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Introduction: Mellitus Diabetes belongs to a group of metabolic diseases, which is caused due to the disturbance in insulin secretion, destruction of beta cells, auto immune reasons, necrosis as well as insulin resistance. Stem cells therapy has recently been suggested as a treatment method of Diabetes. Since adipose tissue-derived stem cells present wide availability, easy access, hight proliferation and less immunological rejection, the present study aimed to investigate their effect on the control of the blood glucose level. Methods: In this experimental-interventional study, adipose tissue-derived stem cells, harvested from the liposuction surgery were purified and after being counted by neubuaer lam, were evaluated via flow cytometry in order to identify and approve the existence of stem cells. Sixteen male wistar rats weighing about 250-300 gr, induced diabetes by streptozotocin (60 mg/kg), which were divided randomly into two groups of eight. Group 1 (Diabetes control) received the normal saline treatment, and group 2 (treatment) received 1.5x106 adipose tissue-derived stem cells. In order to evaluate the improvement process, blood glucose level of rats was measured by glucometer every day for a period of 25 days after the tissues transaction. Results: The results of flow cytometry indicated high percentages of CD29 and CD90 in mesenchymal adipose tissue-derived stem cells. The blood glucose level of diabetic rats revealed a significant reduction (P < 0.001) in blood glucose level in the rats treated with derived adipose tissue-derived stem cells in comparison with the control group. Conclusion: The findings of the present study revealed a signification decrease of blood glucose level after confirmation of stem cells isolated from the adipose tissue using cell surface antigens and its injection into diabetic rats (P

BACKGROUND AND OBJECTIVE: Human umbilical cord blood (HUCB) is a rich source of stem cells. The aim of this study was the investigation of the therapeutic effects of these cells on cerebral ischemia in rat. METHODS: This study was carried out on 30 male Wistar rats (100-150 g). They were divided into three groups. Firstly, to create a laboratory model of ischemic stroke, right carotid artery of animals was occluded for 30 minutes in two groups of experimental and sham. Then, mononuclear cells of cord blood were isolated and labeled using bromodeoxyuridine (BrdU) and then 2×105 cells were injected into the experimental group via the tail vein seven day after surgery. Rats in sham group didn’t receive any injection. Control group considered as intact animals. The animals were evaluated for 14 days with modified limb placing and corner turn tests. The transplanted HUCB cells were also detected by immunohistochemistry. FINDINGS: Seven days after surgery, there was a significant recovery in the behavioral performance in the experimental group (12.7± 0.26) compared with sham group (10±0.4) and this significant difference continued by the day 14 (15.3±0.31 vs. 11.9±0.53, p

Background: Excessive bleeding is common and can be life-threatening in patients undergoing coronary artery bypass grafting (CABG) surgery. Existing conventional methods for preventing bleeding are ineffective or impractical; thus, additional strategies are required. This study used the autologous platelet-rich plasma fibrin-glue (PRP-FG) as a topical hemostatic and tissue regenerative agent to evaluate its preventive effect in postoperative bleeding in off-pump CABG surgery anastomosis. Methods: Patients undergoing elective off-pump CABG were randomly allocated into control (16 males and ten females) and case (19 males and seven females) groups. In the control group, hemostasis was accomplished exclusively using electrocautery and overcharging. In contrast, in the case group, PRP-FG was applied in the place of distal and proximal coronary graft anastomosis and sternotomy at the end of the operation and after surgical homeostasis. Patients were closely monitored for 48 hours in the intensive care unit (ICU), and the drainage volume was estimated based on blood accumulation in the chest tube bottle. Mean hemoglobin, platelet count, international normalized ratio (INR), time of surgery, bleeding volume in the operating room, and bleeding (drainage) volume in ICU after 48 hours were documented for both case and control groups. Results: There were no meaningful differences between the two groups regarding sex, age, mean hemoglobin, platelet count, INR, time of surgery, and bleeding volume in the operating room. A significant decrease in the postoperative bleeding volume was observed in ICU after 48 hours for the case group compared to the control group. Conclusion: Topical application of autologous PRP-FG significantly reduces postoperative bleeding volume after CABG surgery without adding extra risks to the patient. [ABSTRACT FROM AUTHOR]

Background: Around the world, the COVID-19 pandemic has presented many difficulties, and acute respiratory distress syndrome (ARDS) has become a major worry. The antiviral and anti-inflammatory characteristics of methylene blue (MB) have garnered interest for potential medicinal applications. The object of the current study is to assess the effect of orally administered MB on the treatment of ARDS associated with COVID-19., Method: A randomized clinical study was carried out on 122 hospitalized patients who had ARDS related to COVID-19. Patients who met the eligibility requirements were randomized at random to either the control group (CG) (n = 60) or the intervention group (IG) (n = 62). Standard treatments were administered to both groups, with the addition of oral MB to the IG. Clinical outcomes, including SpO2 levels, CRP levels were assessed on the third and fifth days. Additionally, at the time of discharge, patients' assessments were made in terms of APACHE II scores, SOFA scores, LDH and CRP levels, SpO2, and respiratory rate in comparison to the day prior to the intervention. Patients were followed for mortality outcomes at one month and three months after the intervention., Results: Significant changes were observed in SpO2 levels over time (P < 0.001) and between groups (P = 0.022), with higher levels in the MB-treated group. The interaction between time and group (P = 0.019) indicated a stronger increase in SpO2 in the IG, with the IG's SpO2 level increasing by 6.42%. Furthermore, CRP levels showed significant changes over time (P < 0.001), but not between groups (P = 0.092). However, the interaction between group and CRP change over time (P = 0.019) suggested a distinct pattern of CRP decrease in the IG. Significant improvement in RR, SpO2, CRP, and APACHE II score were found according to discharge results. However, in terms of SpO2 and the APACHE II score, this improvement was noteworthy for IG. The length of hospitalization and mortality rates at one- and three-month follow-ups did not differ significantly., Conclusion: Oral administration of MB demonstrated positive effects on improving SpO2 levels and reducing inflammatory markers in COVID-19-related ARDS patients. Despite no significant impact on survival rates or hospitalization length, the study supports the potential efficacy of MB as an alternative treatment for COVID-19 ARDS., Trial Registration: This study was registered with the Iranian Registry of Clinical Trials ( http://www.irct.ir ) under the registration code IRCT20200409047007N2 on 11/29/2021., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Evaluation of preliminary cosmetic and functional outcomes of biodegradable scaffolds covered with platelet-rich plasma in penile girth augmentation., Materials and Methods: Between June 2016 and June 2018, 36 males who had a mean age of 28.91 years (range 20 - 48 years) with micropenis underwent this procedure. A mixture of platelets-fibrin glue and mesenchymal cells obtained from dermal fat tissue were prepared. Then the mixture was seeded on the pretreated tube-shaped poly lactic-co-glycolic acid scaffold and underwent a whole day of incubation. Following penile degloving, scaffolds were surgically implanted within the interface region of dartos and Buck's fascia. The 5-point Likert scoring scale was used to evaluate the patients' satisfaction with surgery., Results: Patients followed up for 6-12 (8 ± 2.86) months. The penile length in an erected state before surgery was 6.5 - 12.5 cm (9.08 ± 1.6) which enhanced to 7 - 14 cm (10.59 ± 1.71) after surgery (P < .0001). The penile girth before and after surgery were 8.49 ± 1.53 and 10.91 ± 1.96 cm, respectively (P < .0001). An augment in penile length and girth of 1.5 and 2.6 cm were achieved, respectively. Patients appraised surgical intervention on a rating of one to five. The highest possible score (5) was assigned by 27 %, 33 % expressed a very good mark (4), and 19 % gave a good mark (3)., Conclusion: Covering the scaffold with a mixture of Platelets-Fibrin glue and mesenchymal cells seems a safe and feasible method for penile reconstruction surgery. More studies should be done to determine the effect of platelets- fibrin glue and mesenchymal cells for treating micropenis.

