Tissue Engineering Auricular Cartilage: A Review of Auricular Cartilage Characteristics and Current Techniques for Auricular Reconstruction.

Microtia and anotia are congenital auricular anomalies that negatively impact the psychosocial development of those affected. Because auricular cartilage is a type of elastic cartilage that lacks regenerative capacity, any notable defect in its structure requires a surgical approach to reconstructing the auricle. While there are several reconstructive options available between alloplastic and prosthetic implants, autologous rib cartilage grafts remain the most commonly used treatment modality. Still, this widely used technique is accompanied by significant patient discomfort in a young child and carries additional risks secondary to the traumatic process of rib cartilage extraction, such as pneumothorax and chest wall deformities, and the final esthetic results may not be ideal. To circumvent these limitations, tissue engineering approaches have been used to create a realistic-looking ear that mirrors the complex anatomy of the normal ear. This article reviews the biochemical and biomechanical properties of human auricular cartilage as they relate to design criteria. In addition, a variety of cell sources, biocompatible scaffolds, scaffold-free techniques, and mechanical and biological stimuli are discussed. This review aims to identify knowledge gaps in the literature related to auricular cartilage characteristics and make recommendations to drive the field of auricular tissue engineering.

The translational implications of the science behind the overactive bladder and the role of OnabotulinumtoxinA.

Urinary incontinence (UI) is a very common condition that can affect patients of all ages and the commonest cause is an overactive bladder (OAB). Most patients with OAB were treated with pharmacotherapy and major surgery. Over 25 years ago, Dasgupta, Fowler et al. studied the presence and role of C fibres in the human bladder which are highly sensitive to capsaicin, the active ingredient of chillies. When capsaicin was instilled into patients' bladders as a synthetic solution, it was found to be highly effective in some patients. Capsaicin was later replaced by Resiniferatoxin. Both toxins desensitised C-fibres through the capsaicin receptor, TRPV1, without any lasting damage to the bladder itself. The discovery of botulinum toxin and its use in the treatment of OAB represents a major breakthrough, in the treatment of OAB. Another key innovation was the development of technique to administer the drug under local anaesthesia which allowed numerous patients to benefit from treatment who would otherwise have been precluded because of the need for injection under general anaesthetic. After extensive trials over many years Botox (OnabotulinumtoxinA) is now licensed for use in OAB. Compared to other treatments for overactive bladder, OnabotulinumtoxinA is more cost-effective and less invasive. It is thought to have changed the quality of life of an estimated 5 million patients worldwide.

Hyperbaric and topical oxygen therapies in thermal burn wound healing: a review

OBJECTIVE: This review aims to evaluate the effectiveness of the two most commonly used oxygen delivery methods for the treatment of thermal burn wound healing: hyperbaric oxygen therapy (HBOT) and topical oxygen therapy (TOT). METHOD: The PubMed database was searched for articles discussing the use of HBOT or TOT in the treatment of thermal burns. RESULTS: The search yielded 43,406 articles, of which 28 (23 HBOT, 5 TOT) met the inclusion criteria. Both experimental and clinical studies have demonstrated conflicting results after treating thermal burns with HBOT or TOT. Overall, 14/23 studies demonstrated positive results for HBOT on the healing of burn wounds and associated complications, such as oedema and pain. Findings from these studies showed it can reduce morbidity and mortality in certain high-risk groups such as those with diabetes or extensive burns. Although the five studies (one human and four animal trials) reviewing TOT showed promising outcomes, this therapeutic modality has not been well investigated. CONCLUSION: Therapeutic use of HBOT in thermal burns has been popular in the past but its use remains controversial due to inconsistent results, serious side-effects, lack of convenience and high costs. The use of TOT in the management of burns needs further exploration by scientists and clinicians alike, in addition to the implementation of a standardised treatment protocol.

Learning Surgical Skills Through Video-Based Education: A Systematic Review.

