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METHODS In (methods + in)
Selected AbstractsSkin Repair Using a Porcine Collagen I/III Membrane,Vascularization and Epithelization PropertiesDERMATOLOGIC SURGERY, Issue 6 2010FALK WEHRHAN MD BACKGROUND Collagen membranes have been developed to overcome the problem of limited availability of skin grafts. Vascularization and restricted functional epithelization limit the success of bioartificial constructs. OBJECTIVE To compare the vascularization, epithelization, and integration of a porcine collagen I/III membrane with that of split-thickness skin grafts on skin wounds. MATERIALS AND METHODS In 21 adult pigs, full-thickness skin defects on the rear side of the ear healed by split-thickness skin grafting, by covering with the membrane, or by free granulation. Skin samples on postoperative days 1, 3, 7, 14, 21, and 28 were evaluated histologically (hematoxylin-eosin, Sirius Red) and using immunohistochemistry (cytokeratin 5/6, transforming growth factor beta receptor (TGF,R-III) and immunoblot (TGF,1,3, Smad2/3). Epithelial thickness and TGF,R-III-positive capillary area were quantitatively assessed. RESULTS Epithelization and vascularization in the membrane group were not significantly different from in the group treated with a split-thickness skin graft. Free granulation showed significantly slower epithelization and vascularization (p<.05). TGF,1 and Smad2/3 complex expression were high during free granulation. Matrix was distinguishable until day 7. CONCLUSIONS This membrane serves as a suitable full-thickness dermal substitute, because the membrane is vascularized faster than free granulation tissue and enables early epithelization. Geistlich Biomaterials (Wolhusen, Switzerland) provided the collagen membrane used in this study [source] In Vivo Follicular Unit Multiplication: Is It Possible to Harvest an Unlimited Donor Supply?DERMATOLOGIC SURGERY, Issue 11 2006ERGIN ER MD BACKGROUND Follicular unit extraction is a process of removing one follicular unit at a time from the donor region. The most important limitation of this surgical procedure is a high transection rate. OBJECTIVE In this clinical study, we have transplanted different parts of transected hair follicle by harvesting with the follicular unit extraction technique (FUE) in five male patients. MATERIALS AND METHODS In each patient, three boxes of 1 cm2 are marked at both donor and recipient sites. The proximal one-third, one-half, and two-thirds of 15 hair follicles are extracted from each defined box and transplanted in recipient boxes. The density is determined at 12 months after the procedure. RESULTS A mean of 3 (range, 2,4) of the proximal one-third, 4.4 (range, 2,6) of the proximal one-half, and 6.2 (range, 5,8) of the proximal two-thirds of the transplanted follicles were observed as fully grown after 1 year. At the donor site, the regrowth rate was a mean of 12.6 (range, 10,14) of the proximal one-third, 10.2 (range, 8,13) of the proximal one-half, and 8 (range, 7,12) of the proximal two-thirds, respectively. CONCLUSION The survival rate of the transected hair follicles is directly related to the level of transection. Even the transected parts, however, can survive at the recipient site; the growth rate is not satisfactory and they are thinner than the original follicles. We therefore recommend that the surgeon not transplant the sectioned parts and be careful with the patients whose transection rate is high during FUE procedures. [source] Histometric and Histochemical Analysis of the Effect of Trichloroacetic Acid Concentration in the Chemical Reconstruction of Skin Scars MethodDERMATOLOGIC SURGERY, Issue 10 2006SUNG BIN CHO MD BACKGROUND Atrophic scars can be induced by various causes, including severely inflamed acne, chicken pox, and trauma. Many treatment modalities are used for reconstructing and improving the appearance of scars with various treatment results. OBJECTIVE A recent report shows the clinical efficacy of the chemical reconstruction of skin scars (CROSS) method, which consists of the focal application of trichloroacetic acid (TCA) in a higher concentration. Histometric analysis of the CROSS method, however, has not yet been established. METHODS In this study, five hairless mice were used to evaluate the effect of the CROSS method and to analyze the difference between the CROSS method and simple TCA application. RESULTS Similar histologic changes were observed in the two methods, including epidermal and dermal rejuvenation with new collagen deposition. These changes, however, were more prominent in the CROSS method,treated areas, particularly when 100% TCA was used. CONCLUSION The results of this study suggest that treatment of atrophic scars using the CROSS method is more effective than simple application of TCA in activating fibroblasts in the dermis and increasing the amount of collagen. [source] Pain Sensation during Intradermal Injections of Three Different Botulinum Toxin Preparations in Different Doses and DilutionsDERMATOLOGIC SURGERY, Issue 7 2006GOTTFRIED KRANZ MD BACKGROUND Pain sensation associated with injections of botulinum neurotoxin (BoNT) is commonly reported. To date differences in pain sensation between the commercially available products containing BoNT have not been quantified. OBJECTIVES The pain sensations during injection of Dysport, Botox, Neurobloc, and pure saline (control) were compared. In addition, the nociceptive effect of different volumes used for the dilution of the same BoNT dose was investigated. METHODS In a prospective, double-blind, controlled