Topical N-Acetylcysteine Improves Wound Healing Comparable to Dexpanthenol: An Experimental Study

In this study, we aimed to compare the effects of dexpanthenol and N-acetylcysteine on wound healing. The wound healing process is a multifaceted sequence of activities associated with tissue restoration process. A number of investigations and clinical studies have been performed to determine new approaches for the improvement of wound healing. A total of 30 rats were divided into 3 equal groups. A linear 2-cm incision was made in the rats'' skin. No treatment was administered in the first (control) group. Dexpanthenol cream was administered to the rats in the second group and 3% N-acetylcysteine cream was administered to the rats in the third group. The wound areas of all of the rats were measured on certain days. On the 21st day, all wounds were excised and histologically evaluated. The epithelialization and granulation rates between the groups were revealed to be similar in microscopic evaluations. Although the fibrosis was remarkable in the control group as compared with the other groups, it was similar in N-acetylcysteine and dexpanthenol groups. Angiogenesis rate was remarkable in the N-acetylcysteine group compared with the others. In multiple-comparison analysis, Dexpanthenol and N-acetylcysteine groups had similar results in terms of wound healing rates (P < 0.05), which were both higher than in the control group (P > 0.05). The efficacy of N-acetylcysteine in wound healing is comparable to dexpanthenol, and both substances can be used to improve wound healing.Key words: N-acetylcysteine, Dexpanthenol, Wound healingWound healing is a multifaceted sequence of activities associated with the tissue restoration process.¹ This activity takes place in 4 main steps: inflammation, proliferation, matrix deposition, and remodeling.^2,3 Moreover, there are many factors that might have harmful effects on the wound healing process. In this regard, there have been numerous analyses and clinical studies aiming to find new methods for the improvement of wound healing processes.⁴Dexpanthenol is the biologically-active alcohol of pantothenic acid, which leads to an elevation in the amount of coenzyme A in the cell. Dexpanthenol is extensively used in topical form, since it can easily penetrate the skin even at large local concentrations. When used in formulations, dexpanthenol is most effective for the stimulation of epithelialization, granulation, and the mitigation of itching.⁵N-acetylcysteine (NAC) is a prodrug that supplies bioavailable cysteine for glutathione replenishment and prevents oxidative damage as well as inflammation. It also leads to glutathione (GSH) formation in the body. Besides fostering angiogenesis, it is used to scavenge free radicals. NAC has a number of functions in the stages of repair process, including cell proliferation, migration, and scratch wound healing. Moreover, NAC has also been reported to promote wound healing in diabetic rats.⁶In this study, we aimed to compare the effects of dexpanthenol, a molecule that is widely used to improve wound healing, and NAC, a molecule that reduces oxidative stress and inflammation, on wound healing.     

An evaluation of the role of tumor load in cytoreductive nephrectomy

IntroductionNew radiological tools can accurately provide preoperative three-dimensional spatial assessment of metastatic renal cell carcinoma (RCC). We aimed to determine whether the distribution, volume, shape, and fraction of RCC resected in a cytoreductive nephrectomy associates with survival.MethodsWe retrospectively reviewed 560 patients undergoing cytoreductive nephrectomy, performing a comprehensive volumetric analysis in eligible patients of all detectable primary and metastatic RCC prior to surgery. We used Cox regression analysis to determine the association between the volume, shape, fraction resected, and distribution of RCC and overall survival (OS).ResultsThere were 62 patients eligible for volumetric analysis, with similar baseline characteristics to the entire cohort, and median survivor followup was 34 months. Larger primary tumors were less spherical, but not associated with different metastatic patterns. Increased primary tumor volume and tumor size, but not the fraction of tumor resected, were associated with inferior survival. The rank of tumors based on unidimensional size did not completely correspond to the rank by primary tumor volume, however, both measurements yielded similar concordance for predicted OS. Larger tumor volume was not associated with a longer postoperative time off treatment.ConclusionsPrimary tumor volume was significant for predicting OS, while the fraction of disease resected did not appear to impact patient outcomes. Although rich in detail, our study is potentially limited by selection bias. Future temporal studies may help elucidate whether the primary tumor shape is associated with tumor growth kinetics.     

The epigenetic effect of nicotine on dopamine D1 receptor expression in rat prefrontal cortex

Nicotine is a highly addictive drug and exerts its effect partially through causing dopamine release, thereby increasing intrasynaptic dopamine levels in the brain reward systems. Dopaine D1 receptor (DRD1) mRNAs and receptors are localized in reward‐related brain regions, which receive cholinergic input. The aim of this study is to evaluate whether nicotine administration affects the expression of DRD1s, and if so, whether epigenetic mechanisms, such as histone acetylation, are involved. Twenty Male Sprague Dawley rats received nicotine (0.4 mg/kg/day, s.c.) or saline injections for 15 days. After nicotine/saline treatment, rats were perfused with saline; prefrontal cortex (PFC), corpus striatum (STR), and ventral tegmental area (VTA) were dissected. Homogenates were divided into two parts for total RNA isolation and histone H4 acetylation studies. DRD1 mRNA expression was significantly higher in the PFC of the nicotine‐treated group compared with controls; similar trends were observed in the VTA and STR. To study epigenetic regulation, the 2kb upstream region of the DRD1 gene promoter was investigated for histone H4 acetylation in PFC samples. After chromatin immunoprecipitation with anti‐acetyl histone H4 antibody, we found an increase in histone acetylation by two different primer pairs which amplified the ?1365 to ?1202 (P < 0.005) and ?170 to +12 (P < 0.05) upstream regions of the DRD1 promoter. Our results suggest that intermittent subcutaneous nicotine administration increases the expression of DRD1 mRNA in the PFC of rats, and this increase may be due to changes in histone H4 acetylation of the 2kb promoter of the DRD1 gene. Synapse 67:545–552, 2013. © 2013 Wiley Periodicals, Inc.     

