Localized deferoxamine injection augments vascularity and improves bony union in pathologic fracture healing after radiotherapy

BackgroundMedically based efforts and alternative treatment strategies to prevent or remediate the corrosive effects of radiotherapy on pathologic fracture healing have failed to produce clear and convincing evidence of success. Establishing an effective pharmacologic option to prevent or treat the development of non-unions in this setting could have immense therapeutic potential. Experimental studies have shown that deferoxamine (DFO), an iron-chelating agent, bolsters vascularity and subsequently enhances normal fracture healing when injected locally into a fracture callus in long bone animal models. Since radiotherapy is known to impede angiogenesis, we hypothesized that the pharmacologic addition of DFO would serve to mitigate the effects of radiotherapy on new vessel formation in vitro and in vivo.Materials and MethodsIn vitro investigation of angiogenesis was conducted utilizing HUVEC cells in Matrigel. Endothelial tubule formation assays were divided into four groups: Control, Radiated, Radiated + Low-Dose DFO and Radiated + High-Dose DFO. Tubule formation was quantified microscopically and video recorded for the four groups simultaneously during the experiment. In vivo, three groups of Sprague–Dawley rats underwent external fixator placement and fracture osteotomy of the left mandible. Two groups received pre-operative fractionated radiotherapy, and one of these groups was treated with DFO after fracture repair. After 40 days, the animals were perfused and imaged with micro-CT to calculate vascular radiomorphometrics.ResultsIn vitro, endothelial tubule formation assays demonstrated that DFO mitigated the deleterious effects of radiation on angiogenesis. Further, high-dose DFO cultures appeared to organize within 2 h of incubation and achieved a robust network that was visibly superior to all other experimental groups in an accelerated fashion. In vivo, animals subjected to a human equivalent dose of radiotherapy (HEDR) and left mandibular fracture demonstrated quantifiably diminished μCT metrics of vascular density, as well as a 75% incidence of associated non-unions. The addition of DFO in this setting markedly improved vascularity as demonstrated with 3D angiographic modeling. In addition, we observed an increased incidence of bony unions in the DFO treated group when compared to radiated fractures without treatment (67% vs. 25% respectively).ConclusionOur data suggest that selectively targeting angiogenesis with localized DFO injections is sufficient to remediate the associated severe vascular diminution resulting from a HEDR. Perhaps the most consequential and clinically relevant finding was the ability to reduce the incidence of non-unions in a model where fracture healing was not routinely observed.     

Adhesion of 10-MDP containing resin cements to dentin with and without the etch-and-rinse technique

PURPOSE

This study evaluated the adhesion of 10-MDP containing self-etch and self-adhesive resin cements to dentin with and without the use of etch-and-rinse technique.

MATERIALS AND METHODS

Human third molars (N=180) were randomly divided into 6 groups (n=30 per group). Conventional (Panavia F2.0, Kuraray-PAN) and self-adhesive resin cements (Clearfil SA, Kuraray-CSA) were bonded to dentin surfaces either after application of 3-step etch-and-rinse (35% H₃PO₄ + ED Primer) or two-step self-etch adhesive resin (Clearfil SE Bond). Specimens were subjected to shear bond strength test using the universal testing machine (0.5 mm/min). The failure types were analyzed using a stereomicroscope and quality of hybrid layer was observed under a scanning electron microscope. The data (MPa) were analyzed using two-way ANOVA and Tukey''s tests (α=.05).

RESULTS

Overall, PAN adhesive cement showed significantly higher mean bond strength (12.5 ± 2.3 - 14.1 ± 2.4 MPa) than CSA cement (9.3 ± 1.4 - 13.9 ± 1.9 MPa) (P<.001). Adhesive failures were more frequent in CSA cement groups when used in conjunction with two-step self-adhesive (68%) or no adhesive at all (66%). Hybrid layer quality was inferior in CSA compared to PAN cement in all conditions.

CONCLUSION

In clinical situations where bonding to dentin substrate is crucial, both conventional and self-adhesive resin cements based on 10-MDP can benefit from etch-and-rinse technique to achieve better quality of adhesion in the early clinical period.     

Preventive Effect of Ethyl Pyruvate on Postoperative Adhesion Formation Following Abdominal Surgery

Objective: Postoperative adhesions are among the major causes of morbidity and mortality following abdominal surgery. As an antioxidant and antiinflamatory agent, the potential effect of ethyl pyruvate on adhesion prevention has not been clearly studied. We aimed to investigate the possible anti-adhesive effect of ethyl pyruvate compared with an effective barrier membrane, Seprafilm, in a rat cecal abrasion model. Materials and Methods: Male Wistar albino rats separated into three adhesion model groups (n = 8, each) with applications of different agents during surgery: control (intraperitoneal normal saline), Seprafilm group (intraperitoneal Seprafilm), and Ethyl pyruvate group (40 mg/kg intraperitoneal ethyl pyruvate). Postoperative adhesion was graded both macroscopically and histopathologically. Malondialdehyde and nitric oxide levels were determined from tissue samples for assessment of oxidative stress. Results: Seprafilm and Ethyl pyruvate groups had lower adhesion scores (both macroscopic and microscopic) and decreased malondialdehyde and nitric oxide levels compared to the control group (p < 0.05 for all parameters). The results were comparable for both Seprafilm and Ethyl pyruvate groups for all parameters (p > 0.05). Conclusions: Intraperitoneal ethyl pyruvate application reduced the incidence and the extent of postoperative adhesions in rat cecal abrasion model. Ethyl pyruvate also had comparable overall efficacy for adhesion prevention as Seprafilm.     

