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Bronchoscopic lung volume reduction treatment with Zephyr one-way valves is an effective guideline-based treatment option for patients with severe emphysema and hyperinflation. However, in some cases the treatment response is less than anticipated or there might be a loss of initial treatment effect. Reasons for the lack of response can include incorrect assessment of collateral ventilation, improper valve placement, or patient related factors. Loss of initial benefit can be due to granulation tissue formation and subsequent valve dysfunction, or there may be side effects such as excessive coughing or infectious problems. Careful follow-up after treatment with valves is important and evaluation with a CT scan and/or bronchoscopy is helpful if there is no improvement after treatment or loss of initial benefit. This paper aims to describe the most important causes and provide a strategy of how to approach and manage these patients., Bronchoscopic lung volume reduction treatment with Zephyr one-way valves is an effective guideline-based treatment option for patients with severe emphysema and hyperinflation. However, in some cases the treatment response is less than anticipated or there might be a loss of initial treatment effect. Reasons for the lack of response can include incorrect assessment of collateral ventilation, improper valve placement, or patient related factors. Loss of initial benefit can be due to granulation tissue formation and subsequent valve dysfunction, or there may be side effects such as excessive coughing or infectious problems. Careful follow-up after treatment with valves is important and evaluation with a CT scan and/or bronchoscopy is helpful if there is no improvement after treatment or loss of initial benefit. This paper aims to describe the most important causes and provide a strategy of how to approach and manage these patients.

Bronchoscopic lung volume reduction treatment with Zephyr one-way valves is an effective guideline-based treatment option for patients with severe emphysema and hyperinflation. However, in some cases the treatment response is less than anticipated or there might be a loss of initial treatment effect. Reasons for the lack of response can include incorrect assessment of collateral ventilation, improper valve placement, or patient related factors. Loss of initial benefit can be due to granulation tissue formation and subsequent valve dysfunction, or there may be side effects such as excessive coughing or infectious problems. Careful follow-up after treatment with valves is important and evaluation with a CT scan and/or bronchoscopy is helpful if there is no improvement after treatment or loss of initial benefit. This paper aims to describe the most important causes and provide a strategy of how to approach and manage these patients., Bronchoscopic lung volume reduction treatment with Zephyr one-way valves is an effective guideline-based treatment option for patients with severe emphysema and hyperinflation. However, in some cases the treatment response is less than anticipated or there might be a loss of initial treatment effect. Reasons for the lack of response can include incorrect assessment of collateral ventilation, improper valve placement, or patient related factors. Loss of initial benefit can be due to granulation tissue formation and subsequent valve dysfunction, or there may be side effects such as excessive coughing or infectious problems. Careful follow-up after treatment with valves is important and evaluation with a CT scan and/or bronchoscopy is helpful if there is no improvement after treatment or loss of initial benefit. This paper aims to describe the most important causes and provide a strategy of how to approach and manage these patients.

Forensic post-mortem examinations of animals are carried out on suspicion of violation of European and national legislation. In Denmark, and probably also in other countries with large-scale cattle production, cattle are regularly submitted for forensic assessment. Unfortunately, only few studies of forensic pathology in cattle are available. This paper presents a retrospective study of forensic case files on Danish cattle from January 2010 to December 2021. The case files were characterized with respect to types of lesion, age assessments of lesions and other parameters such as age and sex. A total of 118 forensic case files had been archived and related to 132 cattle (14 weeks–20 years of age; 68% female, 30% male and 2% unknown sex) with 228 lesions. Locomotor disorders constituted the majority of lesions. However, cachexia/emaciation, skin ulcerations and overgrowth of cornual horn were also frequent. Most lesions were chronic (91%) and age assessments for more than 2 weeks were stated for 79% of the lesions. This indicates that in Denmark at least, there is a need to consider how cattle with locomotor disorders are treated in a timely manner in order to avoid prolonged futile treatment and, thereby, suffering. Grossly visible reparative granulation tissue and new bone formation were present in lesions of 1–2 weeks and longer duration. However, all age assessments were stated in broad time intervals due to the lack of scientifically based forensic studies of age assessments of lesions in cattle. Therefore, to improve age assessments in forensic cattle cases, studies concerning the chronology of tissue reparation in cattle are warranted. We also present a guideline for the forensic examination of cattle.

Forensic post-mortem examinations of animals are carried out on suspicion of violation of European and national legislation. In Denmark, and probably also in other countries with large-scale cattle production, cattle are regularly submitted for forensic assessment. Unfortunately, only few studies of forensic pathology in cattle are available. This paper presents a retrospective study of forensic case files on Danish cattle from January 2010 to December 2021. The case files were characterized with respect to types of lesion, age assessments of lesions and other parameters such as age and sex. A total of 118 forensic case files had been archived and related to 132 cattle (14 weeks–20 years of age; 68% female, 30% male and 2% unknown sex) with 228 lesions. Locomotor disorders constituted the majority of lesions. However, cachexia/emaciation, skin ulcerations and overgrowth of cornual horn were also frequent. Most lesions were chronic (91%) and age assessments for more than 2 weeks were stated for 79% of the lesions. This indicates that in Denmark at least, there is a need to consider how cattle with locomotor disorders are treated in a timely manner in order to avoid prolonged futile treatment and, thereby, suffering. Grossly visible reparative granulation tissue and new bone formation were present in lesions of 1–2 weeks and longer duration. However, all age assessments were stated in broad time intervals due to the lack of scientifically based forensic studies of age assessments of lesions in cattle. Therefore, to improve age assessments in forensic cattle cases, studies concerning the chronology of tissue reparation in cattle are warranted. We also present a guideline for the forensic examination of cattle.

