The aromatase inhibitor letrozole reduces adhesion formation after intraperitoneal surgery in a rat uterine horn model

Objective

To investigate, in an experimental animal study, the effects of letrozole and tamoxifen in the reduction of adhesion formation following abdominopelvic surgery.

Study design

Thirty female Wistar albino rats were included and divided into three groups. One group received 500 μg/d tamoxifen and a second group received 1 mg/kg/d letrozole through an enteric tube. A third group did not receive any drugs and served as the control group. On the fifth day, a laparotomy was performed and the right uterine horn was injured by monopolar cautery. The left uterine horn was incised with a scalpel and sutured. The preventive therapy protocols were continued for 7 days after surgery. On the 14th day after first surgery the animals were sacrificed, and the intraperitoneal macroscopic adhesion formation and microscopic adhesion features were evaluated. The Kruskal–Wallis test was used to compare the scores of the macroscopic adhesion scores and histologic features among the three groups, followed by a post hoc Mann–Whitney test. The total histological score was analyzed with a one-way ANOVA, followed by post hoc Bonferroni correction tests. p values ≤0.05 were considered statistically significant. The level of significance was set at p ≤ 0.016 for the post hoc tests.

Results

The letrozole and tamoxifen groups had significantly lower adhesion scores for the right uterine horn than the control group (p = 0.005 and p = 0.013, respectively). For the left horn, however, only the letrozole group had a lower macroscopic adhesion score than the controls (p = 0.011). The total histological score was significantly lower in the letrozole group than in the control group (p = 0.014), but no differences were found between the tamoxifen group and the control group (p = 0.954). Inflammation, fibroblastic activity, collagen formation and vascular proliferation were significantly lower in the letrozole group compared with the control group (p < 0.05). The foreign body reactions were similar among the three groups (p > 0.05). Tamoxifen administration did not result in any significant effects on the histological scores (p > 0.05).

Conclusion

Letrozole resulted in a significant decrease in postoperative macroscopic adhesion formation and the total histological scores, but tamoxifen did not demonstrate a similar effect on the histological scores.     

Electrocardiographic detection of emphysema

Emphysema of any pathogenesis (nearly always chronic obstructive pulmonary disease) verticalizes the frontal P-wave axis >60° in adults, which, as a single criterion, has screened for obstructive pulmonary disease. In patients with emphysema, the QRS was of a significantly shorter duration than that in matched control patients. We investigated whether combining these 2 criteria would better detect or screen for emphysema. From consecutive unselected daily electrocardiograms with sinus rhythm, 50 were selected with a P-wave axis of >60°. An equal control group from the same electrocardiogram continuum with a P-wave axis of ≤60° was matched for age and gender. The QRS durations were those measured by the electrocardiographic computer and manually verified individually. The charts were then reviewed for the diagnosis of chronic obstructive pulmonary disease and/or pulmonary emphysema according to the pulmonary function test and chest radiographic findings, respectively. The patients and controls were well matched demographically. Those with a vertical P axis had a strikingly greater incidence of emphysema than did the controls (86% vs 4%, respectively). The sensitivity of a P axis >60° was 96% and the specificity was 87%. The mean QRS duration with emphysema was significantly shorter (78 ± 8 vs 89 ± 6 ms, p <0.01). The combination of QRS duration <75 ms in conjunction with a P axis of >60° achieved a specificity of 100%, although the sensitivity decreased to 33%. We have reported multiple other cutpoints for each and for the combination. In conclusion, a P axis >60° can be used alone with very high sensitivity and specificity to detect emphysema. The verticality of the P axis is usually immediately visible in the limb leads; therefore, this could be a rapid screening test for emphysema. The specificity was increased when combined with a shortened QRS duration, at the cost of the sensitivity.     

