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In recent years, researchers have shown an increased interest in using medicinal plants for the synthesis of silver nanoparticles (AgNPs) having various therapeutic properties. Centella asiatica (CA), a medicinal plant, has been used to treat minor burn wounds, psoriasis, and hypertrophic wounds among many other pathological conditions. The current study aimed to synthesize CA coated AgNPs (CA-AgNPs) with appropriate biocompatibility and various therapeutic properties, including antimicrobial and analgesic activities. The synthesized CA-AgNPs were characterized by ultraviolet-visible (UV-Vis) spectroscopy, zeta potential measurements, and fourier transform infrared (FT-IR) spectroscopy. The formation of spherical CA-AgNPs was confirmed by a single surface plasmon resonance (SPR) peak emerging at 420 nm wavelength by UV-Vis. The average hydrodynamic diameter and zeta potential of the particles were found to be 29.5 nm and -24.5 mV, respectively. The FT-IR analyses showed that the AgNPs were coated and stabilized by bioactive compounds from the CA extract. MTT cytotoxicity assay revealed that CA-AgNPs at ≤1 mM concentrations exhibited biocompatibility for L929 fibroblast cells. The antimicrobial activity of CA-AgNPs was confirmed by significant inhibition of Staphylococcus aureus and Escherichia coli. In addition, the analgesic effect of CA-AgNPs was investigated for the first time in the literature by tail-flick and hot plate methods, and statistically significant results were obtained for both methods. Taken together, these results suggest that CA-AgNPs can be used as an effective antibacterial and analgesic agent in a variety of biomedical applications, including coating wound dressings.

Purpose This study evaluated the results of polidocanol sclerotherapy in the treatment of venous malformations (VM) including patient satisfaction, perceived improvement, and predictors of satisfaction. Material and Method Patients with VM that underwent polidocanol foam sclerotherapy between June 2013 and July 2021 in a single center were retrospectively evaluated. Patient demographics, VM, and treatment characteristics were analyzed. Patient-reported outcomes and satisfaction were analyzed with a questionnaire. Results This study included 232 (136, 58.6%, female) patients. The mean age was 24.49 ± 12.45 years (range 3–72). The clinical response rate was 82.3%. The rate of satisfaction was 82.3%, and 116 (50%) patients were significantly satisfied. There were no major complications. Clinical response and VM margin were related to satisfaction ( p < 0.01, p = 0.012, respectively). Clinical response to pretreatment swelling was related to significant satisfaction ( p = 0.02). Conclusion Polidocanol sclerotherapy was safe and effective in VM treatment with high satisfaction and low complication rates.

Basal cell carcinoma (BCC) is the most common skin cancer. Removing the lesion with wide surgical margins and obtaining a microscopically intact margin is considered sufficient in the treatment of BCC. However, it may not always be possible to provide wide and intact margins in cosmetically and functionally important areas. Although recurrence rates after BCC excision vary among studies, the recurrence rate at 5 years is considered to be 2%. BCC subtype, perineural invasion, and close margin are important factors in recurrence. The aims of this study are to investigate the other factors associated with recurrence in BCC treatment and reveal the value of the "histopathological surgical margin" which can help in making the decision for re-excision. A statistically significant correlation is observed between the increase in tumour size and recurrence(p0.05). The recurrence rate after excision with a histopathologic margin of 1 mm or less is 19%. This rate is found to be 8% in patients with a histopathological margin greater than 1 mm and 3 mm or less. Reticular dermis and deeper tissue invasion statistically increase the recurrence rate. Multiple excision and the presence of residual tumour in the re-excision sample also increase the recurrence rate. In conclusion, recurrence in BCC patients is affected by more than one parameter. We highly recommend re-excision in patients with a histopathological margin of 1 mm or less. In tumours with histopathological margins between 1 mm and 3 mm, the decision for re-excision or "wait-and-see" approach should be made according to the characteristics of the tumours and patients.

Summary En coup de sabre deformity (ECDS) is a form of localized scleroderma in the frontoparietal region caused by progressive subcutaneous tissue atrophy and bony defect. Although ECDS involves two layers, skin/subcutaneous tissue and bone, the existing literature mainly focuses only on treating the skin/subcutaneous tissue layer. In this case series, we aimed to propose a novel approach that includes the combined use of fat grafting and demineralized bone matrix (DBM). Four patients with ECDS deformity, operated between February 2016 and October 2018, were retrospectively evaluated. All the patients were treated with the novel approach. Patients were evaluated with localized scleroderma scale and computed tomography (CT) scan in the preoperative period and at the annual follow-up. We observed remarkable improvement in the localized scleroderma scale including appearance, palpation, and size scores in all patients at the annual follow-up. CT scans at the annual follow-up revealed new callus formation at the bony defect area in all patients. Reinforcing fat grafting with DBM could promote healing of the bony and skin/subcutaneous tissue defects associated with ECDS.

