Combined Non-Ablative Laser and Microfat Grafting for Burn Scar Treatment.

BACKGROUND: Burn scar treatment persists as an unsolved problem, involving thousands of affected patients disfigured for life. OBJECTIVES: We sought to present our experience with the use of combined treatments for patients with burn scars. METHODS: This was a case series report of the senior author's experience during 8 years utilizing the combined treatments of Fraxel Restore (fractional laser) and microfat graft injection for 288 patients with burn scars. RESULTS: Laser treatment reduced scar intensity and attenuated skin irregularities and hyperpigmentation. All patients demonstrated marked improvement of skin texture and an increase in scar softness after 3 sessions of microfat grafting. However, the degree of improvement varied between patients and was related to the severity of the scar and the type of tissue. Overall, a 40% to 80% improvement was noted in our patients. All patients and their families expressed satisfaction with the results. CONCLUSIONS: The combined treatment of Fraxel and microfat grafting is an effective technique for improving the appearance of a hypertrophic scar or keloid on burn patients. Fat tissue stem cells may have helped to repair the damaged skin.

Perinatal outcomes of sonographically detected nuchal cord in southeastern Turkey.

PURPOSE: To investigate the outcomes of pregnancies with a sonographically detected nuchal cord (NC) from a single center in south-eastern Turkey. MATERIALS AND METHODS: A retrospective study was carried out at Maternity and Child Health Hospital Diyarbakir, Turkey, between 2011 and 2013. A-total of 477 pregnancies with sonographically detected NC during the second and third trimesteri of gestation (20-40 weeks) were included. The control group consisted of 1,043 randomly selected pregnancies without NC matched for gestational age at the time of ultrasound examination. Outcome variables, including maternal age, parity, gestational age at delivery, mnode of delivery, intrapartum fetal heart abnormalities, meconium-stained amniotic fluid, birth weight, and one- and five-minute Apgar scores, were compared between the two groups. RESULTS: There were no statistically significant differences in any of the outcome variables between patients with sonographically detected NC and controls. CONCLUSIONS: The presence of NC indicates a need for increased care but is not associated with adverse perinatal outcomes.

Analysis of the population genetic structure of Hb D-Los Angeles [ß121 (GH4) Glu→Gln GAA→CAA] in Denizli, Turkey; genetic diversity, historical demography and estimation of the mutation rates based on haplotype variation.

OBJECTIVE: Understanding the genetic origin of the Hb D-Los Angeles hemoglobin may elucidate population interactions such as movements, migrations, and environmental effects on mutation mechanisms in human biology throughout history. Our study aimed to understand the genetic origin of Hb D-Los Angeles based on haplotype data, observed in the Denizli province of Turkey. METHODS: We studied DNA samples from 40 unrelated patients with abnormal hemoglobin Hb D-Los Angeles and 59 unrelated healthy subjects from our DNA bank. Possible associated haplotypes, HWE, genetic diversity and population differentiation, population genetic structure analysis and historical-demographic analysis for the two populations were determined by Arlequin ver. 3.5. RESULTS: Molecular diversity results from the two populations show that both populations are genetically similar as far as development and expansion during the historical period. Historical gene flow results show high gene flow between the two populations. SSD and rg tests failed to reject the null hypothesis of population expansion which is consistent with unimodal distribution. Our estimated τ values show that the average time since the demographic expansion for normal and Hb D-Los Angeles populations ranged from approximately 42,000-38,000 ybp, respectively. CONCLUSIONS: Our data suggest that the Hb D-Los Angeles population originated within the normal population in Denizli, Turkey. Our results support the hypothesis that the Hb D-Los Angeles mutation may have originated in the Mediterranean area, independent from other populations such as India and China. The evaluation of such data may contribute valuable information to anthropological, paleoclimatic, archaeological, and phylogeographical approaches to human biology throughout the historical period. Am. J. Hum. Biol. 28:476-483, 2016. © 2015 Wiley Periodicals, Inc.

Comparison of p57, c-erbB-2, CD117, and Bcl-2 expression in the differential diagnosis of hydatidiform mole and hydropic abortion.