BACKGROUND: Educational videos are a potent resource for the learning of surgical skills among different study cohorts. However, there is limited evidence on the effectiveness of different educational video interventions and their features.A systematic search of MEDLINE (via PubMed), Embase (via OVID), Cochrane libraries and Clinicaltrials.gov was performed from inception to 28/02/21. Studies included were not limited by date of publication, studies aiming to assess the impact of video-based interventions in the direct acquisition of surgical skill were included. Eligible studies were analysed based on study type, type of video intervention, method of assessment and period of education. The educational impact of the studies was also assessed as per Messick's framework for testing validity of evaluation methods and McGhagie's model for analysing translational outcomes.22 studies were deemed suitable for inclusion, of which 14/22 (63.6%) demonstrated a significant improvement in knowledge/skills following the video-based teaching interventions, 3/22 (13.6%) studies demonstrated an improvement in trainee satisfaction scores. A recurrent limitation of the included studies was the lack of validation of selected assessment methods. None of the included studies scored on all 5 parameters of validity as defined by Messicks validity framework. Furthermore, none of the included trials were conducted for long enough to indicate direct changes to patient outcomes resultant from educational methods. CONCLUSION: Video-based surgical education is effective in learning surgical skills within different levels of surgical training; however, superior study quality and follow-up is required to determine which aspects of video-based interventions are most impactful.

Effects of diet-induced obesity in the development of lymphedema in the animal model: A literature review.

BACKGROUND: Obesity poses deleterious consequences on every organ system, especially the lymphatic network. However, the underlying cellular mechanisms through which obesity causes lymphatic dysfunction remains unclear. We aimed to summarize experimental studies that evaluated the effect of obesity on the lymphatic system on animal models. METHODS: We used the following terms to search the Ovid EMBASE, Ovid MEDLINE(R), Cochrane, and Scopus databases: "lymphedema", "lymphatic diseases", "lymphatic system/complications* ", "lymphatic system/injuries* ", "lymphatic system/abnormalities* ", AND "obesity/complications* ", "diet/high-fat", "adipogenesis" and "lipid metabolism disorder". From a total of 166 articles identified in the initial search, 13 met our eligibility criteria. RESULTS: Long-term exposure to high-fat diet in mice demonstrated significant amount of adipose tissue deposition which sets off an inflammatory cascade resulting in disruption of the chemokine gradient, inhibition of lymphangiogenesis, and changes in gene expression of lymphatic endothelial cells, that alter vessel permeability and induce cell death. Reduced contractile properties of lymphatic collectors, dilated capillaries, increased tissue pressure, and reduced hydraulic conductivity collectively contribute to reduced impaired lymphatic drainage. Aerobic exercise has shown reversal of lymphatic dysfunction in the obese and pharmacological interventions targeting T-cells, iNOS and VEGFR-3 signaling have the potential to combat acquired lymphedema. CONCLUSION: Scientists should focus their future experiments on developing therapies that regulate expression of T-cell derived cytokines and VEGFR-3 expression whereas clinicians are urged to counsel their patients to reduce weight through aerobic exercise.

Patient-Reported Satisfaction After Autologous Auricular Reconstruction in Patients with Microtia: A Systematic Review.

Importance: In a patient-centered field such as plastic surgery, patient-reported satisfaction can measure the success and value of surgery, since it is not uncommon for patient and surgeon assessments to differ. Currently, there is no standard for evaluating patient-reported satisfaction postauricular reconstruction. Objective: To systematically review the literature regarding patient-reported satisfaction postauricular reconstruction in microtia patients. Evidence Review: The databases MEDLINE, EMBASE, Cochrane, and Scopus were searched and preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Studies documenting patient-reported satisfaction postauricular reconstruction in microtia patients were included. All techniques for ear reconstruction have been included in this review. Findings: Nineteen studies utilizing autologous reconstruction technique, comprising 3694 patients, met inclusion criteria. No standardized patient satisfaction assessment was used throughout the studies, indicating criteria variability to measure outcomes. Auricular substructure analysis highlighted lower patient satisfaction with the tragus and antitragus compared with the upper units. In addition, satisfaction depended on patient perception, not on a low surgical complication rate. Conclusions: There is a clear need to incorporate a standardized validated surgery-specific questionnaire related to patient satisfaction in the auricular reconstruction protocol.

Neonatal Parotitis: A case report.