Key Clinical Message: Innovative mixed treatment offers hope for persistent mixed urinary incontinence (MUI): PRP-Fibrin Glue-Stem Cell injection, Botox, and TVT in a single session. Successful case study reveals promising outcomes, emphasizing the need for further research., Abstract: Mixed urinary incontinence is a complaint of stress and urge incontinence which affects patients' quality of life and dramatic changes in patients' physical, mental, and socioeconomic status. The treatment is challenging and depends on the dominance of one of the complaints to the other. The progress in the method of treatment is still under discussion. This study reports treatment of a MUI case in a 56-year-old, with a history of MUI of 7-year duration, which was persistent to pharmacological treatment, pelvic muscle training, biofeedback, and anti-incontinence surgery (Burch Colposuspension). PRP-Fibrin Glue-Stem Cell injection, Botox injection, and TVT were performed in a one surgery session. Patient was discharged with ability to urinate with acceptable amount of post void residue. After 3-month follow-up, patient was completely satisfied and happy. Further research is needed to substantiate the efficacy of these mixed treatments for MUI., Competing Interests: The authors declare no competing interest regarding the publication of this article.All human subjects provided written informed consent with guarantees of confidentiality. The authors are employed at an academic or research institution where research or education is the primary function of the entity., (© 2024 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

The ear is a very important facial feature and enhances the overall look of the face. Usually, patients with entire ear burns also have large areas of burn in their bodies. To save the patient, skin grafting to reduce the injured body surface area is prioritized and the treatment of the ears may be inevitably delayed, which results in minor to very severe cosmetic deformity. This has a deep effect on the life quality of a patient who survives a burn injury. Therefore, any step that decreases ear deformity or loss is very crucial for the patient. There are different challenging procedures for ear reconstruction which are very tedious works. In this study, for one patient, repairing gel-platelet-rich plasma-fibrin glue was applied for the treatment of a deep dermal burned ear as a novel, non-invasive, and simple approach to give a normal shape to the ear to prevent extensive morbidity during the acute phase and deformities later as a consequence of burns. No keloid is observed after treatment., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The newest virus from the SARS family of viruses called acute syndrome-coronavirus-2 (SARS-CoV-2), which causes COVID-19 disease, was identified in China at the end of 2019. In March 2020, after it spread to 29 additional countries, it was declared a pandemic by the World Health Organization (WHO). SARS-CoV-2 infection mainly starts through the respiratory tract and causes a wide spectrum of symptoms from asymptomatic infections to acute respiratory distress syndrome with multi-organ failure and vasoplegic shock. Among the many immunomodulatory and antiviral drugs that have been studied for the treatment of COVID-19, methylene blue (MB) may play an influential role. This article reviews the history of MB applications, the antiviral effects of MB against SARS-CoV-2, and the results of in vivo and in vitro studies of the use of MB in COVID-19. Based on studies, MB can simultaneously affect most of the host's harmful responses caused by SARS-CoV-2 infection due to its multiple properties, including anti-hypoxemia, anti-oxidant, immune system modulator, and antiviral. The use of MB is associated with a reduction in the possibility of getting infection, and mortality, and can be used as a safe, effective, cheap, and available treatment option with minimal side effects for the clinical management of COVID-19., Competing Interests: None.

The significance of angiogenesis in tumour progression has been widely documented. Hence, the identification of anti-angiogenic agents with fewer common side effects would be valuable in cancer therapy. In this study, we evaluated the anti-angiogenic and anti-proliferative effects of a hydro-alcoholic extract of fenugreek seed (HAEF) on human umbilical vein endothelial cells (HUVECs). Human umbilical vein endothelial cells were treated with various concentrations of HAEF and the half-maximal inhibitory concentration (IC 50 ) value was estimated by using the MTT assay. Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and matrix metalloproteinase enzyme (MMP-2 and MMP-9) gene expression profiles were evaluated by using quantitative RT-PCR (qRT-PCR). Moreover, MMP activities and PI3K, Akt and cyclin D1 protein expression levels were evaluated by gel zymography and Western blotting, respectively. HAEF reduced HUVEC viability, with an IC 50 value of 200 μg/ml. The qRT-PCR results demonstrated that treatment with HAEF markedly reduced MMP-2/MMP-9, VEGF and bFGF gene expression, as compared to the control group. We also found that MMP-2/MMP-9 enzyme activity and PI3K/Akt/cyclin D1 protein expression were notably decreased in cells treated with HAEF. Our results suggest that HAEF can potentially inhibit angiogenesis, and also affect cellular proliferation by targeting the PI3K/Akt/cyclin D1 pathway. Thus, fenugreek seed extract merits further investigation as a source of compounds with anti-cancer properties.