CRUE-CSIC (Acuerdos Transformativos 2022), Objectives To identify titanium particles (TPs) in biopsy specimens harvested from peri-implantitis lesions and secondarily to study the histopathological characteristics in peri-implantitis compared to periodontitis, in order to evaluate whether the presence of TPs could alter respective inflammatory patterns. Material and methods Biopsies containing granulation tissue were harvested during routine surgical treatment in 39 peri-implantitis cases and 35 periodontitis controls. Serial sections were obtained using titanium-free microtome blades. The first and last sections of the peri-implantitis specimens were used for identification of TPs by scanning electron microscopy coupled with dispersive X-ray spectrometry. Intermediate sections and periodontitis specimens were processed for descriptive histological study using haematoxylin–eosin staining and for immunohistochemical analysis using CD68, IL-6, Nf-kB and VEGF markers. Results TPs were identified in all peri-implantitis specimens as free metal bodies interspersed within granulation tissue. However, presence of macrophages or multinucleated giant cells engulfing the TPs were not identified in any specimen. Peri-implantitis granulations were characterized by a chronic inflammatory infiltrate rich in neutrophils. About half of peri-implantitis patients exhibited a subacute infiltrate characterized with lymphocytes interweaved with neutrophils and eosinophils. When compared to periodontitis, peri-implantitis tissues showed higher proportions of macrophages and a more intense neovascularization, based on significantly higher expression of CD68 and VEGF respectively. Conclusion TPs were identified in all peri-implantitis specimens, but without evidencing any foreign body reaction suggestive for direct pathological effects of TPs. The peri-implantitis granulation tissue was characterized by intense neovascularization and presence of a chronic inflammatory infiltrate dominated by plasma cells, neutrophils and macrophage, Depto. de Especialidades Clínicas Odontológicas, Fac. de Odontología, TRUE, pub

Lobular capillary hemangioma (LCH-PG) is a type of pyogenic granuloma characterized by proliferating blood vessels that resemble conventional granulation tissue. Granulation tissue is very often seen in association with ingrown toenails. Despite the close relationship between both entities, LCH-PG shows clinically different behaviors, such as rapid growth and frequent recurrence. Currently, it is unknown exactly how the different etiological factors contribute to the formation of differences between entities. We present a case of a large LCH-PG associated with chronic onychocryptosis in a 26-year-old man. Histopathological features included extensive signs of ulceration, hyperkeratosis, and patchy epidermal acanthosis with the presence of fibrous septa with lobular areas beneath the ulcerative area. The presence of stroma with a marked proliferation of blood vessels with wall thickening and mixed-type inflammatory changes was also characteristic. In advanced stages of onychocryptosis, as presented here, conventional granulation tissue or pyogenic granuloma can be clinically difficult to distinguish from other benign or malignant neoplasms. Histological examination is mandatory, and excisional biopsy can provide a definitive diagnosis.

Lobular capillary hemangioma (LCH-PG) is a type of pyogenic granuloma characterized by proliferating blood vessels that resemble conventional granulation tissue. Granulation tissue is very often seen in association with ingrown toenails. Despite the close relationship between both entities, LCH-PG shows clinically different behaviors, such as rapid growth and frequent recurrence. Currently, it is unknown exactly how the different etiological factors contribute to the formation of differences between entities. We present a case of a large LCH-PG associated with chronic onychocryptosis in a 26-year-old man. Histopathological features included extensive signs of ulceration, hyperkeratosis, and patchy epidermal acanthosis with the presence of fibrous septa with lobular areas beneath the ulcerative area. The presence of stroma with a marked proliferation of blood vessels with wall thickening and mixed-type inflammatory changes was also characteristic. In advanced stages of onychocryptosis, as presented here, conventional granulation tissue or pyogenic granuloma can be clinically difficult to distinguish from other benign or malignant neoplasms. Histological examination is mandatory, and excisional biopsy can provide a definitive diagnosis.

Lobular capillary hemangioma (LCH-PG) is a type of pyogenic granuloma characterized by proliferating blood vessels that resemble conventional granulation tissue. Granulation tissue is very often seen in association with ingrown toenails. Despite the close relationship between both entities, LCH-PG shows clinically different behaviors, such as rapid growth and frequent recurrence. Currently, it is unknown exactly how the different etiological factors contribute to the formation of differences between entities. We present a case of a large LCH-PG associated with chronic onychocryptosis in a 26-year-old man. Histopathological features included extensive signs of ulceration, hyperkeratosis, and patchy epidermal acanthosis with the presence of fibrous septa with lobular areas beneath the ulcerative area. The presence of stroma with a marked proliferation of blood vessels with wall thickening and mixed-type inflammatory changes was also characteristic. In advanced stages of onychocryptosis, as presented here, conventional granulation tissue or pyogenic granuloma can be clinically difficult to distinguish from other benign or malignant neoplasms. Histological examination is mandatory, and excisional biopsy can provide a definitive diagnosis.

We report a case of a nine-year-old boy with clinical evidence of foreign body (FB) aspiration with 3 months of delay in diagnosis. The bronchoscopy found soft tissue FB with surrounding inflamed granulation tissue at the entrance to the lateral segmental bronchus. Repeated attempts to remove the FB with flexible forceps were unsuccessful due to friable FB and granulation tissue. Ablation of the granulation tissue using nitrous oxide cryotherapy was then successfully performed and the distal and organic FB was extracted. Early diagnosis is important for minimizing granulation tissue development which complicates FB removal. Cryotherapy with a flexible bronchoscope is an option if organic FB cannot be removed using conventional bronchoscopic instrumentation.

Objectives/Hypothesis: To establish comprehensive transcriptomic profiles of cholesteatoma perimatrix tissue and granulation tissue from chronic otitis media (COM) that did not develop cholesteatoma, which can indicate molecular pathways involved in the cholesteatoma perimatrix pathology and invasiveness. Study Design: Retrospective Case Series. Methods: Transcriptome data were obtained from cholesteatoma perimatrix tissue and COM granulation tissue by an Illumina iScan microarray. Differentially expressed genes (DEGs) were subsequently analyzed using both bioinformatical functional annotation and network analysis. Expression of candidate genes (MMP9 and LCN2) was validated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) on a larger group of samples. Results: Analysis of the transcriptome led to the identification of 169 differentially expressed genes between investigated tissues. Bioinformatic analysis suggested that most significant biological processes involving DEGs were previously described in cholesteatoma pathology. Network analysis identified ERBB2, TFAP2A, and TP63 as major hubs of the DEGs molecular network. Furthermore, it was observed that the cellular component most significantly enriched in DEGs was extracellular space containing 47 DEGs. Using qRT-PCR, it was confirmed that mRNA levels of the major extracellular hub (MMP9) are increased, whereas its interacting molecule (LCN2) mRNA levels were decreased in cholesteatoma perimatrix tissue compared to COM granulation tissue. Conclusions: The current study approach offers an overall look at molecular mechanisms that describe the cholesteatoma entity by focusing exclusively on the perimatrix processes in comparison to COM granulation tissue. The observed differences in gene expression between cholesteatoma perimatrix and COM granulation tissue could suggest novel markers potentially influenced by the perimatrix–matrix molecular interplay, which is not present in COM without chole