Medical faculty and school of health student knowledge of and behavior regarding swine flu and vaccine, in Kahramanmaras, Turkey

This study was carried out to determine Medical Faculty and School of Health student knowledge of and behavior regarding swine flu and vaccine. The study was carried out at Kahramanmaras Sutcuimam University School of Health among the medical faculty and students. All 296 students of the Kahramanmaras Sutcuimam University School of Health and 76 students of the Faculty of Medicine were supposed to participate in the study. Ninety-six point one percent of the students in the study know high fever was one of the symptoms of swine flu, 91.8% said it was spread directly by sneezing or coughing and 95.5% knew washing hands with soap and water especially after coughing and sneezing, should be done to reduce the.risk of infection. Sixty-five point four percent of students knew fatigue and body aches were adverse effects of the swine flu vaccine. Only 9.6% of students received the pandemic flu vaccine. Their knowledge regarding symptoms and methods of spread was low, but regarding measures taken for prevention was high. Both swine flu knowledge and vaccine knowledge were higher in those who received the flu vaccine than in those who did not receive it. In pandemic situations, training should be given immediately to medical, midwifery and nursing students who are models for society.     

Childhood intracranial germinoma with granulomatous reaction

Central nervous system tumors are the second most common type of childhood cancer in Turkey. Germinomas constitute two thirds of intracranial germ cell tumors. The granulomatous inflammation occurring around germinomas can cause histological diagnostic difficulty. We present a 12-year-old girl with a diagnosis of germinoma in the corpus callosum associated with granulomatous reaction to emphasize the diagnostic challenge which may occur during stereotactic biopsy interpretation or intraoperative consultation.     

The use of mouse models to investigate shear bond strength in amelogenesis imperfecta

Patients with amelogenesis imperfecta (AI) have defective enamel; therefore, bonded restorations of patients with AI have variable success rates. To distinguish which cases of AI may have good clinical outcomes with bonded materials, we evaluated etching characteristics and bond strength of enamel in mouse models, comparing wild-type (WT) with those having mutations in amelogenin (Amelx) and matrix metalloproteinase-20 (Mmp20), which mimic 2 forms of human AI. Etched enamel surfaces were compared for roughness by scanning electron microscopy (SEM) images. Bonding was compared through shear bond strength (SBS) studies with 2 different systems (etch-and-rinse and self-etch). Etched enamel surfaces of incisors from Amelx knock-out (AmelxKO) mice appeared randomly organized and non-uniform compared with WT. Etching of Mmp20KO surfaces left little enamel, and the etching pattern was indistinguishable from unetched surfaces. SBS results were significantly different when AmelxKO and Mmp20KO enamel surfaces were compared. A significant increase in SBS was measured for all samples when the self-etch system was compared with the etch-and-rinse system. We have developed a novel system for testing shear bond strength of mouse incisors with AI variants, and analysis of these data may have important clinical implications for the treatment of patients with AI.     

Evaluation of microemulsion and liposomes as carriers for oral delivery of transforming growth factor alpha in rats

The aim of the present study is to develop microemulsion and liposome carrier systems for oral administration of transforming growth factor alpha (TGF-α) and to investigate the effects of these carrier systems on the gastrointestinal efficiency in rats. Microemulsion (w/o) and liposomes (MLV) were developed and characterised. The carrier systems were administered intragastrically by gastric cannula to male Wistar rats. The highest reduction in the basal acid secretion was observed in the microemulsion containing TGF-α and aprotinin group (TAME).The gastric mucus secretion in microemulsion containing TGF-α (TME) and TAME treatment groups increased significantly compared to the other groups. TGF-α levels in both stomach and duodenum were significantly increased in the TAME group. As a result, it was determined through confocal laser scanning microscope (CLSM) studies that exogenous-applied TGF-α attached to endogenous EGF receptors. The microemulsion formulation was found to be a more suitable carrier system for oral administration of TGF-α.     

Innovative topical formulations for treatment of dermatitis

The treatment of dermatitis with conventional dosage forms (ointment, cream, lotion etc.) has many concerns due to side effects especially in long-term therapy. Recent studies focused on strategies to optimize the potency of formulation while minimizing side effects. Several attempts have been made to increase the safety of treatment, including special vehicles (nanoparticle, liposome, patch etc.), combined therapy and new synthesized agents. This review provides major innovations and advances of new approaches for dermatitis treatment based on the published articles and patent applications.