Supralevator fistula stays a challenge in general surgery. We present a case with supralevator anorectal fistula and subsequent retroperitoneal necrotizing fasciitis in which autologous platelet-rich plasma and platelet-rich fibrin glue were used for fistula closure. A 59-year-old man was admitted with pelvic pain and fever. Abdominopelvic sonography and CT scan reported a deep horseshoe-shaped anorectal abscess with extension to the pelvic floor, supralevator, psoas, retroperitoneal muscles, and kidneys. He was managed with antibiotics, abscess drainage, repeated radical surgical debridement, and necrosectomy. After 30 days, he was discharged, but he returned to the office with the complaint of purulent discharge from the hypogastric region and a diagnosis of fistula formation. Platelet-rich plasma was injected around the fistula into the tissue, and platelet-rich fibrin glue was introduced to the fistula tract. At the 11-month follow-up, the patient did not have voiding dysfunction, constipation, diarrhea, or fistula tract infection. Autologous platelet-rich plasma injection and platelet-rich fibrin glue insertion suggest a secure and effective approach for treating supralevator anorectal fistula., Competing Interests: None

Tibia open fractures and lower limb soft tissue injuries are undesired conditions for orthopedic and general surgeons, and there is no ideal procedure for treating recalcitrant ulcers or severe traumatic ulcers. Recently, several novel approaches have been proposed, such as bone marrow stem cells, platelets, fibrin glue, and collagen matrix. The current study was conducted to evaluate the effectiveness of combining platelets, fibrin glue, and a collagen matrix for treating a serious limb-threatening wound in a 33-year-old male with a right lower limb injury. After treatment, the wound was fully closed, tissue granulation was grown, skin grafting was done, and the right leg was saved. In conclusion, the combination of the mentioned components can be utilized to synergistically enhance wound healing and preserve the limb., Competing Interests: The author(s) do NOT have any potential conflicts of interest for this manuscript., (2023 © BY THE ARCHIVES OF BONE AND JOINT SURGERY.)

Aim: The current study purposed to evaluate the autologous platelet-rich plasma (PRP), and platelet-rich fibrin glue (PRFG) effect on the treatment of complex, and recalcitrant anal fistula (AF) which was not cured by several surgeries., Background: AF has remained one of difficult challenges for centuries. Surgery is the common treatment method for it, but the risk of fecal incontinence and recurrence is still a distressing complication for patients and surgeons. New procedures were published in the scientific literature, each with advantages and disadvantages. According to reports, an effective therapy option is the autologous fibrin glue that is rich in platelets., Methods: Autologous PRP and PRFG were prepared from 10 patients' own blood. The surgeon curetted the tract of anal fistula for the deepithelialisation till hemorrhage occurred; PRP was injected around the fistula into the tissue, and PRFG was interpositioned in the tract. Age, number of previous surgeries, complications, number of PRP and PRFG administrations, and duration of halting the discharge were among the information gathered. Patients were followed up between 10 months to 84 months after treatment., Results: No complications were observed during and after the injection. During the period of follow-up, AF leakage was stopped for 6 patients, but not for 4 patients., Conclusion: Since autologous PRP injection, and PRFG interposition is a safe, effective, and minimally invasive procedure for resistant AF to surgeries; it can be used, along with surgery to increase the healing rate of complex anal fistula., Competing Interests: The authors indicate no potential conflicts of interest., (© 2023, Gastroenterology and Hepatology From Bed to Bench (GHFBB).)

Introduction: Many ongoing challenges have been applied to reduce the considerable postoperative pain and increase wound healing after tonsillectomy, but they are still not optimally managed. This study applied autologous platelet-rich plasma (PRP) & platelet-rich fibrin glue (PRFG) to reduce pain and increase wound healing., Materials and Methods: PRP & PRFG were prepared from 26 patients' blood. At the end of the tonsillectomy, one tonsillar bed was selected randomly, PRP was injected, PRFG was applied topically on the bed wound, and the other sites were left untreated. The treated and untreated tonsillar beds were compared for pain and wound healing the next day, 3rd day, 6th day, 9th day, and 15th day., Results: There were no complications during and after the injection. The mean age was 24.76 ±5.54 years. In the treated beds in comparison to untreated beds, pain decreased marginally in 1st day (intervention:4.5±2.54, control:5.53±2.94, P-value=0.18) and 3rd day (intervention:3.92±2.96, control:4.8±2.82, P-value=0.276), and significantly in 6th day (intervention:2.3±2.46, control:3.92±2.6, P-value=0.026), 9th day (intervention:1.26±1.48, control:2.76±2.4, P-value=0.009) and 15th day (intervention:0.73±1.07, control:1.84±2.36, P-value=0.08) after surgery. Healing did not change in 1st day (P-value=1), changed marginally in 3rd day (P-value=0.2), and increased significantly in 6th day (P-value=0.001), 9th day (P-value=0.006), and 15th day (P-value=0.004) after surgery., Conclusions: Autologous PRP injection & PRFG application offer an effective, safe, and non-invasive method for reducing pain and increasing wound healing after tonsillectomy.