Objectives/Hypothesis: To establish comprehensive transcriptomic profiles of cholesteatoma perimatrix tissue and granulation tissue from chronic otitis media (COM) that did not develop cholesteatoma, which can indicate molecular pathways involved in the cholesteatoma perimatrix pathology and invasiveness. Study Design: Retrospective Case Series. Methods: Transcriptome data were obtained from cholesteatoma perimatrix tissue and COM granulation tissue by an Illumina iScan microarray. Differentially expressed genes (DEGs) were subsequently analyzed using both bioinformatical functional annotation and network analysis. Expression of candidate genes (MMP9 and LCN2) was validated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) on a larger group of samples. Results: Analysis of the transcriptome led to the identification of 169 differentially expressed genes between investigated tissues. Bioinformatic analysis suggested that most significant biological processes involving DEGs were previously described in cholesteatoma pathology. Network analysis identified ERBB2, TFAP2A, and TP63 as major hubs of the DEGs molecular network. Furthermore, it was observed that the cellular component most significantly enriched in DEGs was extracellular space containing 47 DEGs. Using qRT-PCR, it was confirmed that mRNA levels of the major extracellular hub (MMP9) are increased, whereas its interacting molecule (LCN2) mRNA levels were decreased in cholesteatoma perimatrix tissue compared to COM granulation tissue. Conclusions: The current study approach offers an overall look at molecular mechanisms that describe the cholesteatoma entity by focusing exclusively on the perimatrix processes in comparison to COM granulation tissue. The observed differences in gene expression between cholesteatoma perimatrix and COM granulation tissue could suggest novel markers potentially influenced by the perimatrix–matrix molecular interplay, which is not present in COM without chole

Hidradenitis suppurativa (HS) is a potentially debilitating dermatological disease that negatively impacts patients' quality of life. Severe cases can be further complicated by persistent granulation tissue at the ostia of sinus tracts, which may prove recalcitrant to standard interventions. Herein we report such a case in which a patient experienced significant improvement from severe HS but was left with persistent granulation tissue that complicated his course of recovery. When standard interventions failed, we elected to begin treatment with topical timolol. After three months, the majority of the granulation tissue had regressed and has remained quiescent after 12 months of follow up. The patient has tolerated the treatment well and continues to use topical timolol daily as needed for flares. We believe that topical timolol can provide a practical and painless alternative to current invasive and expensive therapies for persistent granulation tissue associated with severe HS.

Hidradenitis suppurativa (HS) is a potentially debilitating dermatological disease that negatively impacts patients' quality of life. Severe cases can be further complicated by persistent granulation tissue at the ostia of sinus tracts, which may prove recalcitrant to standard interventions. Herein we report such a case in which a patient experienced significant improvement from severe HS but was left with persistent granulation tissue that complicated his course of recovery. When standard interventions failed, we elected to begin treatment with topical timolol. After three months, the majority of the granulation tissue had regressed and has remained quiescent after 12 months of follow up. The patient has tolerated the treatment well and continues to use topical timolol daily as needed for flares. We believe that topical timolol can provide a practical and painless alternative to current invasive and expensive therapies for persistent granulation tissue associated with severe HS.

The results of experimental research of the local use influence of hyaluronic acid on peculiarities of granulation tissue formation round the elements of reticular implant of the muscular-aponeurotic layer of the anterior abdominal wall are presented in this article. The research was carried out on 54 laboratory rats which were implanted by reticular implant into the muscular-aponeurotic layer of the anterior abdominal wall. Gel of hyaluronic acid in the form of LACERTA 1,5% preparation of YURI-FARM was applied along the surface of reticular implant to the animals of the main group. The group of comparison consisted of animals which had been just implanted by the reticular implant into the muscular-aponeurotic layer of the anterior abdominal wall. Material sampling was carried out on the 3th, 5th and 7th day following the operative interference by means of cutting tissues together with reticular implant. Parafine sections were coloured with hematotoxiline and eosine, as well as water blue-chromotrop 2 B according to N.Z. Slinchenko. Descriptive method of the detected pathomorphological changes was used. Morphometry was carried out with the help of computer microdensitometry. The obtained data of the investigation are evidence that local use of hyaluronic acid in plastics of the anterior abdominal wall with reticular implant during the first five days of early post-operative period do not influence upon formation of granulation tissue formation with the exception that it decreases the quantity of fibrinogen. During the next 4 days of early post-operative period, hyaluronic acid results in significant increase of the quantity of collagenous fibres round the elements of reticular implant and their density, however, the quantity of cells almost did not change, that is not quite logical from the point of view of pathophysiology of the wound process. Hyaluronic acid also positively influence on decreasing specific gravity of the blood vessels in granula, В даній статті представлено результати експериментального дослідження впливу місцевого застосування гіалуронової кислоти на особливості формування грануляційної тканини навколо елементів сітчастого імплантату м’язово-апоневротичного шару передньої черевної стінки.Встановлено, що місцеве застосування гіалуронової кислоти, при пластиці передньої черевної стінки сітчастим імплантатом, призводить до збільшення питомого об’єму та щільності колагенових волокон навколо елементів останньої, тим самим укріплює передню черевну стінку, а також зменшує запальні процеси в тканинах, спричинені операційною травмою., В данной статье представлено результаты экспериментального исследования влияния местного применения гиалуроновой кислоты на особенности формирования грануляционной ткани вокруг элементов сетчатого имплантата мышечно-апоневротического слоя передней брюшной стенки.Установлено, что местное применение гиалуроновой кислоты, при пластике передней брюшной стенки сетчатым имплантатом, приводит к увеличению удельного веса и плотности колагеновых волокон вокруг элементов последнего, тем самым укрепляет переднюю брюшную стенку, а также уменьшает воспалительные процессы в тканях причиненных операционной травмой.