PURPOSE: To explore the utility of p57, c-erbB-2, CD 117, and Bel-2 immunostaining in the differential diagnosis of complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), and hydropic abortion (HA). MATERIALS AND METHODS: Immunohistochemical expression of the p57, c-erbB-2, CD117, and Bel-2 proteins were investigated semi-quantitatively using paraffin-embedded tissue sections from histologically unequivocal cases of CHM (n = 20), PHM (n = 23), and HA (n = 17). RESULTS: All cases of CHM exhibited a striking absence of p57 expression. The percentage of positive p57 staining was similar between PHMs (73.9%) and HAs (76.5%) (p >0.05). The comparison of c-erbB-2 expression revealed a significantly higher percentage of positive c-erbB-2 staining in CHMs (45%) compared with that in PHMs (8.7%) and HAs (5.9%) (p = 0.006 and 0.01, respectively). The CD 117 expression pattern (immunoreactivity score, percentage of positive cells, and staining intensity) was significantly lower in HAs compared with that in PHMs and CHMs (p < 0.05 for all). A significantly increased Bel-2 expression pattern was observed in HAs compared with that in PHMs and CHMs (p < 0.05 for all). CONCLUSION: Immunohistochemical examination of p57, c-erbB-2, CD 117, and Bel-2 expression represents a relatively simple, reliable, and cost-efficient procedure to definitively distinguish among CHM, PHM, and HA.

Serum level and placental expression of resistin in pregnancies complicated by preeclampsia: relationship with disease severity.

The authors aimed to compare the maternal serum level and placental expression of resistin in pregnancies complicated by preeclampsia and clarify their relationship with disease severity. This cross-sectional study included 50 healthy pregnant women, 50 women with mild preeclampsia, and 48 women with severe preeclampsia. Serum resistin levels were measured by enzyme immunoassay and placental resistin expression was determined by immunohistochemistry. Resistin levels were significantly higher in women with mild and severe preeclampsia than in the healthy controls (p = 0.012 andp < 0.001, respectively). Placental resistin expression was significantly higher in women with severe preeclampsia compared to women with mild preeclampsia (p = 0.003) and healthy controls (p < 0.001). Serum resistin levels were positively correlated with gestational age and umbilical and uterine artery Doppler indices, as well as systolic and diastolic blood pressure, but negatively correlated with birth weight (p < 0.05). On the other hand, placental resistin expression was positively correlated with systolic blood pressure and uterine artery indices, but negatively correlated with birth weight (p < 0.05). In conclusion, increased cir- culating levels and placental expression of resistin in pregnancies complicated by preeclampsia were correlated with disease severity.

Microfat Grafting in Nasal Surgery.

BACKGROUND: Injectable fillers are sometimes necessary to correct slight skin irregularities. However, there have been reports of necrosis after injection of alloplastic materials and heterogeneous transplants. On the other hand, the advantages of autogenous tissue grafts over those fillers are well established. Volumetric reshaping of the face with autologous tissue injection is a popular and reliable method with good long-term results. However, procedures performed on the fragile skin of the nose are prone to complications. OBJECTIVES: The author conducted a study of injectable autologous microfat grafting to the nose in patients with secondary nasal deformities. METHODS: During a 5-year period, 313 patients who had secondary nasal deformities with slight skin irregularities or severe nasal skin damage were treated with microfat grafting. At each patient's first injection session, excess harvested fat was cryopreserved for subsequent injection. To correct minor irregularities, 0.3 to 0.8 mL of microfat was injected during each session; for major irregularities or defects, 1 to 6 mL was required for each session. RESULTS: One to 3 injections of microfat provided satisfactory results in all patients who had minor irregularities. For patients with multiple and severe irregularities, 3 to 6 injections were necessary and resulted in high patient satisfaction. In another group of patients, with severe traumatic skin damage, 6 to 16 injections were necessary for reconstruction. After repeated injections, each patient's skin damage was repaired. CONCLUSIONS: Autologous microfat injection appears to be safe and effective for correcting slight irregularities of the nose. LEVEL OF EVIDENCE: 4.

Examining the Behaviour subscale of the Hypoglycaemia Fear Survey: an international study.