Background: Platelet-rich plasma (PRP), an autologous source of growth factors, and hyaluronic acid (HA) are among the minimally invasive treatments for knee osteoarthritis (OA). This trial was designed to compare the effectiveness of intra-articular injection of PRP with HA (as one of the standard treatments) on mild to moderate knee OA., Methods: In this phase I open-label clinical trial, 10 patients underwent intra-articular PRP injection and 10 others received HA injection. At baseline (pre-injection) visit and 1, 3, 6, and 12 months post-injection, clinical assessments were performed using visual analogue scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Physical examinations of the knee, including crepitation and range of motion (ROM) were performed at each visit. The follow-up responses were compared with the baseline visit., Results: The PRP treatment was ascertained to be safe and caused no adverse effects. Significant improvements in the majority of KOOS subscales and VAS were found throughout the entire 12-month follow-up, following the PRP injections. HA injection, however, caused only one month significant improvement in the majority of patient-reported outcomes. In the majority of visits, the extent of improvements in the scores of KOOS subscales, as well as the extent of reduction in VAS were significantly greater in PRP recipients, compared to HA recipients. The ROM in both groups slightly increased after interventions. The frequency of coarse crepitation, which was detected in 100% of the patients in both groups at the baseline visit, decreased significantly to fine crepitation at the first follow-up visit in 80% and 40% of the PRP and HA recipients, respectively., Conclusion: Intra-articular injection of PRP or HA alleviates symptoms and pain and improves functionality and physical examinations in patients with knee OA. However, PRP therapy produces greater and longer-lasting improvements in most of the outcome parameters compared to HA., Competing Interests: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Background and Aim of the Work: Several studies have shown beneficial effects for Platelet-rich plasma (PRP). We aimed to assess the efficacy of pure PRP injection for facial rejuvenation in Iran., Methods: 30 female consecutive participants were injected with PRP in two sessions with 3 month interval. Evaluations were performed by comparing the pre- and post-improvement measurements of skin scan, before after photography by participants, therapeutic physician and blindly by a second dermatologist., Results: In 3 and 6 months follow-ups respectively,  moderate to excellent improvement in periorbital dark circles (47.8,60.9%), periorbital wrinkles (73.9%,78.3%), nasolabial fold (52.2%,56.6%) and skin rigidity (52.3%,60.9%)  reported by patients, was statistically significant only for dark circle(P value 0.031). Moderate to good improvement in periorbital dark circles (47.9%,74%), periorbital wrinkles (39.1%,43.5%)and nasolabial folds (4.3% ,13.1%)  demonstrated by therapeutic physician's evaluation , was statistically significant for dark circle (P value 0.008) and nasolabial folds (P value 0.025). Moderate to good improvement in periorbital dark circles (34.8%, 52.2%), periorbital wrinkles (26.1%, 34.8%) and nasolabial folds (4.4%, 13%)   by second dermatologist, was statistically significant for dark circle (P value 0.025)., Conclusion: Face rejuvenation with PRP is a promising and noninvasive technique with best results observed in improving periorbital dark circles and wrinkles.

Objective: The current study assesses the effects of platelet-rich plasma-fibrin glue (PRP-FG) dressing along with oral vitamin E and C on wound healing and biochemical markers in patients with non-healing diabetic foot ulcers (non-healing DFU)., Methods: This randomized controlled trial was performed on 25 patients with non-healing DFU. Patients were treated with PRP-FG dressing plus oral vitamin E and C (intervention group) or PRP-FG dressing plus placebo (control group) for 8 weeks., Results: Eight weeks after treatment, six wounds in the intervention group and two wounds in the control group were completely closed, and also wound size significantly reduced in both intervention and control groups ( p  < 0.05). This reduction in wound size was significantly greater in the intervention group compared to the control group ( p  = 0.019). Also, a significant decrease in prooxidant-antioxidant balance (PAB) , ESR, and hs-CRP was observed in the intervention group compared to the control group ( p  < 0.05)., Conclusion: Our results showed that PRP-FG dressing along with oral vitamin E and C could be used to increase wound healing in patients with non-healing DFU by enhancing the wound healing process and reducing oxidative stress., Trial Registration: This trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT04315909).

Background: There is no pharmacological intervention on the treatment of hypoxemia and respiratory distress in COVID-19 patients., Objective: The objective of the study was to study the effect of the reduced form of methylene blue (MB) on the improvement of oxygen saturation (SpO 2 ) and respiratory rate (RR)., Methods: In an academic medical center, 80 hospitalized patients with severe COVID-19 were randomly assigned to receive either oral MB along with standard of care (SOC) (MB group, n = 40) or SOC only (SOC group, n=40). The primary outcomes were SpO 2 and RR on the 3 rd and 5 th days. The secondary outcomes were hospital stay and mortality within 28 days., Results: In the MB group, a significant improvement in SpO 2 and RR was observed on the 3 rd day (for both, p < 0.0001) and also the 5 th day (for both, p < 0.0001). In the SOC group, there was no significant improvement in SpO 2 (p = 0.24) and RR (p = 0.20) on the 3 rd day, although there was a significant improvement of SpO 2 (p = 0.002) and RR (p = 0.01) on the 5 th day. In the MB group in comparison to the SOC group, the rate ratio of increased SpO 2 was 13.5 and 2.1 times on the 3 rd and 5 th days, respectively. In the MB group compared with the SOC group, the rate ratio of RR improvement was 10.1 and 3.7 times on the 3 rd and 5 th days, respectively. The hospital stay was significantly shortened in the MB group (p = 0.004), and the mortality was 12.5% and 22.5% in the MB and SOC groups, respectively., Conclusions: The addition of MB to the treatment protocols significantly improved SpO 2 and respiratory distress in COVID-19 patients, which resulted in decreased hospital stay and mortality. ClinicalTrials.gov: NCT04370288., (Copyright: © 2021 Permanyer.)

In this report we have discussed our experience with a special home-made platelet-rich plasma (PRP)-fibrin glue (FG) as a last resort for treatment of a challenging case of postoperative CA. A 25 years old, ill woman was admitted with severe ascites and hepatic encephalopathy in our center. She was a known case of autoimmune hepatitis and cirrhosis who had undergone liver transplantation 5 years ago and developed chronic rejection. During the surgery an old organized thrombosis in the portal vein was detected, accordingly an iliac vein graft was used to bypass the superior mesenteric vein. After surgery the patient developed chylous ascites. Having no other choice, based on our experience with PRP-FG in similar situations, we decided to use this method as a last resort to treat postoperative chylous ascites. It can be concluded that when conservative management is not working for the treatment of postoperative chylous ascites in intractable cases, PRP-FG can be considered as a last resort treatment. A special home-made PRP-FG was prepared for the patient and of that, 90 mL was injected to the abdominal cavity via the drainage tube followed by a 25 mL of isotonic saline solution to prevent clot formation within the tube. Few days after treatment, chylous secretion decreased and then completely ceased. It can be concluded that when conservative management is not working for the treatment of postoperative chylous ascites in intractable cases, PRP-FG can be considered as a last resort treatment., Competing Interests: None declared.