The use of natural materials as wound healing is an alternative that is widely used. Red Dragon Fruit Extract (EBNM) has antioxidant and anti-inflammatory content that is needed to accelerate the wound healing, but studies have reported effects on wound healing is still limited. The purpose of this study was to evaluate the effect of topical Red Dragon Fruit Extract on DM wound and Non-DM wound healing in Wistar rats. This research method is an Experimental Study with post-test with control group design. Albino Male Wistar rat (n = 18) with the weight (200-250 grams) were divided into 2 groups (group A (n = 9) Wistar DM + incision divided into 3 groups, each with 3 rats and group B (n = 9) Non-DM Wistar + incision divided into 3 groups of each 3 rats). Furthermore Wistar rat wounded in the back left and right using 8 mm punch biopsy. 7.5% topical Red Dragon Fruit Extract cream was applied to the surface of the wound with the cotton bud. Tissue preparat colored with Hematoxylin and Eosin (HE) then the wound healing parameters were assessed; the thickness of the granulation tissue and epithelialization with histopathology assessment. Data were analyzed using independent T test and paired T test (SPSS 21, Chicago Inc.) Granulation scores tend to be better at a concentration of 7.5% in the topical Red Dragon Fruit Extract than the negative control group for DM (p <0.068) and non-DM (p <0.034). Epithelialization Scores are better at concentrations of 7.5% in Topical Red Dragon Fruit Extract group than the negative control group for DM (p <0.034) and non DM (p <0.034). Topical Red Dragon Fruit Extract 7.5% increase the growth of granulation tissue and epithelialization in wound healing of acute non-DM and DM at Wistar rats.

The use of natural materials as wound healing is an alternative that is widely used. Red Dragon Fruit Extract (EBNM) has antioxidant and anti-inflammatory content that is needed to accelerate the wound healing, but studies have reported effects on wound healing is still limited. The purpose of this study was to evaluate the effect of topical Red Dragon Fruit Extract on DM wound and Non-DM wound healing in Wistar rats. This research method is an Experimental Study with post-test with control group design. Albino Male Wistar rat (n = 18) with the weight (200-250 grams) were divided into 2 groups (group A (n = 9) Wistar DM + incision divided into 3 groups, each with 3 rats and group B (n = 9) Non-DM Wistar + incision divided into 3 groups of each 3 rats). Furthermore Wistar rat wounded in the back left and right using 8 mm punch biopsy. 7.5% topical Red Dragon Fruit Extract cream was applied to the surface of the wound with the cotton bud. Tissue preparat colored with Hematoxylin and Eosin (HE) then the wound healing parameters were assessed; the thickness of the granulation tissue and epithelialization with histopathology assessment. Data were analyzed using independent T test and paired T test (SPSS 21, Chicago Inc.) Granulation scores tend to be better at a concentration of 7.5% in the topical Red Dragon Fruit Extract than the negative control group for DM (p <0.068) and non-DM (p <0.034). Epithelialization Scores are better at concentrations of 7.5% in Topical Red Dragon Fruit Extract group than the negative control group for DM (p <0.034) and non DM (p <0.034). Topical Red Dragon Fruit Extract 7.5% increase the growth of granulation tissue and epithelialization in wound healing of acute non-DM and DM at Wistar rats.

BACKGROUND: Although pediatric tracheotomy is potentially life-saving, the procedure is associated with high risk of complications, and indications have changed the last decade. We report indications, complications, and lower airway infections (LAIs) to pediatric tracheotomy performed at a tertiary referral center.METHODS: We identified all children (<18 years) who underwent tracheotomy at our institution during 2008-2015. A review of hospital records was performed to extract data on indication of the procedure, complications, and information on pre- and postoperative LAI.RESULTS: At a median age of 8 years (range: 4 months to 17 years), a total of 69 tracheotomies were performed. Neuromuscular disease (n = 21) was the most common cause for tracheotomy. The postoperative complication rate was 22%; early complications (<30 days) occurred in four patients, and nine patients encountered late complications such as wound granulation and tracheocutaneous fistula. Children without LAI prior to tracheotomy were at increased risk of LAI from the initial 30-days following surgery (OR: 2.91, 95% CI: 1.17-7.21; p = .02). Fifty-three percent (10/19) of all LAIs following tracheotomy were caused by Staphylococcus aureus (p < .01).CONCLUSIONS: Pediatric tracheotomy was associated with considerable rates of minor early and late complications and high risk of short-term LAI. The main cause leading to tracheotomy was neuromuscular disease.

The use of natural materials as wound healing is an alternative that is widely used. Red Dragon Fruit Extract (EBNM) has antioxidant and anti-inflammatory content that is needed to accelerate the wound healing, but studies have reported effects on wound healing is still limited. The purpose of this study was to evaluate the effect of topical Red Dragon Fruit Extract on DM wound and Non-DM wound healing in Wistar rats. This research method is an Experimental Study with post-test with control group design. Albino Male Wistar rat (n = 18) with the weight (200-250 grams) were divided into 2 groups (group A (n = 9) Wistar DM + incision divided into 3 groups, each with 3 rats and group B (n = 9) Non-DM Wistar + incision divided into 3 groups of each 3 rats). Furthermore Wistar rat wounded in the back left and right using 8 mm punch biopsy. 7.5% topical Red Dragon Fruit Extract cream was applied to the surface of the wound with the cotton bud. Tissue preparat colored with Hematoxylin and Eosin (HE) then the wound healing parameters were assessed; the thickness of the granulation tissue and epithelialization with histopathology assessment. Data were analyzed using independent T test and paired T test (SPSS 21, Chicago Inc.) Granulation scores tend to be better at a concentration of 7.5% in the topical Red Dragon Fruit Extract than the negative control group for DM (p <0.068) and non-DM (p <0.034). Epithelialization Scores are better at concentrations of 7.5% in Topical Red Dragon Fruit Extract group than the negative control group for DM (p <0.034) and non DM (p <0.034). Topical Red Dragon Fruit Extract 7.5% increase the growth of granulation tissue and epithelialization in wound healing of acute non-DM and DM at Wistar rats.