AIMS: The Hypoglycemia Fear Survey (HFS)-II Behaviour and Worry subscales were developed to measure behaviours and anxiety related to hypoglycaemia in diabetes. However, previous studies found lower reliability in the HFS Behaviour subscale and inconsistent relationships with glucose control. The purpose of this study was to conduct extensive analyses of the internal structure of the HFS Behaviour subscale's internal structure and its relationships with diabetes outcomes, including HbA1c and episodes of severe hypoglycaemia. METHODS: HFS-II survey data from 1460 adults with Type 1 diabetes were collected from five countries. This aggregated sample underwent exploratory factor analysis and item analysis to determine the internal structure of the survey and subscales. RESULTS: A three-factor solution showed the best fit for the HFS, with two subscales emerging from the HFS Behaviour representing tendencies towards (1) maintenance of high blood glucose and (2) avoidance of hypoglycaemic risks by other behaviours, and a third single HFS Worry subscale. Subscale item analysis showed excellent fit, separation and good point-measure correlations. All subscales demonstrated acceptable (0.75) to excellent (0.94) internal reliability. HbA(1c) correlated with Maintain High Blood Glucose subscale scores, r = 0.14, P < 0.001, and severe hypoglycaemia frequency correlated with all subscales. CONCLUSIONS: The HFS Worry subscale measures one construct of anxiety about various aspects of hypoglycaemia. In contrast, the HFS Behaviour subscale appears to measure two distinct aspects of behavioural avoidance to prevent hypoglycaemia, actions which maintain high blood glucose and other behaviours to avoid hypoglycaemic risk. These results demonstrate the clinical importance of the HFS Behaviour subscales and their differential relationships with measures of diabetes outcome such as HbA1c .

The role of oxidative stress parameters in the differential diagnosis of malignant and benign ascites.

OBJECTIVE: Ascites is the pathological fluid accumulation in the peritoneal cavity and there are mainly two reasons for its etiology. These are malignant diseases such as hepatoma or pancreas cancer and benign diseases such as liver cirrhosis and heart failure. In this study, we investigated the diagnostic utility of arylesterase (ARES), paraoxonase (PON), stimulated paraoxonase (SPON), catalase (CAT) and myeloperoxidase (MPO) in the differential diagnosis of malignant and benign ascites. PATIENTS AND METHODS: This study was conducted between February and September 2016. Patients with acute infection, those taking vitamin supplements and antioxidant medication, smoking, and drinking alcohol were excluded from the study. RESULTS: The study population consisted of 60 patients: 36 had benign (60%) and 24 had malignant (40%) ascites. The mean age of the patients was 63.3 years. MPO levels (14.2 vs. 4.2; p=0.028) were found to be higher and PON (2.6 vs. 4.5; p<0.001), SPON (10.7 vs. 23.9; p<0.001), ARES (615.7 vs. 823.5, p<0.001) and CAT (13.3 vs. 36.8; p=0.044) were found to be lower in malignant patients compared to benign patients. There was a positive correlation between PON, SPON, and ARES levels, and a negative correlation between MPO levels and SPON, ARES, and CAT levels. MPO levels showed superior diagnostic performance compared to ARES and CAT levels (p<0.05) for predicting malignancy but showed no diagnostic superiority compared to PON and SPON levels (p>0.05). CONCLUSIONS: PON, SPON, ARES, CAT, and MPO can be used with high sensitivity and specificity in the differential diagnosis of malignant and benign ascites.

Incidence and clinical significance of fovea plana in the French population with age-related cataract.

BACKGROUND: Fovea plana is defined as an immature macula diagnosed by OCT, showing the unusual shunt of the inner retinal layers into the fovea. The incidence of fovea plana in the adult population remains to be determined. The aim of this study was to determine the incidence of fovea plana in the French population with age-related cataract. METHODS: Consecutive patients who underwent cataract surgery in Rothschild Foundation Hospital, France, between January and March 2021, with preoperative analyzable OCT scans available, were retrospectively screened in order to determine the incidence of fovea plana in these population. Ophthalmological characteristics of patients were reported, and detailed. RESULT: Fovea plana was encountered in 20 out of 204 patients during the 3 months corresponding to an incidence of 9.8%. One of those patients had stage 2 fovea plana. CONCLUSION: Although fovea plana is defined as an immature macula, it is not rare in preoperative population. This macular aspect was not associated with poor visual acuity in our cohort.

Allele frequency of VNTR locus D1S80 observed in Hb D-Los Angeles carrires.