Safety and efficacy of single-incision sling for female stress urinary incontinence: 3 years’ results

Introduction and hypothesis

The purpose of this study was to investigate the success and complication rates of single-incision sling for treating stress urinary incontinence (SUI), with a 3-year follow-up.

Methods

This study comprised 173 female patients with SUI or mixed urinary incontinence (MUI) with dominant SUI who underwent minisling procedure. All patients had positive cough stress test preoperatively; they were followed up for 3 years after surgery (1, 3, 6, 12 months, and yearly).

Results

Total follow-up was 36 months, and mean age 51 years (44–77); 128 (74 %) patients presented SUI and 45 (26 %) MUI. Objective and subjective cure and failure rates were 83.8 % (145 cases), 6.4 % (11 cases), and 9.8 % (17 cases), respectively. There were no differences in cure rates between 1 and 3 years. Mean body mass index was 28.7 (26.1–35.2), and mean operating time 7.9 min. (6.5–11.9). There were no major intraoperative complications. Eleven patients (6.4 %) had de novo urge incontinence that resolved using anticholinergic drugs; no patient had urinary retention. Vaginal mesh extrusion was reported in nine (5.2 %) patients.

Conclusions

The minisling system attained high success rates at 3 years’ follow-up. The procedure was easy to learn and has lower complication rate.

     

The Intelligibility of Interrupted Speech: Cochlear Implant Users and Normal Hearing Listeners

Compared with normal-hearing listeners, cochlear implant (CI) users display a loss of intelligibility of speech interrupted by silence or noise, possibly due to reduced ability to integrate and restore speech glimpses across silence or noise intervals. The present study was conducted to establish the extent of the deficit typical CI users have in understanding interrupted high-context sentences as a function of a range of interruption rates (1.5 to 24 Hz) and duty cycles (50 and 75 %). Further, factors such as reduced signal quality of CI signal transmission and advanced age, as well as potentially lower speech intelligibility of CI users even in the lack of interruption manipulation, were explored by presenting young, as well as age-matched, normal-hearing (NH) listeners with full-spectrum and vocoded speech (eight-channel and speech intelligibility baseline performance matched). While the actual CI users had more difficulties in understanding interrupted speech and taking advantage of faster interruption rates and increased duty cycle than the eight-channel noise-band vocoded listeners, their performance was similar to the matched noise-band vocoded listeners. These results suggest that while loss of spectro-temporal resolution indeed plays an important role in reduced intelligibility of interrupted speech, these factors alone cannot entirely explain the deficit. Other factors associated with real CIs, such as aging or failure in transmission of essential speech cues, seem to additionally contribute to poor intelligibility of interrupted speech.     

Solitary bone metastasis in the tibia as a presenting sign of endometrial adenocarcinoma: a case report and the review of the literature

Background Metastasis to bone from endometrial adenocarcinoma is rare, when metastasises it usually locates in axial skeleton. Metastasis to extremities is extremely rare. Additionally the detection of the bone metastasis as a presenting feature is uncommon. In the present study we report the 10th cases of bone metastasis in the literature which located at tibial diaphysis and originated from endometrial adenocarcinoma as a presenting feature of the primary disease. Case Single tibial lesion was observed in a 70 years old woman. Biopsy confirmed metastatic adenocarcinoma of the unknown origin. We couldn’t find the primary origin with aggressive work-up. Tibial lesion regressed with radiotherapy. Endometrial adenocarcinoma is detected after the end of disease-free one year with the symptom of vaginal bleeding. After 47 months from initial tibial lesion and 35 months from gynaecologic operation, patient is still alive and disease free. Discussion Patients with endometrial adenocarcinoma presenting an isolated skeletal metastasis may exhibit an unusual group with a better prognosis. This study was presented as a poster exhibition at the 5th Meeting of Asia-Pasific Musculo Skeletal Tumour Society held between 23 and 25, April 2004, Izmir, Turkey.     

Utilization of health‐care services by young children: The aftermath of the Turkish Health Transformation Program

The Turkish Health Transformation Program, initiated in 2003, has identified achieving universal access to health care as 1 of its main tenets. To date, substantial progress has been made toward universal health coverage. Service utilization statistics display an upward trend. In this study, we use official and nationally representative microdata collected by the Turkish Health Research Surveys to examine young children's (ages 0‐5) utilization of health services. Children in this age group deserve special attention because adverse health conditions in early childhood are known to have long‐time consequences. Policy makers regularly monitor statistics such as infant mortality rate and under‐5 mortality rate. We conduct logistic regression analyses to explain the probabilities of being taken to a health institution, to a dentist, and being included in the newborn screening program. We use a rich set of explanatory variables that represent the socioeconomic status (SES) of the child's household. Contrary to our expectations and to the goals of universal health coverage is SES indicators such as the insurance ownership of the parent matter for utilization. Decomposition analyses confirm these findings and reveal that the increase in utilization should have been higher than observed. Children from low SES households should be given special attention and that research efforts should focus on identifying the barriers that still hinder children's utilization of health‐care services.     

A new approach to alar rim defects: mucocartilaginous turnover flap

The main principle of reconstructive surgery is replacement of the defective tissues with like tissues. A full-thickness defect of the nasal ala should be reconstructed in three layers: innermost mucosal layer, outermost skin, and the cartilage in-between. The aim of this study is to describe a technique for single-stage, three-layer reconstruction of the full-thickness ala nasi defects. This technique was used on three patients with tumors involving the nasal ala. Resulting full-thickness defects are reconstructed with a mucocartilaginous turnover flap planned from the contralateral side. Aesthetically acceptable results are obtained without the compromise of the nasal airway and with minimal donor site morbidity. None of the patients requested a revision operation. In conclusion, this is a novel technique with minimal donor site morbidity and good postoperative results. Moreover, lost tissues are replaced with exactly the same kind of tissues.