Objectives: The postoperative persistence of chylothorax is a fatal complication of paediatric cardiac surgery. There is an urgent need for an effective treatment of chylothorax. This study reports the application of allogenic platelet-rich plasma fibrin glue (PRP-FG) as a conservative therapy before reoperation., Methods: Over a 9-year period, from 2010 to 2019, 27 patients with persistent chylothorax following a cavopulmonary connection, with a mean latency period of 11 days (range 10-15 days), were treated with PRP-FG. These patients were selected because they had not responded positively to initial conservative management plans. The patients were followed up for 9 years., Results: Twenty-five patients (92%) responded positively to treatment with PRP-FG; 2 patients did not respond to the treatment and died after reoperation. All of the successfully treated patients in follow-up continued to live a healthy life without further complications., Conclusions: Recalcitrant chylothorax that persists after paediatric cardiac surgery responded positively to treatment with PRP-FG. This technique precluded the need for another operation and significantly decreased the morbidity and mortality rates., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

The severe acute respiratory syndrome caused by COVID-19 is now a global catastrophic event. Currently there is no approved drug or vaccine for the disease. Methylene blue (MB, oxidized form, blue color) has been used in many different areas of clinical medicine, ranging from malaria to orthopedics. Leucomethylene Blue (reduced form of MB, colorless) may be applied for the treatment of COVID-19 according to the scientific evidences. In severe patients, there is a cytokine storm (hyperinflammation) and high oxidative stress (OS). Inflammation and OS has a mutual correlation and exacerbate each other. In human body, MB first induces OS through absorbing electron (like a free radical) from other molecules, if the body could counteract to this OS, then reduced MB decreases OS through other mechanisms. Reduced MB could prevent inflammation, propagation of the virus RNA, and also improves hypoxia through reducing methemoglobin. Therefore, to avoid the increment of OS, we suggest using Leucomethylene Blue through the following protocol: The IV cocktail contains 50 mg MB (1mg/kg, 50-kg weight), 1000-2000 mg vitamin C, 500-1000 mg N-Acetylcysteine (or glutathione or cysteine or α-lipoic acid) and 10-20 gr urea (optional) in 100 ml dextrose 5%. Before the injection, the cocktail should be kept in a dark place for 1-2 hour to become fade or colorless.

Introduction: One of the most common complications following total laryngectomy is pharyngocutaneous fistula (PCF). Various methods have been proposed to treat this disorder in recent studies, including a range of simple and conservative treatments to more aggressive therapies, such as various surgical procedures. One of the most innovative and least developed methods is the use of plasma-rich compounds, such as fibrin glue., Case Report: The patient was a 55-year-old woman with a transglottic squamous cell carcinoma of the T3N0M0 stage and PCF development following total laryngectomy surgery with total thyroidectomy and bilateral elective cervical lymph node dissection level I-IV. In spite of conservative treatment, the fistula was not recovered after 3 weeks. It was decided to perform fibrin glue injection into the fistula tract via the endoscopic approach. One month after the fibrin glue injection, no evidence of contrast extravasation was observed on barium swallow test, and the fistula was completely closed., Conclusion: No PCF has been treated with fibrin glue using only the endoscopic technique. The present study showed that fibrin glue can be used as an effective way to treat chronic fistulas in head and neck surgeries.

Background: Androgenetic alopecia is the most common type of hair loss in men, which is manifested by a progressive terminal hair loss in specific areas of scalp. Platelet-rich plasma (PRP) is among treatment options for androgenetic alopecia. PRP is a human platelet concentrate in a small volume of plasma containing certain cytokines., Aim: The aim of this study was to evaluate the efficacy and safety of autologous PRP in treatment of male androgenetic alopecia., Methods: This was a clinical trial in 19 patients with grade III vertex to grade V androgenetic alopecia referring to the Clinic of Ghaem Hospital between March 2015 and March 2016. All obtained liquid PRP (5 cc) was injected at around 125 points (equals to 125 cm 2 ) into the scalp, and operation was repeated in three sessions at 0, 4, and 8 weeks. We took macroscopic and dermoscopic pictures of each patient in 0, 4, and 8 weeks and 3 months after the last injection session. A dermatologist evaluated the treatment response using dermoscopy photos., Result: Our results showed that the trend of hair thickness and number variations during study period was significant (P < 0.001). However, there was no significant change in the hair thickness from the second injection forward. Our findings indicate the number of hair follicles during follow-up in pairwise comparison was significantly more than baseline., Conclusion: Findings of our study were in line with other studies in this field and showed that the use of PRP as a new and safe treatment can be effective in androgenetic alopecia., (© 2019 Wiley Periodicals, Inc.)

The present study aimed to evaluate serum prooxidant -antioxidant balance (PAB) in an Iranian population exposed to sulfur mustard (SM) more than 20 years ago. In this study, 42 SM-exposed subjects and 30 unexposed subjects (as controls) were recruited. Serum PAB, biochemical, and hematological parameters were measured in all subjects. Correlation of PAB with biochemical and hematological parameters was determined. The mean PAB values in the SM-exposed group (82.5 ± 34.8 HK) were significantly higher than that in the control group [47.5 ± 17.8 HK] ( p  < 0.001). The results demonstrated that serum PAB values were positively correlated with alkaline phosphatase activities in the SM-exposed group. Furthermore, PAB values showed a significant negative correlation with hepatic enzymes (AST, ALT), triglycerides, total bilirubin, and mean corpuscular hemoglobin concentrations. PAB values showed a borderline significant negative correlation with uric acid. The present results suggest that late oxidative stress and alterations in biochemical and hematological parameters may be a consequence of the frequent respiratory infections rather than direct toxic effects of SM.