trial, 10 healthy subjects were injected intradermally with Dysport (12 U), Botox (3 and 4 U), Neurobloc (150 and 300 U) reconstituted in 0.9% saline, and pure saline. Pain sensation was quantified during injections. RESULTS Neurobloc injections caused significantly more injection pain than Botox, Dysport, and saline. No significant differences between Dysport, Botox, and saline were found, although there was a trend toward less pain with pure saline injections. Higher pain levels with higher volumes could not be demonstrated significantly. CONCLUSION Our data demonstrate that BoNT type B injections are associated with substantial pain. There is a considerable difference between the commercially available BoNT type B compared to the two BoNT type A preparations. Therefore, considering mitigation of injection pain seems necessary when using BoNT type B. [source] Healthcare Providers' Attitudes Toward Parent Participation in the Care of the Hospitalized ChildJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2003Susan Daneman BSN ISSUES AND PURPOSE To examine healthcare providers' attitudes toward parent participation in the care of their hospitalized child. DESIGN AND METHODS In this descriptive, comparative study, 504 pediatric healthcare providers were surveyed to measure attitudes toward parent participation. RESULTS Results from 256 respondents indicated support for parent participation, but there was substantially less support for parental activities usually carried out by healthcare providers and those involving complex patient care tasks. PRACTICE IMPLICATIONS Although pediatric healthcare providers support parent participation, they tend to draw the line on what they believe are suitable parent activities. Newly developed pain standards and cardiopulmonary resuscitation guidelines incorporating parent participation have important implications for expanding the boundaries of parental involvement. [source] Effects of age on the cardiac and vascular limbs of the arterial baroreflexEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 1 2003C. M. Brown Abstract Background Healthy ageing has several effects on the autonomic control of the circulation. Several studies have shown that baroreflex-mediated vagal control of the heart deteriorates with age, but so far there is little information regarding the effect of ageing on sympathetically mediated baroreflex responses. The aim of this study was to assess the effects of ageing on baroreflex control of the heart and blood vessels. Materials and Methods In 40 healthy volunteers, aged 20,87 years, we applied oscillatory neck suction at 0·1 Hz to assess the sympathetic modulation of the heart and blood vessels and at 0·2 Hz to assess the effect of parasympathetic stimulation on the heart. Breathing was maintained at 0·25 Hz. Blood pressure, electrocardiographic RR intervals and respiration were recorded continuously. Spectral analysis was used to evaluate the magnitude of the low-frequency (0·03,0·14 Hz) and high-frequency (0·15,0·50 Hz) oscillations in the RR interval and blood pressure. Responses to neck suction were assessed as the change in power of the RR interval and blood pressure fluctuations at the stimulation frequency from baseline values. Results Resting low- and high-frequency powers of the RR interval decreased significantly with age (P < 0·01). However, the low-frequency power of systolic blood pressure did not correlate with age. Spontaneous baroreflex sensitivity (alpha-index) showed a significant inverse correlation with age (r = ,0·46, P < 0·05). Responses of the RR interval and systolic blood pressure to 0·1 Hz neck suction stimulation were not related to age, however, the RR interval response to 0·2 Hz neck suction declined significantly with age (r = ,0·61, P < 0·01). Conclusions These results confirm an age-related decrease in cardiovagal baroreflex responses. However, sympathetically mediated baroreflex control of the blood vessels is preserved with age. [source] The effect of amitriptyline on pain intensity and perception of stress in bruxersJOURNAL OF PROSTHODONTICS, Issue 2 2001Ariel J. Raigrodski DMD Purpose The purpose of this clinical pilot study was to evaluate the effect of a tricyclic antidepressant, amitriptyline, on pain-intensity level and level of stress in bruxers. Materials and Methods In a randomized, double-blind, crossover experimental design, 10 subjects received active (amitriptyline 25 mg/night) and inactive (placebo 25 mg/night) medication, over a period of 4 weeks. Results The administration of amitriptyline for 4 weeks did not significantly (p > .05) reduce pain intensity. However, it significantly (p < .05) reduced the level of stress perception. Conclusion The results of this limited study do not support the administration of small doses of amitriptyline over a period of 4 weeks for the management of pain resulting from sleep bruxism. However, the results support the administration of small doses of amitriptyline for the management of the perception of stress levels associated with sleep bruxism. [source] Ventilation Time of the Middle Ear in Otitis Media With Effusion (OME) After CO2 Laser MyringotomyTHE LARYNGOSCOPE, Issue 4 2002Benedikt Sedlmaier MD Abstract Objective The aim of this study was to investigate the transtympanic ventilation time, the healing course of the tympanic membrane, the early and late complications, and the recurrence rate of otitis media with effusion (OME) within 6 months after CO2 laser myringotomy with the CO2 laser otoscope Otoscan. Study Design Prospective clinical study. Materials