One of our previous studies presented the allele frequencies of D1S80 VNTR locus in province Denizli including the high frequencies of allele 24 and 18. In Denizli province of Turkey, the most common abnormal variant is Hb D-Los Angeles with a frequency of 57.8 % of the total abnormal Hbs. The aim of this study is to identify the allele frequencies of D1S80 VNTR locus in Hb D-Los Angeles carriers in Denizli province of Turkey. We studied unrelated 36 Hb D-Los Angeles carriers residing in Denizli province of Turkey. The size range of the D1S80 VNTR locus PCR products was determined first by agarose gel electrophoresis and then by a capillary electrophoresis system. For all subjects, DNA sequencing was performed. Allele frequency, theta (k) value, and observed and expected heterozygosity were calculated using Arlequin Software version 3.11. The most common alleles were the 24 (32 %), 18 (18.1 %) and 29 (16.7 %) alleles, and frequencies of these alleles were 0.329, 0.186 and 0.171 respectively. Other observed alleles percentages were 33, 2 %. We did not observe alleles 6, 15, 27 and 35, but we observed alleles 20 and 33. Results were in Hardy-Weinberg linkage disequilibrium. Observed heterozygosity was 0.889, and expected heterozygosity was 0.847. Theta (k) value was 4.91 (95 % confidence interval limits). According to our results, we concluded that Hb D-Los Angeles carriers have different allele frequencies in D1S80 VNTR and also have their own D1S80 VNTR locus divergence.

Percutaneous electrothrombosis: a minimally invasive technique for the treatment of deep hemangiomas.

BACKGROUND: A percutaneous electrocauterization technique for the treatment of deep hemangiomas is introduced as an alternative and minimally invasive treatment mode. METHODS: Percutaneous electrothrombosis was applied through a needle-catheter that is a small silicone catheter with a needle guide in it. Thus, it is possible to do needle-point monopolar electrocauterization only at the needle tip because of the insulation of the other parts of the needle by the silicone catheter. By retracting the needle with catheter on it during electrocauterization, electrothrombosis was achieved through and around the channel of the needle, leaving vascularized tissue areas between the channels to perfuse the skin or mucosa covering the hemangioma. RESULTS: This technique was applied as a single treatment or before surgery for the treatment of cavernous hemangiomas to more than 40 patients. However, adequate documentation was found for only 10 patients. After percutaneous electrocauterization of deep hemangiomas, discrete areas of skin necrosis appeared in some patients during the healing period, but the subsequent debridement and surgical excisions were easier because of the thrombosis effect of the technique due to the diffuse denaturation and fibrosis through and around the electrocauterization channels. The follow-up period was 1-13 years. CONCLUSION: The proposed percutaneous electrocauterization technique for the treatment of deep hemangiomas achieved four effects: (1) volume reduction, (2) bleeding reduction, (3) anesthesia time reduction, and (4) cost reduction. The technique can be defined as a minimally invasive and effective alternative treatment for deep hemangiomas.

Geomorphic reconstructions in the environs of ancient troy.

Sea level rise, deltaic progradation, and floodplain aggradation have changed the landscape in the vicinity of ancient Troy during the past 10,000 years. With the waning of the last major world glaciation and resultant sea level rise and fluctuation, a marine embayment protruded nearly 10 kilometers south of the site of Troy at Hisarlik in the Troad of northwest Turkey. As the sea approached its present level approximately 6000 years ago, fluvial and marine deposition caused a northerly migration of the delta and floodplain of the Scamander and Simois Rivers past the site of Troy toward the present-day coast about 6 kilometers north of the site. In view of these major changes in morphology, interpretations of ancient geographies related to historical or historical-mythological settings must be changed. A number of paleogeographic maps have been reconstructed with the use of subsurface data that records the continuing landscape change since the first occupancy of the site at Troy 5000 years ago. These show that ancient Troy was located on an embayment of the sea. If the Trojan War occurred, then the axis of the battlefield and associated events must be relocated to the south and west of Troy.

Delayed breast reconstruction with latissimus dorsi flap.