A 26-year-old female without any medical comorbidities presented with increasing epigastric abdominal pain, 10 days after inadvertently ingesting a toothbrush. In an effort to induce emesis, she had introduced a toothbrush into the pharynx, only for the brush to break at the head. A CT scan demonstrated a 10-cm linear hyperdense object, in the distal stomach extending across the pylorus, into the first and second part of the duodenum. There was no evidence of any perforation or collection. Initial gastroscopy revealed the toothbrush penetrating into the lateral wall of the second part of the duodenum. Due to the complexity, the case was referred to a tertiary interventional endoscopy unit. On repeat gastroscopy under general anaesthetic, after careful inspection and surgical back-up, a 20-mm snare was used to lasso the handle of the toothbrush, allowing it to be extracted by gentle traction and manipulation through the pylorus and removed per orally in one piece. A protective overtube was not required. The residual duodenal perforation (Image 1), which in 10 days had formed a tract, was closed with a single over-the-scope clip (Ovesco 12T, Tubingen, Germany). A decompressive nasogastric tube was placed and intravenous antibiotics were given prophylactically. The patient had an uneventful recovery, progressing to a full diet after no leak was seen on follow-up contrast CT scan of the abdomen 3 days later. Repeat gastroscopy six weeks later showed complete closure of the duodenal wall defect with granulation tissue. No Ovesco clip was found. (Figure presented).

Site-specific chemical dimerization of fibroblast growth factor 2 (FGF2) with the optimal linker length resulted in a FGF2 homodimer with improved granulation tissue formation and blood vessel formation at exceptionally low concentrations. Homodimers of FGF2 were synthesized through site-specific linkages to both ends of different molecular weight poly(ethylene glycols) (PEGs). The optimal linker length was determined by screening dimer-induced metabolic activity of human dermal fibroblasts and found to be that closest to the inter-cysteine distance, 70 Å, corresponding to 2 kDa PEG. A straightforward analysis of the kinetics of second ligand binding as a function of tether length showed that, as the polymerization index (the number of monomer repeat units in the polymer, N) of the tether decreases, the mean time for second ligand capture decreases as ∼N(3/2), leading to an enhancement of the number of doubly bound ligands in steady-state for a given (tethered) ligand concentration. FGF2-PEG2k-FGF2 induced greater fibroblast metabolic activity than FGF2 alone, all other dimers, and all monoconjugates, at each concentration tested, with the greatest difference observed at low (0.1 ng/mL) concentration. FGF2-PEG2k-FGF2 further exhibited superior activity compared to FGF2 for both metabolic activity and migration in human umbilical vein endothelial cells, as well as improved angiogenesis in a coculture model in vitro. Efficacy in an in vivo wound healing model was assessed in diabetic mice. FGF2-PEG2k-FGF2 increased granulation tissue and blood vessel density in the wound bed compared to FGF2. The results suggest that this rationally designed construct may be useful for improving the fibroblast matrix formation and angiogenesis in chronic wound healing.

Accurate and rapid assessment of the healing status of a wound in a simple and noninvasive manner would enable clinicians to diagnose wounds in real time and promptly adjust treatments to hasten the resolution of nonhealing wounds. Histologic and biochemical characterization of biopsied wound tissue, which is currently the only reliable method for wound assessment, is invasive, complex to interpret, and slow. Here we demonstrate the use of Raman microspectroscopy coupled with multivariate spectral analysis as a simple, noninvasive method to biochemically characterize healing wounds in mice and to accurately identify different phases of healing of wounds at different time-points. Raman spectra were collected from "splinted" full thickness dermal wounds in mice at 4 time-points (0, 1, 5, and 7 days) corresponding to different phases of wound healing, as verified by histopathology. Spectra were deconvolved using multivariate factor analysis (MFA) into 3 "factor score spectra" (that act as spectral signatures for different stages of healing) that were successfully correlated with spectra of prominent pure wound bed constituents (i.e., collagen, lipids, fibrin, fibronectin, etc.) using non-negative least squares (NNLS) fitting. We show that the factor loadings (weights) of spectra that belonged to wounds at different time-points provide a quantitative measure of wound healing progress in terms of key parameters such as inflammation and granulation. Wounds at similar stages of healing were characterized by clusters of loading values and slowly healing wounds among them were successfully identified as "outliers". Overall, our results demonstrate that Raman spectroscopy can be used as a noninvasive technique to provide insight into the status of normally healing and slow-to-heal wounds and that it may find use as a complementary tool for real-time, in situ biochemical characterization in wound healing studies and clinical diagnosis.

En masse cell migration is more relevant compared with single-cell migration in physiological processes of tissue formation, such as embryogenesis, morphogenesis, and wound healing. In these situations, cells are influenced by the proximity of other cells including interactions facilitated by substrate mechanics. Here, we found that when fibroblasts migrated en masse over a hydrogel, they established a well-defined deformation field by traction forces and migrated along a trajectory defined by field gradients. The mechanics of the hydrogel determined the magnitude of the gradient. For materials stiff enough to withstand deformation related to cellular traction forces, such patterns did not form. Furthermore, migration patterns functioned poorly on very soft matrices where only a minimal traction gradient could be established. The largest degree of alignment and migration velocity occurred on the gels with the largest gradients. Granulation tissue formation in punch wounds of juvenile pigs was correlated strongly with the modulus of the implanted gel, in agreement with in vitro en masse cell migration studies. These findings provide basic insight into the biomechanical influences on fibroblast movement in early wounds and relevant design criteria for the development of tissue-engineered constructs that aim to stimulate en masse cell recruitment for rapid wound healing.

En masse cell migration is more relevant compared with single-cell migration in physiological processes of tissue formation, such as embryogenesis, morphogenesis, and wound healing. In these situations, cells are influenced by the proximity of other cells including interactions facilitated by substrate mechanics. Here, we found that when fibroblasts migrated en masse over a hydrogel, they established a well-defined deformation field by traction forces and migrated along a trajectory defined by field gradients. The mechanics of the hydrogel determined the magnitude of the gradient. For materials stiff enough to withstand deformation related to cellular traction forces, such patterns did not form. Furthermore, migration patterns functioned poorly on very soft matrices where only a minimal traction gradient could be established. The largest degree of alignment and migration velocity occurred on the gels with the largest gradients. Granulation tissue formation in punch wounds of juvenile pigs was correlated strongly with the modulus of the implanted gel, in agreement with in vitro en masse cell migration studies. These findings provide basic insight into the biomechanical influences on fibroblast movement in early wounds and relevant design criteria for the development of tissue-engineered constructs that aim to stimulate en masse cell recruitment for rapid wound healing.