and Methods In this study, laser myringotomy was performed with the CO2 laser otoscope Otoscan in a patient population comprising 81 children (159 ears) with a history of otitis media with effusion (OME) associated with adenoidal and sometimes tonsillar hyperplasia. The procedure on the tympanic membrane was accordingly combined with an adenoidectomy, a CO2 laser tonsillotomy, or a tonsillectomy and therefore performed under insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12 to 15 W, a pulse duration of 180 msec, and a scanned area of 2.2 mm in diameter. Results None of the children showed postoperative impairment of cochleovestibular function such as sensorineural hearing loss or nystagmus. Otomicroscopic and videoendoscopic monitoring documented the closure time and healing pattern of tympanic membrane perforations. The mean closure time was found to be 16.35 days (minimum, 8 days; maximum, 34 days). As a rule, an onion-skin-like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow-up 6 months later, the condition of the tympanic membrane of 129 ears (81.1%) could be checked by otomicroscopy and videoendoscopy and the hearing ability by audiometry and tympanometry. The CO2 laser myringotomy sites appeared normal and irritation-free. Two of the tympanic membranes examined (1.6%) showed atrophic scar formation, and 1 (0.8%) had a perforation with a diameter of 0.3 mm. The perforation was seen closed in a control otoscopy 15 months postoperatively. OME recurred in 26.3% of the ears seen intraoperatively with mucous secretion (n = 38) and in 13.5% of the ears with serous secretion (n = 37;P <.05). Conclusion The most important principle in treating OME is ventilation of the tympanic cavity. CO2 laser myringotomy achieves this through a self-healing perforation in which its diameter roughly determines the duration of transtympanic ventilation. Laser myringotomy competes with ventilation tube insertion in the treatment of OME. It may be a useful alternative in the surgical management of secretory otitis media. [source] Increases in collagen type I synthesis in asthma: the role of eosinophils and transforming growth factor-b,CLINICAL & EXPERIMENTAL ALLERGY, Issue 6 2002A. Nomura Summary Background Collagen type I is one of the major deposits in thickening of the reticular basement membrane of asthma. Objective and Methods In this study, we assessed turnover of collagen type I in asthma by measuring procollagen type I C-terminal peptide (PICP) and collagen type I C-terminal telopeptide (ICTP) in induced sputum. Results PICP but not ICTP was found to be significantly higher in asthma subjects than in normal volunteers (P < 0.05). In asthma, PICP was inversely correlated with %FEV1.0 (r = ,0.539), and its levels significantly increased upon exacerbation (P < 0.05), indicating that collagen synthesis increases during asthma exacerbation. Additionally, PICP was found to significantly correlate with eosinophil counts in sputum (r = 0.539), indicating that eosinophils stimulate collagen turnover. Because eosinophils can produce TGF-,, a potent stimulator of collagen synthesis, we immunocytochemically examined TGF-,-positive cells in sputum. TGF-,-positive cells significantly correlated with eosinophil counts (r = 0.811) and PICP (r = 0.569), suggesting that TGF-, released from eosinophils is involved in collagen synthesis. Conclusions The results of the present study suggest that collagen synthesis is stimulated in asthmatic airways by eosinophils through TGF-,, while collagen degradation is not, and that PICP in sputum can act as a new marker for airway inflammation in asthma. [source] Medical students' personality characteristics and academic performance: a five-factor model perspectiveMEDICAL EDUCATION, Issue 11 2002Filip Lievens Objectives, This study investigates: (1) which personality traits are typical of medical students as compared to other students, and (2) which personality traits predict medical student performance in pre-clinical years. Design, This paper reports a cross-sectional inventory study of students in nine academic majors and a prospective longitudinal study of one cohort of medical students assessed by inventory during their first preclinical year and by university examination at the end of each pre-clinical year. Subjects and methods In 1997, a combined total of 785 students entered medical studies courses in five Flemish universities. Of these, 631 (80·4%) completed the NEO-PI-R (i.e. a measure of the Five-Factor Model of Personality). This was also completed by 914 Year 1 students of seven other academic majors at Ghent University. Year end scores for medical students were obtained for 607 students in Year 1, for 413 in Year 2, and for 341 in Year 3. Results, Medical studies falls into the group of majors where students score highest on extraversion and agreeableness. Conscientiousness (i.e. self-achievement and self-discipline) significantly predicts final scores in each pre-clinical year. Medical students who score low on conscientiousness and high on gregariousness and excitement-seeking are significantly less likely to sit examinations successfully. Conclusions, The higher scores for extraversion and agreeableness, two dimensions defining the interpersonal dynamic, may be beneficial for doctors' collaboration and communication skills in future professional practice. Because conscientiousness affects examination results and can be reliably assessed at the start of a medical study career, personality assessment may be a useful tool in student counselling and guidance. [source] | ||||||||||