BACKGROUND: The ideal method of breast reconstruction should be safe, reliable, and have minimal or no donor-site morbidity. We present our experience with the latissimus dorsi musculocutaneous flap for delayed breast reconstruction with immediate permanent implant insertion. METHODS: The latissimus dorsi musculocutaneous flap was performed on patients who presented for delayed breast reconstruction. From 1999 to 2007, charts of patients were reviewed for age, type of mastectomy, history of chest wall irradiation, nipple-areola complex reconstruction, and complications at both the donor site and the reconstructed breast site. RESULTS: The latissimus dorsi was used as a musculocutaneous flap in 33 patients who had breast cancer surgery. The mean age was 51.14 (range = 30-63) years. Nine patients (27%) asked for nipple-areola reconstruction. Three patients had major complications (9%), including infection, partial flap ischemia, and liponecrotic pseudocysts. Eight patients required revision. Seroma was the most common problem observed at the donor site. CONCLUSION: The latissimus dorsi flap provides adequate soft tissue with a reliable blood supply for the enhancement of missing tissue after mastectomy. It is a safe method for breast reconstruction and an excellent alternative flap for patients at high risk for abdominal flap complications.

Treatment of hypertrophic scars and keloids using intense pulsed light (IPL).

BACKGROUND: Keloids and hypertrophic scars are extremely disturbing to patients, both physically and psychologically. This study prospectively assessed the safety and efficacy of intense pulsed light (IPL) on scars originating from burns, trauma, surgery, and acne. METHODS: Hypertrophic scars in 109 patients, originating from surgical incisions (n = 55), traumatic cuts (traffic accidents) (n = 24), acne scars (n = 6), keloids (n = 5), and burns (n = 19), were treated using an IPL Quantum device. Treatment was administered at 2-4-week intervals, and patients received an average of 8 treatments (range = 6-24). Using digital photographs, Changes in scar appearance were assessed by two physicians who were blinded to the study patients and treatments. The photographs were graded on a scale of 0 to 4 (none, minimal, moderate, good, excellent) for improvement in overall clinical appearance and reduction in height, erythema, and hardness. RESULTS: An overall clinical improvement in the appearance of scars and reductions in height, erythema, and hardness were seen in the majority of the patients (92.5%). Improvement was excellent in 31.2% of the patients, good in 25.7%, moderate in 34%, and minimal in 9.1%. Over half the patients had good or excellent improvement. In the preventive IPL treatment group, 65% had good to excellent improvement in clinical appearance. Patient satisfaction was very high. CONCLUSION: This study suggests that IPL is effective not only in improving the appearance of hypertrophic scars and keloids regardless of their origin, but also in reducing the height, redness, and hardness of scars.

Estimating the age of Hb G-Coushatta [ß22(B4)Glu→Ala] mutation by haplotypes of ß-globin gene cluster in Denizli, Turkey.

BACKGROUND: Hb G-Coushatta variant was reported from various populations' parts of the world such as Thai, Korea, Algeria, Thailand, China, Japan and Turkey. In our study, we aimed to discuss the possible historical relationships of the Hb G-Coushatta mutation with the possible migration routes of the world. For this purpose, associated haplotypes were determined using polymorphic loci in the beta globin gene cluster of hemoglobin G-Coushatta and normal populations in Denizli, Turkey. METHODS: We performed statistical analysis such as haplotype analysis, Hardy-Weinberg equilibrium, measurement of genetic diversity and population differentiation parameters, analysis of molecular variance using F-statistics, historical-demographic analyses, mismatch distribution analysis of both populations and applied the test statistics in Arlequin ver. 3.5 software program. RESULTS: The diversity of haplotypes has been shown to indicate different genetic origins for two populations. However, AMOVA results, molecular diversity parameters and population demographic expansion times showed that the Hb G-Coushatta mutation develops on the normal population gene pool. Our estimated τ values showed the average time since the demographic expansion for normal and Hb G-Coushatta populations ranged from approximately 42,000 to 38,000 ybp, respectively. CONCLUSION: Our data suggest that Hb G-Coushatta population originate in normal population in Denizli, Turkey. These results support the hypothesis that the multiple origin of Hb G-Coushatta and indicate that mutation may have been triggered the formation of new variants on beta globin haplotypes.

Time estimations by network of beta globin gene cluster haplotypes linked with Hb D-Los Angeles [ß121 (GH4) Glu → Gln GAA → CAA] mutation in the world populations.