Learning objectives: To describe the diverse imaging patterns of bronchiolitis obliterans organising pneumonia (BOOP) as well as the less frequently recognised appearances that have recently been described. Background(s): BOOP was first described in the early eighties as a clinicopathological syndrome characterised by a subacute respiratory illness and histopathologically by the presence of granulation tissue in the bronchial lumen, alveolar ducts and alveoli. It represents a nonspecific pathological pattern of response to injury by the lung and may occur in isolation (cryptogenic organising pneumonia) or in association with a myriad of conditions such as infections and connective tissue diseases. Imaging findings: Typically BOOP manifests as consolidation and ground glass opacity predominantly in a subpleural or peribronchial distribution. This pattern however is seen in only 60% of cases. The consolidation may be more often seen in the mid to lower zones of the lungs and is usually bilateral. Ill-defined peribronchial nodules or larger mass-like lesions are occasionally observed. Linear and nodular opacities, bronchial dilatation and small bilateral pleural effusions may also be seen. In recent years, the perilobular pattern of opacity and the 'reversed halo' sign have been described. It has also recently been established that in many cases of BOOP, an interstitial fibrosis pattern is observed on follow up CT studies, often resembling non-specific interstitial pneumonia (NSIP). Conclusion(s): The imaging features of BOOP are many and varied. The exhibit illustrates established patterns as well as new findings of BOOP which have been described in recent years. The usefulness of these radiographic signs in diagnosing and predicting outcome of BOOP is explored.

The aim of this study was to evaluate the 4-year clinical outcomes following regenerative surgery in intrabony defects with either EMD + BCP or EMD. Twenty-four patients with advanced chronic periodontitis, displaying one-, two-, or three-walled intrabony defect with a probing depth of at least 6 mm, were randomly treated with either EMD + BCP (test) or EMD alone (control). The following clinical parameters were evaluated at baseline, at 1 year and at 4 years after regenerative surgery: plaque index, gingival index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. No differences in any of the investigated parameters were observed at baseline between the two groups. The test group demonstrated a mean CAL change from from 10.8 ± 1.6 mm to 7.4 ± 1.6 mm (p < 0.001) and to 7.6 ± 1.7 mm (p < 0.001) at 1 and 4 years, respectively. In the control group, mean CAL changed from 10.4 ± 1.3 at baseline to 6.9 ± 1.0 mm (p < 0.001) at 1 year and 7.2 ± 1.2 mm (p < 0.001) at 4 years. At 4 years, two defects in the test group and three defects in the control group have lost 1 mm of the CAL gained at 1 year. Compared to baseline, at 4 years, a CAL gain of ≥3 mm was measured in 67% of the defects (i.e., in 8 out of 12) in the test group and in 75% of the defects (i.e., in 9 out of 12) in the control group. There were no statistically significant differences in any of the investigated parameters at 1 and at 4 years between the two groups. Within their limits, the present results indicate that: (a) the clinical improvements obtained with both treatments can be maintained over a period of 4 years, and (b) in two- and three-walled intrabony defects, the addition of BCP did not additionally improve the outcomes obtained with EMD alone. In two- and three-walled intrabony defects, the combination of EMD + BCP did not show any advantage over the use of EMD alone.

Learning objectives: To describe the diverse imaging patterns of bronchiolitis obliterans organising pneumonia (BOOP) as well as the less frequently recognised appearances that have recently been described. Background(s): BOOP was first described in the early eighties as a clinicopathological syndrome characterised by a subacute respiratory illness and histopathologically by the presence of granulation tissue in the bronchial lumen, alveolar ducts and alveoli. It represents a nonspecific pathological pattern of response to injury by the lung and may occur in isolation (cryptogenic organising pneumonia) or in association with a myriad of conditions such as infections and connective tissue diseases. Imaging findings: Typically BOOP manifests as consolidation and ground glass opacity predominantly in a subpleural or peribronchial distribution. This pattern however is seen in only 60% of cases. The consolidation may be more often seen in the mid to lower zones of the lungs and is usually bilateral. Ill-defined peribronchial nodules or larger mass-like lesions are occasionally observed. Linear and nodular opacities, bronchial dilatation and small bilateral pleural effusions may also be seen. In recent years, the perilobular pattern of opacity and the 'reversed halo' sign have been described. It has also recently been established that in many cases of BOOP, an interstitial fibrosis pattern is observed on follow up CT studies, often resembling non-specific interstitial pneumonia (NSIP). Conclusion(s): The imaging features of BOOP are many and varied. The exhibit illustrates established patterns as well as new findings of BOOP which have been described in recent years. The usefulness of these radiographic signs in diagnosing and predicting outcome of BOOP is explored.

Succeed of the healing of patients of Fournier gangrene not only depends upon emergency medical performance, but also it depends upon the autonomous role carried out by the nursing staff in the surveillance and continuity of the treatment of the injury. Quantitative study since 1991 to 2009. Results: 21 cases, average age 61, pain (74%), one treatment (61,9%), plastic surgery (47,61%), death 19%. A clinic casa is presented with simple closing in 38 days. Discussion: effectiveness of polihexamida-Undecilenamidopropil betaina. Conclusión: treatment improves the injury, reduces hospital staying and morbidity., El éxito de la curación de los pacientes afectos de gangrena de Fournier no depende sólo de una actuación médica urgente, sino también del rol autónomo desempeñado por el personal de enfermería en la vigilancia y continuidad en el tratamiento del lecho de la lesión. Estudio cuantitativo desde 1991 a 2009. Resultados: 21 casos. Edad media 61 años, dolor (71,4%), tratamiento (61,9%), reconstrucción plástica (47,61%), exitus 19%. Se presenta un caso clínico con cierre simple en 38 días. Discusión: efectividad de la polihexamida-undecilenamidopropil betaína. Conclusión: el tratamiento mejora la lesión, reduce estancias hospitalarias y la morbilidad

Succeed of the healing of patients of Fournier gangrene not only depends upon emergency medical performance, but also it depends upon the autonomous role carried out by the nursing staff in the surveillance and continuity of the treatment of the injury. Quantitative study since 1991 to 2009. Results: 21 cases, average age 61, pain (74%), one treatment (61,9%), plastic surgery (47,61%), death 19%. A clinic casa is presented with simple closing in 38 days. Discussion: effectiveness of polihexamida-Undecilenamidopropil betaina. Conclusión: treatment improves the injury, reduces hospital staying and morbidity., El éxito de la curación de los pacientes afectos de gangrena de Fournier no depende sólo de una actuación médica urgente, sino también del rol autónomo desempeñado por el personal de enfermería en la vigilancia y continuidad en el tratamiento del lecho de la lesión. Estudio cuantitativo desde 1991 a 2009. Resultados: 21 casos. Edad media 61 años, dolor (71,4%), tratamiento (61,9%), reconstrucción plástica (47,61%), exitus 19%. Se presenta un caso clínico con cierre simple en 38 días. Discusión: efectividad de la polihexamida-undecilenamidopropil betaína. Conclusión: el tratamiento mejora la lesión, reduce estancias hospitalarias y la morbilidad