Objective: Schizophrenia is a disease with unknown etiology. There is evidence suggesting that oxidative damage occurs in schizophrenia. Oxidative damage may arouse from imbalance between oxidant and anti-oxidant factors in cellular and tissue environment. Although it may not be the primary cause, it can worsen the disease and may be a reason of poor response to therapy in these patients. The present study aimed at evaluating the pro-oxidant antioxidant balance (PAB) and total antioxidant capacity (TAC) in serum of schizophrenia patients. PAB is an assay to determine the pro-oxidant load and antioxidant capacity in a single measurement. Method : In this cross- sectional study, patients with diagnosis of schizophrenia, who referred to a psychiatry university hospital (Ibn-e-Sina Hospital) affiliated to Mashhad University of Medical Sciences, were enrolled. Patients' demographic characteristics and laboratory data were recorded from patients' files. Serum PAB and TAC were measured using a special PAB assay and commercial kit, respectively. Data were analyzed using SPSS 16. Results: A total of 84 individuals (42 schizophrenia cases and 42 healthy controls) participated in this study. Controls were age and sex-matched with the patients' group. The mean TAC in the patient and control groups was 0.49±0.04 and 0.51±0.04 nmol/L, respectively (p = 0.16). PAB was higher in patients' group than in controls (127.36±36.44 vs. 118.93±52.34 HK), however, this difference was not statistically significant (p = 0.09). The change was correlated with the chronicity of the disease. Conclusion: Pro-oxidant antioxidant balance was elevated in serum of patients with schizophrenia. These data suggested the occurrence of oxidative stress during the progression of the disease. Lower antioxidant capacity might suggest that patients with schizophrenia could be more susceptible to oxidative stress damage.

Background: Until recently, a gene polymorphism in the promoter region of endothelial nitric oxide synthase has been suggested as a risk factor for thromboangiitis obliterans (TAO) development. The aim of this study was to compare the metabolites of nitric oxide (NO) and its backup, heme-oxygenase-1 (HMOX1), between TAO patients and those of a smoking control group matched by race, age, sex, and smoking habits., Methods: Twenty-four male Caucasian TAO patients and 20 male Caucasian controls enrolled in the study. Their smoking habits were matched based on the serum cotinine levels of 17 of the TAO patients and the 20 controls. A colorimetric kit was used to measure NO, and an enzyme-linked immunosorbent assay kit was used to measure cotinine and HMOX1 levels., Results: The mean serum level of NO metabolites in the TAO group was significantly less than in the controls (p = 0.03) and also significantly less in the patients with below-knee amputations than in non-amputees (p= 0.018). Also, HMOX1 was significantly greater in the TAO patients than in the controls (p= 0.01). No significant correlation was found between NO and HMOX1 (p = 0.054)., Conclusion: Nitric oxide may play a pivotal role in TAO development and its outcome. However, the intact HMOX1 pathway may demonstrate the unique role of NO, which cannot be compensated for by HMOX1 and whose absence may make patients susceptible to developing TAO. In addition, another pathway besides NO, with influence on vascular tone and hemostasis, might be involved in TAO development, such as the autonomic nervous system. Further studies are suggested regarding these issues.

Background: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is an apoptotic molecule with a key role in the apoptosis of tumors and virus-infected cells. The association of 1525G/A and 1595C/T polymorphisms in the region of 3' UTR on the TRAIL gene has been shown in many cancers and diseases. Polymorphism at the positions of 1525G/A and 1595C/T might influence the clearance of hepatitis B virus (HBV)., Objectives: This study was carried out to determine the role of the TRAIL gene polymorphisms in clinical outcome of HBV infection., Patients and Methods: Polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) was applied to genotype TRAIL polymorphisms at positions 1525G/A and 1595C/T. To evaluate the TRAIL gene polymorphism in the 3' UTR region at position 1525G/A and 1595C/T, 147 patients with HBV infection were divided into three different groups of chronic hepatitis (n = 52), cirrhosis (n = 33), and carrier (n = 62) and there was a group of 101 healthy controls., Results: Our data showed that genotypes 1525G/A and 1595C/T were in complete linkage disequilibrium and the genotype frequencies at the two positions were the same. No significant differences in frequencies of genotype and alleles at positions 1525G/A and 1595C/T were observed between all the three groups (P value > 0.05)., Conclusions: According to our result, 1525G/A and 1595C/T were in strong linkage disequilibrium and the polymorphisms of the TRAIL gene in the 3' UTR region were not associated with the outcome of HBV infection.

Brain trauma is an important cause of mortality and disability among young people worldwide. One of the mechanisms of post-traumatic secondary brain damage is related to free radical release and oxidative stress (OS). OS is the consequence of an imbalance between pro-oxidants and antioxidants in favor of pro-oxidants. This imbalance may lead to macromolecule damage including lipid peroxidation, protein crosslinking, DNA damage and changes in growth and function of cells in brain. Free radical release and subsequent lipid peroxidation are early events following neural tissues injury and are associated with hypo-perfusion, edema, and disruption of axonal guidance. In this study, we determined the prooxidant-antioxidant balance (PAB) in patients with brain injury, and its correlation with number of demographic and clinical parameters. Sera from 98 patients with traumatic brain and 100 healthy subjects were collected. The serum PAB was measured. Age, sex, GCS (Glasgow coma scale), mechanism of injury, brain lesions found on CT scan and lesions in other parts of the body, caused by trauma, were determined. A significantly higher PAB value was observed in the patient group (138.97 ± 15.9 HK unit) compared to the controls (60.82 ± 12.6 HK) (P = 0.001). In the patient group, there was no significant correlation of PAB with GCS, brain lesion characteristic, mechanism of injury, other accompanying traumatic injury, age and gender. When patients were classified into three groups according to GCS: group 1 (GCS>13, n = 28, PAB serum value = 138.51 ± 62.66 HK), group 2 (GCS between 8 and 12, n = 29, PAB serum value = 162.7 ± 50.6 HK) and group 3 (GCS <8, n = 41, PAB serum value = 155.56 ± 58.21 HK); there was no significant difference between groups. The serum PAB values were higher in patients with traumatic brain injury, although this was not associated with the extent of injury.

Context: Cleft palate is the second most common birth defect and is considered as a challenge for pediatric plastic surgeons. There is still a general lack of a standard protocol and patients often require multiple surgical interventions during their lifetime along with disappointing results., Evidence Acquisition: PubMed search was undertaken using search terms including 'cleft palate repair', 'palatal cleft closure', 'cleft palate + stem cells', 'cleft palate + plasma rich platelet', 'cleft palate + scaffold', 'palatal tissue engineering', and 'bone tissue engineering'. The found articles were included if they defined a therapeutic strategy and/or assessed a new technique., Results: We reported a summary of the key-points concerning cleft palate development, the genes involving this defect, current therapeutic strategies, recently novel aspects, and future advances in treatments for easy and fast understanding of the concepts, rather than a systematic review. In addition, the results were integrated with our recent experience., Conclusions: Tissue engineering may open a new window in cleft palate reconstruction. Stem cells and growth factors play key roles in this field.