BACKGROUND: ß-Globin gene cluster haplotypes associated with the Hb D-Los Angeles mutation have been reported in many different locations in different populations including Italy, Iran, Thailand, Belgium, Mexico, Holland, and Turkey. In this study, we have identified genetic relationships and formation periods between the haplotypes reported in the world regarding the Hb D-Los Angeles. METHODS: We comparatively analyzed the RFLP (restriction fragment length polymorphism) data in Denizli region and world populations using Arlequin 3.5 statistical software program. The data obtained from the Arlequin software were then entered into the Phylogenetic Network software to calculate the age estimates and to discover possible links between the haplotypes. RESULTS: We observed the frequencies of the ß-globin gene haplotypes for the seven polymorphic restriction sites around the world and calculated the estimated time of haplotypes using Network software on the basis of ancestral haplotypes. We performed the phylogenetic network analysis of the haplotypes linked with Hb D-Los Angeles mutation by processing the data of frequency and age estimations with Network software. CONCLUSION: Our period of time results suggests that HAP1 was formed before modern human migration to Asia and/or independent origin of the Hb D-Los Angeles mutation from other populations. Considering that the population in Denizli region started the Hb D-Los Angeles mutation past about 40,000 years ago, it can be said that HAP1, HAP15, and HAP21 belong to the gene pool with an external effect. Our period of time results of HAP6 is compatible with published dating results.

Injection of Compressed Diced Cartilage in the Correction of Secondary and Primary Rhinoplasty: A New Technique with 12 Years' Experience.

BACKGROUND: There are instances where small or large pockets are filled with diced cartilage in the nose, without use of wrapping materials. For this purpose, 1-cc commercial syringes were used. The obtained results were partial and incomplete. For better and improved results, the author designed new syringes, with two different sizes, which compress the diced cartilage for injection. METHODS: The author presents his experience accrued over the past 12 years with 2366 primary, 749 secondary, 67 cleft lip and nose, and a total of 3182 rhinoplasties, using his new syringe design, which compresses diced cartilage and injects the diced cartilages as a conglutinate mass, simulating carved costal cartilage, but a malleable one. RESULTS: In 3125 patients, the take of cartilage graft was complete (98.2 percent) and a smooth surface was obtained, giving them a natural appearance. In 21 patients (0.65 percent), there was partial resorption of cartilage. Correction was performed with touch-up surgery by reinjection of a small amount of diced cartilage. In 36 patients (1.13 percent), there was overcorrection that, 1 year later, was treated by simple rasping. CONCLUSIONS: Compared with diced cartilage wrapped with Surgicel or fascia, the amount of injected cartilage graft is predictable because it consists purely of cartilage. The injected diced cartilage, because it is compressed and becomes a conglutinated mass, resembles a wood chip and simulates carved cartilage. It is superior to carved cartilage in that it is moldable, time saving, and gives a good result with no late show or warping. The injection takes only a few minutes.

Long-Term Results and Refinement of the Turkish Delight Technique for Primary and Secondary Rhinoplasty: 25 Years of Experience.

BACKGROUND: All grafts present the potential problem of late visibility, distortion, and (occasionally) absorption. To overcome these problems and obtain a smoother surface, in 1989, the author initiated the use of finely diced cartilage wrapped in Surgicel. It is well known that the resolution of edema at the end of 1 year postoperatively is approximately 90 to 95 percent. Complete resolution continues until the end of 4 years postoperatively. However, it is important to understand what occurs beyond 4 years, and how the nose changes as the face ages. METHODS: The author presents his experience of the past 25 years on 9398 primary and secondary rhinoplasty patients treated using his personal approach, the Turkish delight. Patients with a postoperative range from 4 to 25 years were selected. RESULTS: The Turkish delight type of cartilage graft (diced cartilage wrapped in Surgicel) has been free of late show complications often experienced with other types of tip grafts. Long-term results from 4 to 25 years are very satisfactory, with an acceptably low complication rate. CONCLUSIONS: This technique is safe, reliable, effective, simple, and easily applicable by plastic surgeons at all levels of experience. Early and long-term results from 1 to 25 years are very satisfactory. The overall complication rate is very low compared with other techniques. In addition, there is no late show as is sometimes seen with other types of cartilage grafts such as crushed, oval, or rectangular grafts. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.