Several studies have suggested that mediastinitis is a strong predictor for poor long-term survival after coronary artery bypass surgery (CABG). In those studies, several conventional wound-healing techniques were used. Previously, we have shown no difference in long-term survival between CABG patients with topical negative pressure (TNP)-treated mediastinitis and CABG patients without mediastinitis. The present study was designed to elucidate if TNP, applied over the myocardium, resulted in an increase of the total amount of coronary blood flow. Six pigs underwent median sternotomy. The coronary blood flow was measured, before and after the application of TNP (-50 mmHg), using coronary electromagnetic flow meter probes. Analyses were performed before left anterior descending artery (LAD) occlusion (normal myocardium) and after 20 minutes of LAD occlusion (ischaemic myocardium). Normal myocardium: 171.3 +/- 14.5 ml/minute before to 206.3 +/- 17.6 ml/minute after TNP application, P <0.05. Ischaemic myocardium: 133.7 +/- 18.4 ml/minute before to 183.2 +/- 18.9 ml/minute after TNP application, P <0.05. TNP of -50 mmHg applied over the LAD region induced a significant increase in the total coronary blood flow in both normal and ischaemic myocardium.

Several studies have suggested that mediastinitis is a strong predictor for poor long-term survival after coronary artery bypass surgery (CABG). In those studies, several conventional wound-healing techniques were used. Previously, we have shown no difference in long-term survival between CABG patients with topical negative pressure (TNP)-treated mediastinitis and CABG patients without mediastinitis. The present study was designed to elucidate if TNP, applied over the myocardium, resulted in an increase of the total amount of coronary blood flow. Six pigs underwent median sternotomy. The coronary blood flow was measured, before and after the application of TNP (-50 mmHg), using coronary electromagnetic flow meter probes. Analyses were performed before left anterior descending artery (LAD) occlusion (normal myocardium) and after 20 minutes of LAD occlusion (ischaemic myocardium). Normal myocardium: 171.3 +/- 14.5 ml/minute before to 206.3 +/- 17.6 ml/minute after TNP application, P <0.05. Ischaemic myocardium: 133.7 +/- 18.4 ml/minute before to 183.2 +/- 18.9 ml/minute after TNP application, P <0.05. TNP of -50 mmHg applied over the LAD region induced a significant increase in the total coronary blood flow in both normal and ischaemic myocardium.

No abstract available

Objective: To evaluate whether the extract of Ginkgo biloba (GB) could reverse the healing suppressant effect of Cyclophosphamide(CLP). Methods: The wound healing effects of CLP (12.6 mg/kg/ IP single dose on 3'd post wounding day) and GB (50 mg/kg IP) daily were tested on dead space and excision wound models in male rats. Results: CLP has significantly (p

Tissue neovascularization in postnatal life occurs during post-traumatic tissue healing, neoplastic growth and in the endometrium during the reproductive cycle of females. Although embryonic angiogenesis has been intensively studied, far less is known about tissue revascularization and vessel remodeling in adults due to methodological difficulties. In the current studies, we developed a novel in vivo model of neovascularization that is performed on the chicken chorioallantoic membrane (CAM). A provisional matrix placed on the CAM was vascularized in response to FGF-2. In order to distinguish new from pre-existing vessels, the matrix was separated from the CAM by a nylon grid. Techniques to visualize the three dimensional structure of vascular networks and a method for rapid and semi-automated quantification were developed. This novel model allowed us to study the effects of potential inhibitors of tissue vascularization and their effects on the pre-existing vasculature. We found that while fumagillin or inhibition of MEK and Src inhibited only neovascularization, addition of cortisol or wortmannin was toxic to pre-existing vessels. The CAM model allowed intravital observations during extended periods of time, which together with immunohistochemical analysis revealed a novel mechanism of tissue vascularization. Tensional forces generated by myofibroblast-mediated contraction of the provisional matrix, induced and directed ingrowth of vascular tissue. During the initial stages of vascularization, the vascular network was recruited from the surrounding tissue through a non-angiogenic mechanism by elongation and enlargement of pre-existing vessels, which were moved as vascular loops with constant functional circulation. Ingrown vessels were remodeled, presumably through intussusception, fusion and pruning. The CAM model was validated by observations of neovascularization associated with healing of the injured mouse cornea.

Tissue neovascularization in postnatal life occurs during post-traumatic tissue healing, neoplastic growth and in the endometrium during the reproductive cycle of females. Although embryonic angiogenesis has been intensively studied, far less is known about tissue revascularization and vessel remodeling in adults due to methodological difficulties. In the current studies, we developed a novel in vivo model of neovascularization that is performed on the chicken chorioallantoic membrane (CAM). A provisional matrix placed on the CAM was vascularized in response to FGF-2. In order to distinguish new from pre-existing vessels, the matrix was separated from the CAM by a nylon grid. Techniques to visualize the three dimensional structure of vascular networks and a method for rapid and semi-automated quantification were developed. This novel model allowed us to study the effects of potential inhibitors of tissue vascularization and their effects on the pre-existing vasculature. We found that while fumagillin or inhibition of MEK and Src inhibited only neovascularization, addition of cortisol or wortmannin was toxic to pre-existing vessels. The CAM model allowed intravital observations during extended periods of time, which together with immunohistochemical analysis revealed a novel mechanism of tissue vascularization. Tensional forces generated by myofibroblast-mediated contraction of the provisional matrix, induced and directed ingrowth of vascular tissue. During the initial stages of vascularization, the vascular network was recruited from the surrounding tissue through a non-angiogenic mechanism by elongation and enlargement of pre-existing vessels, which were moved as vascular loops with constant functional circulation. Ingrown vessels were remodeled, presumably through intussusception, fusion and pruning. The CAM model was validated by observations of neovascularization associated with healing of the injured mouse cornea.