Background: The cultured mesenchymal stem cells (MSC) have been used in many clinical trials; however, there are still some concerns about the cultural conditions. One concern is related to the use of FBS as a widely used xenogeneic supplement in the culture system. Human platelet-rich plasma (hPRP) is a candidate replacement for FBS. In this study, the effect of hPRP on MSC proliferation and osteogenic differentiation has been evaluated., Methods: Human adipose-derived stem cells (hADSC) were expanded. Cells from the third passage were characterized by flow cytometric analysis and used for in vitro experiments. Resazurin and alizarin red stains were used for cell proliferation and osteogenic differentiation assays, respectively., Results: Treatment with hPRP resulted in a statistically significant increase in cell proliferation compare to the negative control group (P<0.001). Cell proliferation in the 15% hPRP group was also significantly higher than that in the 10% hPRP group (P<0.05). Additionally, it caused less osteogenic differentiation of the hADSC compared to the FBS (P<0.001), but in comparison to negative control, it caused acceptable mineralization (P<0.001)., Conclusion: These findings indicate that hPRP not only improves the proliferation but also it can be a suitable substitution in osteogenic differentiation for clinical purposes. However, the clinical application value of hPRP still needs more investigation.

Objective: To determine the prooxidant-antioxidant balance (PAB) in neonatal asphyxia and compare it with values for PAB in healthy neonates., Methods: In a prospective observational study, serum PAB of umbilical cord blood of 30 neonates with asphyxia [pH < 7.2, low Apgar score, signs of respiratory distress syndrome (RDS)] as the case group and 35 healthy neonates (without an abnormal clinical event at birth and after the first week) as the control group were compared., Results: Among the 35 neonates in the control group, the average level of serum PAB was 20.00 HK units, which was significantly lower than for the 30 neonates within the case group (40.46 HK units; p = 0.019). The blood pH in the case group was significantly lower than for control group (P < 0.001). In controls, HCO3 (-) and pCO2 were 18.6 mmol/L and 38.5 mmHg respectively, whilst in the case group these values were 15.5 mmol/L and 45.7 mmHg respectively (p < 0.05)., Conclusions: Determination of PAB may be useful in the early diagnosis of perinatal asphyxia and is consistent with HCO3 (-), pCO2 and Apgar score.

Introduction: The aim of this study was to investigate the impact of thromboangiitis obliterans (TAO) sera on activation of primary cultures of human umbilical vein endothelial cells (HUVECs) as a model for vascular endothelial cells., Methods: Study subjects included 21 TAO patients as the case group and 20 healthy smokers and 17 healthy non-smokers as control groups. Case and control groups were matched based on their age, socioeconomic status and smoking habit. HUVECs were incubated with the sera of case and control groups and gene expression of intercellular adhesion molecule (ICAM-1) and vascular adhesion molecule (VCAM-1) were evaluated by real-time polymerase chain reaction, TaqMan method., Results: The expression of ICAM-1 and VCAM-1 were significantly higher in HUVECs after incubation with TAO sera compared to control groups (P < 0.05). VCAM-1 had a significant correlation with duration of smoking (P < 0.001, R = 0.672), while the expression of ICAM-1 had a significant correlation with the number of cigarettes smoked daily (P = 0.04, R = 0.421)., Conclusion: Sera from TAO patients could activate HUVECs. This same activation might occur in vivo by the responsible cytokines, in particular those released from activated platelets, free oxygen radicals, and possibly low levels of nitric oxide (NO) of the sera of TAO patients, as a consequences of chronic cigarette smoking and of endothelial NO synthase polymorphism. Therefore, plasma exchange might be helpful in acute phase of the disease for saving the limbs and administration the combinations of exogenous NO with anti-oxidants might be helpful in long-term management of TAO patients to reduce the risk and rate of amputation., (© 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.)

Introduction: The endoscopic fibrin glue or platelet-rich fibrin glue (PRFG) injection is an easy, safe and effective technique for the fistula. So far, the use of fibrin glue has been limited to selected cases., Case Report: Our case is a three years old male child with a neck trauma resulting in a Esophago-Cutaneous fistula after a 3 month period of follow up we decided to use PRFG for this lesion after fine debridement of the fistula tract, and the surrounding fibrosed tissue twice with a one week interval. Our visit after two weeks showed complete recovery and normal general condition. A contrast study revealed complete disappearance of the lesion., Conclusions: In our case the PRFG completely resolved a long-standing fistula resistant to exhaustive conservative management. The treatment with PRFG has been proved to be effective in the selected cases and it seems that traumatic esophago-cutaneous fistula may be one of these selections. Application of fibrin sealant should be considered early in the management of these difficult clinical problems.

Human umbilical cord blood (HUCB) is now considered as a valuable source for stem cell-based therapies. Previous studies showed that intravascular injection of the HUCB significantly improves neurological functional recovery in a model of intracerebral hemorrhage (ICH). To extend these findings, we examined the behavioral recovery and injured volume in the presence of increasing doses of human umbilical cord blood derived mononuclear cells (HUC-MCs) after intracerebral hemorrhage in rats. The experimental ICH was induced by intrastriatal administration of bacterial collagenase IV in adult rats. One day after the surgery, the rats were randomly divided into 4 groups to receive intravenously either BrdU positive human UC-MCs (4 × 10(6), 8 × 10(6) and 16 × 10(6) cells in 1 ml saline, n=10, respectively) as treated groups or the same amount of saline as lesion group (n=10). There was also one group (control n=10) that received only the vehicle solution of collagenase. The animals were evaluated for 14 days with modified limb placing and corner turn tests. The transplanted human UC-MCs were also detected by immunohistochemistry with labeling of BrdU. Two weeks after infusion, there was a significant recovery in the behavioral performance when 4 × 10(6) or more UC-MCs were delivered (P<0.05-0.001). Injured volume measurements disclosed an inverse relationship between UC-MCs dose and damage reaching significance at the higher UC-MCs doses. Moreover, human UC-MCs were localized by immunohistochemistry only in the injured area. Intravenously transplanted UC-MCs can accelerate the neurological function recovery of ICH rat and diminish the striatum lesion size by demonstrating a dose relationship between them., (Copyright © 2012 Elsevier GmbH. All rights reserved.)