The following is a case report of a 17-day-old female baby, born at 35 weeks' gestation, weighing 2.6 kg. She was brought to us with reluctance to feed, swelling over the left side of her face and a fever documented at 102oF, along with an erythematous, tender, localised swelling over the left pre-auricular region that measured 2 x 1.5 cm in size. Diagnostic workup and ultrasound findings were consistent with parotitis; however, her blood culture was negative. The patient was managed on antibiotics but subsequently, developed a nosocomial infection while she was admitted in the hospital, which prolonged her hospital stay to a total of 16 days. Nevertheless, she had complete resolution of the signs and symptoms on her follow-up visit. Acute parotitis should be considered in the differential diagnosis of a neonate presenting with facial swelling, reluctance to feed or incessant crying. Timely and appropriate management can result in good recovery and minimising the potential for complications.

Grading of Oral Leukoplakia: Can It be Improvised Using Immunohistochemical Markers p63 and CD31.

INTRODUCTION: Oral squamous cell carcinoma is usually preceded by potentially malignant disorders (PMDs), the most common being oral leukoplakia. A conservative management protocol is followed for milder dysplastic cases, while severe dysplastic lesions are surgically excised. Several classification systems have been developed based mainly on histopathological features with a lot of inter-observer variations. The present study was done to assess the use of immunohistochemical (IHC) markers in grading leukoplakic lesions in addition to histopathological grading. AIMS AND OBJECTIVES: To grade leukoplakia using different grading systems and assess if IHC markers can aid in categorizing leukoplakia. MATERIALS AND METHODS: Thirty-five cases of leukoplakia were graded using Ljubljana, 2005 World Health Organization (WHO), and Binary System followed by IHC staining with p63 and CD31. RESULTS AND STATISTICS: Variation was noted in 12 cases while using WHO, 11 using Ljubljana, and 7 using Binary System and was significant on Cohen-Kappa statistics, with the least significant variation noted on Binary System. p63 staining assisted to group doubtful cases and even identify variation in cases graded positively on histopathology. In total, 17 cases stained one-third (mild/low), while 15 cases stained one-half or more (higher grade) epithelial thickness. A weak correlation was observed between all grading systems and p63 on Kendall's Tau-b analysis and the weak correlation was significant for the WHO and binary grading systems. Analyzing p63 and CD31 using Kruskal-Wallis test, an increase in mean vessel density (MVD) was noted for mild/moderate cases but decreased for severe cases. CONCLUSION: Addressing histological categorization of PMDs assisted by IHC markers to understand the biological behavior of the tissues is currently essential with studies on more markers to assist in the management protocol.

A Case Report on Dengue Encephalitis With Optic Neuropathy.

The dengue virus is a type of Flavivirus, responsible for causing dengue fever. It mostly prevails in tropical and subtropical countries, with Southeast Asia reporting the greatest disease burden. The virus can affect a multitude of organ systems and the disease spectrum varies from a mild flu-like illness to severe dengue hemorrhagic fever or dengue shock syndrome. Two serotypes, DENV-2 and DENV-3, have been most frequently associated with neurological complications. We report a case of a 19-year-old male presented with signs and symptoms of encephalitis and optic neuropathy, following a diagnosis of dengue fever. Our diagnosis was supported by findings from brain MRI, electroencephalogram, fundoscopy, and a visual evoked potential test. A high-dose intravenous steroid therapy was given in pulses, which resulted in complete visual and neurological recovery. Dengue fever can present with atypical findings due to its propensity to affect multiple organ systems throughout the body. Neurological involvement is not uncommon and hence, clinicians should be aware of such systemic manifestations in order to diagnose promptly. Effective and timely treatment can reduce associated morbidity and result in complete recovery.

Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review.

Background Lymphedema is an accumulation of protein-rich fluid in the interstitial spaces resulting from impairment in the lymphatic circulation that can impair quality of life and cause considerable morbidity. Lower extremity lymphedema (LEL) has an overall incidence rate of 20%. Conservative therapies are the first step in treatment of LEL; however, they do not provide a cure because they fail to address the underlying physiologic dysfunction of the lymphatic system. Among several surgical alternatives, lymphaticovenous anastomosis (LVA) has gained popularity due to its improved outcomes and less invasive approach. This study aims to review the published literature on LVA for LEL treatment and to analyze the surgical outcomes. Methods PubMed database was used to perform a comprehensive literature review of all articles describing LVA for treatment of LEL from Novemeber 1985 to June 2019. Search terms included "lymphovenous" OR "lymphaticovenous" AND "bypass" OR "anastomosis" OR "shunt" AND "lower extremity lymphedema." Results A total of 95 articles were identified in the initial query, out of which 58 individual articles were deemed eligible. The studies included in this review describe notable variations in surgical techniques, number of anastomoses, and supplementary interventions. All, except one study, reported positive outcomes based on limb circumference and volume changes or subjective clinical improvement. The largest reduction rate in limb circumference and volume was 63.8%. Conclusion LVA demonstrated a considerable reduction in limb volume and improvement in subjective findings of lymphedema in the majority of patients. The maintained effectiveness of this treatment modality in long-term follow-up suggests great efficacy of LVA in LEL treatment.