Speaker Abstracts

Narcolepsy is a rare disorder characterised by sleep disturbances, cataplexy, sleep paralysis and hypnagogic, hypnopompic hallucinations. Although several treatment modalities, such as tricyclic antidepressants or selective serotonin reuptake inhibitors, have been used to treat different symptoms, there is no definite treatment for narcolepsy. Modafinil or amphetamine-like stimulants, such as dexamphetamine or methylphenidate, are used to treat sleepiness. Our case was a 58-year-old woman who was diagnosed as narcolepsy cataplexy syndrome. Her Epworth Sleepiness Scale (ESS) score was 14 and Beck Depression Inventory (BDI) score was 29 in the first evaluation. Imipramine and modafinil were begun for the treatment, but there was no improvement in her symptoms. Subsequently, bupropion was started at 150 mg/day and then dosage was increased to 300 mg/day. She was asymptomatic at the end of 3 months. To our knowledge, this is the second depressive narcoleptic patient who has responded to 300 mg/day of bupropion.     

Angio-Seal Used as a Bailout for Incomplete Hemostasis After Dual Perclose ProGlide Deployment in Transcatheter Aortic Valve Implantation

BackgroundThe failure rate of vascular closure devices remains a significant cause of major vascular complications in contemporary transcatheter aortic valve implantation practice.MethodsThis research aimed to evaluate use of the Angio-Seal device in a bailout context in the setting of incomplete hemostasis following use of dual Perclose ProGlide devices in patients undergoing transfemoral transcatheter aortic valve implantation. A total of 185 patients undergoing transfemoral transcatheter aortic valve implantation with either dual Per-close ProGlide (n = 139) or a combination of dual Perclose ProGlide and Angio-Seal (n = 46) were retrospectively analyzed. The baseline, procedural characteristics, and all outcomes (defined according to Valve Academic Research Consortium-2 criteria) were compared.ResultsNo significant differences were seen between the dual Perclose ProGlide vs dual Perclose ProGlide+Angio-Seal groups with regard to the in-hospital Valve Academic Research Consortium-2 primary end points of major vascular complications (n = 13 [9.4%] vs n = 2 [4.3%]; P = .36), minor vascular complications (n = 13 [9.4%] vs n = 8 [14.7%]; P = .14), major bleeding (n = 16 [11.5%] vs n = 2 [4.3%]; P = .25), and minor bleeding (n = 9 [6.5%] vs n = 5 [10.9%]; P = .34), with higher rates of hematoma in the dual Perclose ProGlide+Angio-Seal group (n = 4 [2.9%] vs n = 5 [10.9%]; P = .044).ConclusionFinding from the current study suggest that adjunctive Angio-Seal deployment may be feasible and safe, especially in patients with incomplete hemostasis following dual Perclose ProGlide use, and can be an optimal “bailout” procedure.     

Clinical assessment of EMA/CO induced DNA damage in peripheral blood lymphocytes of high-risk gestational trophoblastic tumor patients.

From 1989 to 1994, Etoposide, Methotrexate, Actinomycin-D, Cyclophosphamide, Vincristine, Folic acid (EMA/CO) regimen was administered to seven patients with high-risk gestational tumours according to the Bagshawe 1976 criteria. Peripheral blood lymphocytes were obtained from two of these seven high-risk gestational trophoblastic patients receiving the EMA/CO regimen, and damage levels of DNA during chemotherapy were assessed using SCGE (single cell gel electrophoresis) assay. Additionally, the efficacy, toxicity and clinical results of EMA/CO regimen were evaluated in patients with high-risk gestational trophoblastic tumours. Fever (71.4%), leukopenia (57%), increase in transaminase concentrations (57%), trombocytopenia (57%), and anemia (57%) were among the most frequent side-effects of the EMA/CO regimen. All these toxic effects were reversible and there was no need to stop the therapy. EMA/CO is highly effective in patients with high-risk gestational trophoblastic disease and its toxicity is predictable and reversible. Because of chemotherapy, DNA damage that is shown in peripheral blood lymphocytes, increases at the 8th day of the EMA/CO regimen. When DNA damage is higher in patients, the course of chemotherapy per each patient is shortened. When DNA damage is higher in the patients, the multisystem effects due to toxicity are more significant. The SCGE assay has many possibilities in such research and has proved to be a relatively simple, quick and sensitive technique.     

Virchow's node as a first manifestation of ovarian serous carcinoma: case report

Ovarian carcinoma is a malignancy with a poor prognosis especially in patients with advanced disease. The majority of patients with ovarian serous carcinoma are diagnosed in advanced stages. Palpable extraabdominal lymphadenopathy at the time of presentation is distinctly uncommon. This case report addresses a patient with serous ovarian carcinoma presenting as left supraclavicular lymphadenopathy (Virchow's node) and no other symptoms. Not only thyroid or thoracic malignancies but also ovarian malignancies like serous ovarian carcinoma could present with a supraclavicular lymph node without any other symptoms.