Objective. Using a novel assay termed prooxidant-antioxidant balance (PAB) assay to determine prooxidant-antioxidant balance in umbilical cord blood of infants with meconium stained of amniotic fluid (MSAF). Passage of meconium in amniotic fluid is associated with increase of neonatal mortality and morbidity. This complication occurs in about 15% of infants and is more widespread in postterm neonates. About 1.5 percent of neonates with MSAF develop meconium aspiration syndrome. Method. Sera of 29 umbilical cord blood of infants with MSAF and 32 healthy infants (HI) were collected. Both groups had nonsmoker and non-alcoholic mothers with no diseases. The PAB was measured. Result. There was a significant increase of PAB value (32.8 ± 15.9 HK) in umbilical cord blood of infants with MSAF in comparison to HI (24.5 ± 12.6 HK) (P < 0.05). There was no significant correlation between PAB value and age of mothers. Conclusion. The increased PAB value in infants with MSAF showed that these infants are exposed to oxidative stress. Further research with larger population is needed to demonstrate the oxidative stress in infants with MSAF.

Objectives: Human umbilical cord blood (HUCB) is now considered as a valuable source for stem cell-based therapies. Previous studies showed that intravascular injection of the HUCB significantly improves neurological functional recovery in a rat model of intracerebral hemorrhage (ICH). In the present study, we hypothesize transplanted HUCB derived mononuclear cells (UC-MCs) can decrease injured volume and also ameliorate neurological function in ICH rats., Materials and Methods: Experimental ICH was induced by intrastriatal administration of collagenase in rats. One day after surgery, the rats were divided into 3 groups to receive intravenously either BrdU positive human UC-MCs [(4×10(6) and 8×10(6) cells in 1 ml saline, n=10 respectively) as treated groups] or the same amount of saline [as lesion group (n=10)]. There was also one group (control) that received only vehicle solution of collagenase. The animals were evaluated for 14 days with behavioral tests. Transplanted UC-MCs were detected by immunohistochemistry. Histological data and scores of functional tests were analyzed using ANOVA. Cellular co-localization of BrdU+ cells in the histological slides was determined by software Image J., Results: Intravenously transplanted UC-MCs migrated selectively to the hematomal area and reduce injured volume. The UC-MCs transplanted groups showed better performance on functional tests after 2 weeks compared with the lesion and control groups (P< 0.05). There was no difference in the functional recovery and injured volume improvement between the 2 treated groups., Conclusion: Intravenously transplanted UC-MCs accelerate neurological function recovery of ICH rat and diminish the striatum lesion size. Thus these cells may provide a potential cell candidate for cell-based therapy in ICH.

The amount of newborn blood that can be collected from a single cord donor is limited, but a significant amount remains in the placenta. We used a simplified perfusion method to collect this additional blood. Umbilical cord blood from 15 newborns was collected before placental delivery by umbilical vein puncture. After delivery, the placenta was placed on sterile gauze and 63 mL of citrate-phosphate-dextrose-adenine anticoagulant were injected into the umbilical vein that was then clamped near the placenta. The placenta was gently massaged, hung over a sterile vessel, and the umbilical cord cut sterilely near the embryonic surface. Additional blood was collected into the sterile vessel by pressuring a gauze bag around the placenta. We assessed the contribution of this second fraction to the total volume, total nucleated cell (NC), CD34+, hematopoietic progenitors cell, and colony forming unit count and bacterial contamination risk. The total collected volume was 127.3 mL (range 92-170) and the NC content was 1.6+/-0.73x10(9). The mean second fraction contribution from 15 units to the total nucleated and mononuclear cell content was 54+/-9.87% and 54+/-9.52%, respectively. The added percentage of CD34+ and hematopoietic progenitor cells was 54.3+/-10.35% and 46.7+/-11.5%, respectively, while the additional percentages of colony forming-granulocyte macrophage and colony forming-erythroid in the second fraction were 43.2+/-5.5% and 39.8+/-4.3%, respectively, indicating that the cells collected after placental perfusion (second fraction) had similar HPC content and in vitro hematopoietic potential. The method did not increase the risk of bacterial contamination.

Introduction: This study aimed to compare urinary Tamm-Horsfall protein (THP), citrate, and other inhibitors and promoters of stone formation in calcium stone formers with those in healthy individuals., Materials and Methods: From January 2002 to June 2004, 100 calcium stone formers (mean age, 38.6 +/- 10.3 years) who had at least 2 episodes of calcium stone formation were compared with 100 healthy individuals (mean age, 33.8 +/- 9.7 years). Their 24-hour urine THP (using the sodium dodecyl sulfate polyacrylamide gel electrophoresis method), citrate, calcium, uric acid, oxalate, and magnesium values were measured and compared., Results: The mean 24-hour urine THP was 3.3 +/- 8.1 mg in patients in the study group and 4.6 +/- 19.2 mg in controls (P = 0.5). However, THP in individuals with and without bacteriuria was significantly different (15.8 +/- 33.6 versus 2.6 +/- 10.2, P < 0.001). Mean 24-hour urinary calcium, citrate, and oxalate values were 232.6 +/- 95.3 mg and 177.8 +/- 82.7 mg (P < 0.001), 132 +/- 103.2 mg and 395 +/- 258.5 mg (P < 0.001), and 18.9 +/- 22.5 mg and 10.4 +/- 8.5 mg (P < 0.001) in patients in the study and control groups, respectively. There was a significant positive correlation between urinary citrate and promoters of stone formation, including urinary calcium, oxalate, and uric acid, in patients in the control group, but not in patients in the study group., Conclusion: THP in the urine of stone formers is not quantitatively different from that of healthy individuals, but it is different in patients with bacteriuria. Increased urinary excretion of calcium, oxalate, and uric acid in stone formers with no increase in urine citrate may play a role in the pathogenesis of recurrent stone formation.