"SKILL TO KILL" - Oral cancer and potentially premalignant oral epithelial lesions (PPOELs): A survey approach. Emerging of a new system and professionals.

BACKGROUND: Oral cancer is said to be the 6th most common cancer in men and 12th in women. Potentially malignant disorders/potentially premalignant oral epithelial lesion (PMDs/PPOELs) have shown an increased risk of progressing to cancer. In this regard, lack of awareness about identification of oral PMDs among healthcare providers in general and oral pathologists in particular is said to be responsible for the diagnostic delay. Oral cancer is said to be the most common cancer in men and 3rd most common in women in the Indian subcontinent. PMDs have shown an increased risk of progressing to cancer. The various rates of conversion include 14%-51% for erythroplakia, 60%-100% for proliferative verrucous leukoplakia and 7%-26% for oral submucous fibrosis (OSMF). In this regard, early detection at PPOEL level will lead to prevention of malignant transformation. AIMS AND OBJECTIVES: The purpose of this survey was: 1. To determine if awareness among professionals is essential/key to challenge the progression of PMDs of the oral cavity. 2. To examine and/ordiscern if oral pathologists felt enough was being done to address the issue of early detection and prevention and how the scenario could be improved further. MATERIALS AND METHODS: A survey was designed to assess the interest, zeal, knowledge and skill of healthcare providers in general and oral pathologists in particular in careful examination of the oral cavity and early detection of PMDs. A questionnaire with 18 questions was designed to address these issues/points and distributed among post-graduate students and practicing oral pathologists on online platforms. RESULTS: The results of the esurvey were collected, analyzed and the results discussed question wise. The validity and reliability of the questionnaire was assessed and confirmed with Aiken's index for validity and Cronbach's alpha for reliability. Inferential statistical analysis was performed using Chi square test with P = 0.05 being statistically significant. CONCLUSION: On evaluation of the survey, we found that 85% of the surveyees are on agreement that PPOELs should be registered in a standard format and should be included in the list of recognizable diseases. 89.2% and 87.8% of the respondents would like to be part of an active body for early detection and diagnosis and for Cancer screening in our country respectively. In conclusion, the oral pathology fraternity is eager to work for and tackle these PPOELs head on, provided the right opportunities and training are meted out to them.

Determination of epigenetic age through DNA methylation of NPTX2 gene using buccal scrapes: A pilot study.

CONTEXT: DNA methylation (DNAm) age can be used to evaluate the chronological age of individuals often called "epigenetic age." In this study, buccal scrape samples were used for the determination of epigenetic age. AIMS: To examine if epigenetic age could be determined using neuronal pentraxin 2 (NPTX2) gene in buccal cells. SETTING AND DESIGN: This cohort study was designed to validate the use of buccal cells for epigenetic age estimation. Sanger sequencing was used to determine the genetic sequence of the gene of interest postamplification. Nucleotide base sequence for NPTX2 gene was obtained for each case using this protocol. SUBJECTS AND METHODS: The study was conducted on buccal scrapes obtained from 26 subjects of both genders, whose age varied from 1 to 65 years. The samples, collected by wooden spatulas, were placed in cell suspension buffer and stored at 4°C until transported to the laboratory. RESULTS: Methylation levels of 5'-C-phosphate-G-3' located in the gene NPTX2 of 26 subjects were studied and analyzed by bisulfate sequencing. The percentage of methylation in this study falls in the range between 15% and 51%. CONCLUSION: In this study, a sufficient amount of gDNA was retrieved from the buccal cells, thus confirming that buccal scrape was a feasible technique to obtain ample DNA. This study also showed that DNAm-polymerase chain reaction method was a feasible method for the evaluation of methylation pattern of NPTX2 gene.