Tissue neovascularization in postnatal life occurs during post-traumatic tissue healing, neoplastic growth and in the endometrium during the reproductive cycle of females. Although embryonic angiogenesis has been intensively studied, far less is known about tissue revascularization and vessel remodeling in adults due to methodological difficulties. In the current studies, we developed a novel in vivo model of neovascularization that is performed on the chicken chorioallantoic membrane (CAM). A provisional matrix placed on the CAM was vascularized in response to FGF-2. In order to distinguish new from pre-existing vessels, the matrix was separated from the CAM by a nylon grid. Techniques to visualize the three dimensional structure of vascular networks and a method for rapid and semi-automated quantification were developed. This novel model allowed us to study the effects of potential inhibitors of tissue vascularization and their effects on the pre-existing vasculature. We found that while fumagillin or inhibition of MEK and Src inhibited only neovascularization, addition of cortisol or wortmannin was toxic to pre-existing vessels. The CAM model allowed intravital observations during extended periods of time, which together with immunohistochemical analysis revealed a novel mechanism of tissue vascularization. Tensional forces generated by myofibroblast-mediated contraction of the provisional matrix, induced and directed ingrowth of vascular tissue. During the initial stages of vascularization, the vascular network was recruited from the surrounding tissue through a non-angiogenic mechanism by elongation and enlargement of pre-existing vessels, which were moved as vascular loops with constant functional circulation. Ingrown vessels were remodeled, presumably through intussusception, fusion and pruning. The CAM model was validated by observations of neovascularization associated with healing of the injured mouse cornea.

Tissue neovascularization in postnatal life occurs during post-traumatic tissue healing, neoplastic growth and in the endometrium during the reproductive cycle of females. Although embryonic angiogenesis has been intensively studied, far less is known about tissue revascularization and vessel remodeling in adults due to methodological difficulties. In the current studies, we developed a novel in vivo model of neovascularization that is performed on the chicken chorioallantoic membrane (CAM). A provisional matrix placed on the CAM was vascularized in response to FGF-2. In order to distinguish new from pre-existing vessels, the matrix was separated from the CAM by a nylon grid. Techniques to visualize the three dimensional structure of vascular networks and a method for rapid and semi-automated quantification were developed. This novel model allowed us to study the effects of potential inhibitors of tissue vascularization and their effects on the pre-existing vasculature. We found that while fumagillin or inhibition of MEK and Src inhibited only neovascularization, addition of cortisol or wortmannin was toxic to pre-existing vessels. The CAM model allowed intravital observations during extended periods of time, which together with immunohistochemical analysis revealed a novel mechanism of tissue vascularization. Tensional forces generated by myofibroblast-mediated contraction of the provisional matrix, induced and directed ingrowth of vascular tissue. During the initial stages of vascularization, the vascular network was recruited from the surrounding tissue through a non-angiogenic mechanism by elongation and enlargement of pre-existing vessels, which were moved as vascular loops with constant functional circulation. Ingrown vessels were remodeled, presumably through intussusception, fusion and pruning. The CAM model was validated by observations of neovascularization associated with healing of the injured mouse cornea.

Background: During wound repair, fibroblasts orchestrate replacement of the provisional matrix formed during clotting with tenascin, cellular fibronectin and collagen III. These, in turn, are critical for migration of endothelial cells, keratinocytes and additional fibroblasts into the wound site. Fibroblasts are also important in the deposition of collagen I during scar formation. The CXC chemokine chicken Chemotactic and Angiogenic Factor (cCAF), is highly expressed by fibroblasts after wounding and during development of the granulation tissue, especially in areas where extracellular matrix (ECM) is abundant. We hypothesized that cCAF stimulates fibroblasts to produce these matrix molecules. Results: Here we show that this chemokine can stimulate precocious deposition of tenascin, fibronectin and collagen I, but not collagen III. Studies in culture and in vivo show that tenascin stimulation can also be achieved by the N-terminal 15 aas of the protein and occurs at the level of gene expression. In contrast, stimulation of fibronectin and collagen I both require the entire molecule and do not involve changes in gene expression. Fibronectin accumulation appears to be linked to tenascin production, and collagen I to decreased MMP-1 levels. In addition, cCAF is chemotactic for fibroblasts and accelerates their migration. Conclusions: These previously unknown functions for chemokines suggest that cCAF, the chicken orthologue of human IL-8, enhances healing by rapidly chemoattracting fibroblasts into the wound site and stimulating them to produce ECM molecules, leading to precocious development of granulation tissue. This acceleration of the repair process may have important application to healing of impaired wounds. © 2002 Feugate et al; licensee BioMed Central Ltd.

Background: During wound repair, fibroblasts orchestrate replacement of the provisional matrix formed during clotting with tenascin, cellular fibronectin and collagen III. These, in turn, are critical for migration of endothelial cells, keratinocytes and additional fibroblasts into the wound site. Fibroblasts are also important in the deposition of collagen I during scar formation. The CXC chemokine chicken Chemotactic and Angiogenic Factor (cCAF), is highly expressed by fibroblasts after wounding and during development of the granulation tissue, especially in areas where extracellular matrix (ECM) is abundant. We hypothesized that cCAF stimulates fibroblasts to produce these matrix molecules. Results: Here we show that this chemokine can stimulate precocious deposition of tenascin, fibronectin and collagen I, but not collagen III. Studies in culture and in vivo show that tenascin stimulation can also be achieved by the N-terminal 15 aas of the protein and occurs at the level of gene expression. In contrast, stimulation of fibronectin and collagen I both require the entire molecule and do not involve changes in gene expression. Fibronectin accumulation appears to be linked to tenascin production, and collagen I to decreased MMP-1 levels. In addition, cCAF is chemotactic for fibroblasts and accelerates their migration. Conclusions: These previously unknown functions for chemokines suggest that cCAF, the chicken orthologue of human IL-8, enhances healing by rapidly chemoattracting fibroblasts into the wound site and stimulating them to produce ECM molecules, leading to precocious development of granulation tissue. This acceleration of the repair process may have important application to healing of impaired wounds. © 2002 Feugate et al; licensee BioMed Central Ltd.

Objective: To evaluate the effects of Ginkgo biloba on wound healing. Materials and methods: The wound healing effects of dried extract of Ginkgo Biloba (GB) were tested at a dose of 50 mg/kg on dead space and excision wound models in male rats. Results: GB has significantly (p< 0.01) promoted the breaking strength and hydroxyproline content of granulation tissue in dead space wounds. In case of excision wounds while it did not affect the wound contraction, the epithelization period was significantly (p

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