in CHC patients, and the use of at least two tests together will increase their diagnostic value still further.

Photoprotective Activity of Vulpinic and Gyrophoric Acids Toward Ultraviolet B-Induced Damage in Human Keratinocytes.

Vulpinic and gyrophoric acids are known as ultraviolet filters for natural lichen populations because of their chemical structures. However, to the best of our knowledge, there has been no reference to their cosmetic potential for skin protection against ultraviolet B (UVB)-induced damage and, consequently, we propose to highlight their photoprotective profiles in human keratinocytes (HaCaT). Therefore, vulpinic acid and gyrophoric acid were isolated from acetone extracts of Letharia vulpina and Xanthoparmelia pokornyi, respectively. Their photoprotective activities on irradiated HaCaT cells and destructive effects on non-irradiated HaCaT cells were compared through in vitro experimentation: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and lactate dehydrogenase assays, 4',6-diamino-2-phenylindole and tetramethylrhodamine B isothiocyanate-phalloidin staining protocols. Both of the lichen substances effectively prevented cytotoxic, apoptotic and cytoskeleton alterative activities of 2.5 J/cm(2) UVB in a dose-dependent manner. Moreover, vulpinic and gyrophoric acids showed no toxic, apoptotic or cytoskeleton alterative effects on non-irradiated HaCaT cells, except at high doses (≥400 µM) of gyrophoric acid. The findings suggest that vulpinic and gyrophoric acids can be promising cosmetic ingredients to photo-protect human skin cells and should therefore be further investigated by in vitro and in vivo multiple bioassays.

Evolution of complex symbiotic relationships in a morphologically derived family of lichen-forming fungi.

We studied the evolutionary history of the Parmeliaceae (Lecanoromycetes, Ascomycota), one of the largest families of lichen-forming fungi with complex and variable morphologies, also including several lichenicolous fungi. We assembled a six-locus data set including nuclear, mitochondrial and low-copy protein-coding genes from 293 operational taxonomic units (OTUs). The lichenicolous lifestyle originated independently three times in lichenized ancestors within Parmeliaceae, and a new generic name is introduced for one of these fungi. In all cases, the independent origins occurred c. 24 million yr ago. Further, we show that the Paleocene, Eocene and Oligocene were key periods when diversification of major lineages within Parmeliaceae occurred, with subsequent radiations occurring primarily during the Oligocene and Miocene. Our phylogenetic hypothesis supports the independent origin of lichenicolous fungi associated with climatic shifts at the Oligocene-Miocene boundary. Moreover, diversification bursts at different times may be crucial factors driving the diversification of Parmeliaceae. Additionally, our study provides novel insight into evolutionary relationships in this large and diverse family of lichen-forming ascomycetes.

Effects of combined epidural analgesia with total intravenous anesthesia on risky patients underwent major abdominal surgery.

OBJECTIVES: The aim of this study is to investigate the effects of combined epidural analgesia with total intravenous anaesthesia and only total intravenous anaesthesia on the different clinical parameters. METHODS: Sixty high risk patients undergoing a major abdominal surgical procedure were included in this prospective, double blind, randomized study. Induction of anaesthesia was performed with IV remifentanil 0.5µg/kg and propofol titrated to achieve bispectral index score between 40 and 50. after intubation; in Group E, 0.1% bupivacaine and 2 µg/mL fentanyl were administered by an infusion rate at 0.15 ml/kg/h via the epidural catheter and Group C received epidural normal saline as same infusion rate. RESULTS: In group E, intraoperative MAP values were significantly lower than those in group C (p<0.05). Time of extubation, time of eye opening with audible warning and time of verbal response was significantly lower in group E than those in group C. Total anaesthetic drug consumption was significantly higher in group C than those in group E (p<0.05). CONCLUSION: Based on lower requirements for propofol and remifentanil as well as the favourable effects on clinical parameters; we conclude that bispectral index score guided combined epidural with total intravenous anaesthesia is superior to solely total intravenous anaesthesia in this type of surgery.

Insecticidal activity of major lichen compounds, (-)- and (+)-usnic acid, against the larvae of house mosquito, Culex pipiens L.

In this research, (-)-usnic acid and (+)-usnic acid, commonly encountered lichen secondary metabolites, were evaluated for their insecticidal effects against the larvae of Culex pipiens L. (Diptera: Culicidae) under laboratory conditions. Both compounds showed strong larvicidal activity and caused 100% mortality on third-fourth larval stages of the species at 24 h at the doses of 5 and 10 ppm. Bioassays with (-)- and (+)-usnic acids against larvae of C. pipiens revealed that the LC50 values were 0.8 and 0.9 ppm, respectively. The results suggest that lichen compounds could be useful in the search of new insecticides.

Antimicrobial activity of extracts of the lichen Parmelia sulcata and its salazinic acid constituent.

The antimicrobial activity of the acetone, chloroform, diethyl ether, methanol, and petroleum ether extracts of the lichen Parmelia sulcata and its salazinic acid constituent have been screened against twenty eight food-borne bacteria and fungi. All of the extracts with the exception of the petroleum ether extract showed antimicrobial activity against Aeromonas hydrophila, Bacillus cereus, Bacillus subtilis, Listeria monocytogenes, Proteus vulgaris, Yersinia enterocolitica, Staphylococcus aureus, Streptococcus faecalis, Candida albicans, Candida glabrata, Aspergillus niger, Aspergillus fumigatus, and Penicillium notatum. Salazinic acid did not show antimicrobial activity against L. monocytogenes, P. vulgaris, Y. enterocolitica, and S. faecalis but showed activity against Pseudomonas aeruginosa and Salmonella typhimurium as well. The MIC values of the extracts and the acid for the bacteria and fungi have also been determined.

Antimicrobial activity of extracts of the lichen Xanthoparmelia pokornyi and its gyrophoric and stenosporic acid constituents.

The antimicrobial activity of the diethyl ether, acetone, chloroform, petroleum ether, and ethanol extracts of the lichen Xanthoparmelia pokornyi and its gyrophoric acid and stenosporic acid constituents has been screened against some foodborne bacteria and fungi. Both the extracts and the acids showed antimicrobial activity against Aeromonas hydrophila, Bacillus cereus, Bacillus subtilis, Listeria monocytogenes, Proteus vulgaris, Staphylococcus aureus, Streptococcus faecalis, Yersinia enterocolitica, Candida albicans and Candida glabrata. The extracts were inactive against the tested filamentous fungi. The MIC values of the extracts and the acids for the bacteria have also been determined.