Purpose: Patients with arteriovenous malformations (AVMs) have a lower health-related quality of life (QoL) than the general population. QoL assessment of patients with peripheral AVMs after endovascular treatment is scarce in the literature. Radiologic and clinical outcomes are not always correlated in vascular malformation treatment. This study aimed to investigate the relationship between clinical outcomes, QoL, and angiographic outcomes. Materials and Methods: Patients with peripheral AVM that underwent endovascular treatment between January 2009 and December 2021 in a single center were retrospectively evaluated. Patients’ characteristics (age, sex), AVM characteristics (Schobinger classification, location, angiographic architecture), previous treatment, treatment characteristics (type of endovascular approach, embolizing agent and number of sessions), percentages of angiographic response, complications, and recurrence were evaluated. The angiographic architecture was evaluated according to the Yakes classification. The questionnaire was applied for evaluation of clinical response and QoL. Patients older than 12 years and those who can be contacted were included in clinical and QoL analysis. Clinical response was defined as improvement in the patient’s most important pretreatment symptom. Treatment response was defined as clinical response plus >50% angiographic response. Results: Eighty-six patients (41 males [47.7%], 45 females [52.3%]) were included in angiographic analysis. The mean age was 28.44±12.99 years (range=5–61). Forty-three patients (50%) had previous treatment. The median number of sessions was 2 (range 1–15, InterQuartile Range [IOR]=2). Sixty-one patients (30 males [49.2%], 31 females [50.8%]) were included in clinical analysis. The clinical response rate was 73.8%, 95% confidence interval (CI) [0.60, 0.84]. The treatment response rate was 45.9%, 95% CI [0.33, 0.59]. The complication rate was 8.2%. Before treatment, 48 patients (78.7%) reported a negative impact on their QoL. Thirty-three of 48 patients (68.8%) reported improvement on their QoL after treatment. Higher Schobinger stages were related to a negative impact on QoL before treatment (pConclusion: Angiographic architecture and outcomes were not always reflected in QoL after endovascular treatment. Clinical Impact This study’s findings will help clinicians with what to focus on in AVM treatment and how to monitor patients with peripheral AVM after endovascular treatment. Rather than relying too much on the angiographic response, patients should be checked for symptoms and quality of life improvement. No clear data in the literature regarding the applicability of the Yakes Classification in patients with previous treatment. This study questioned the applicability of the Yakes Classification in patients with previous treatments. In this study, type 4 AVMs were more common in patients with previous treatment.

Reduction rhinoplasties, regardless of the methods used (structural or preservation), can cause a reduction in the internal nasal volume, which may lead to breathing problems. In 1977, Webster proposed preserving a little triangle in the beginning of the lower lateral osteotomy line to prevent breathing problem. However, its importance is still controversial. and methods: This prospective randomized controlled study (level of evidence 1) included 46 patients without nasal breathing problem. High-to-low (Webster’s triangle preservation) osteotomy (control group, n = 23) and low-to-low osteotomy (study group, n = 23) were performed. All operations were performed according to the proposed volumetric rhinoplasty steps (examination/measurement, prevention and treatment). Nasal obstruction symptom evaluation (NOSE) test, visual analog scale, acoustic rhinometry, rhinomanometry, peak nasal inspiratory flow (PNIF), and three-dimensional measurements were performed in all patients. Breathing tests were repeated before and 6 months after surgery with and without xylometazoline administration. No statistically significant difference in NOSE and visual analog scale scores was found between the two groups. Acoustic rhinometry, PNIF, and rhinomanometry findings showed no statistically significant breathing difference between the two groups. In reduction rhinoplasties, a decrease in the internal volume may be expected as directly proportional with the reduction amount. The decrease in the internal volume may create nasal breathing problems. To prevent it, nasal airflow should be adjusted according to new anatomy. In this study, we discussed “volumetric rhinoplasty” steps to prevent breathing problems in reduction rhinoplasty. Following these steps, not preserving Webster’s triangle (low-to-low osteotomy) has no effect on the nasal airway. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background In the preauricular region, the frontotemporal branch of the facial nerve is vulnerable to injury, which can result in facial palsy and poor cosmesis after surgical interventions. Objectives The purpose of this study was to describe variations in the branching patterns of the frontotemporal branch of the facial nerve and the relation between this branch and the surrounding anatomic landmarks. Based on our findings, we propose a Danger Zone and Safe Zones for preauricular interventions to avoid frontal branch injury. Methods Twenty cadaveric half-heads, 10 freshly frozen and 10 embalmed, were dissected. The anatomy of the auriculotemporal nerve, facial nerve, and variations of its branching pattern in the preauricular region were investigated. Results The mean [standard deviation] number of frontotemporal branches crossing the zygomatic arch was 2.05 [0.6]. Beginning from the X point at the apex of the intertragal notch, frontal branches ran over the zygomatic arch at a distance extending from 10 to 31 mm anterior to the tragus, which can be defined as the Danger Zone for frontal branches. Safe Zones A and B are triangular regions located behind and in front of the Danger Zone, respectively. Conclusions Mapping of these Safety and Danger Zones is a reliable and simple approach in preauricular interventions to avoid frontal branch injury because the facial nerve typically has multiple frontal branches. This approach provides practical information for surgeons rather than estimating the trajectory of a single frontal branch from Pitanuy's line.

Background: In rhinoplasty, careful management of the dorsum to achieve a smooth transition from radix to tip is necessary to improve outcomes. Grafts and alloplastic materials were previously used for treatment of dorsal irregularities. Bone dust is one of the leading options that is easily moldable into a paste, reliable and an "orthotopic" option that promotes bony healing across the dorsal bony defect. It is especially useful in closed rhinoplasty, where our visual acuity on the dorsum is relatively reduced. Objective: We introduce a new tool for rhinoplasty, a minimally invasive bone collector (Micross), as an effective and safe device for harvesting bone dust from the nasal bony pyramid to obtain a camouflage effect on the bony dorsum and for performing surface ostectomy simultaneously. Material and Method: Eighteen patients were operated for nasal deformity, with closed rhinoplasty between February 2018 and November 2018. In all cases, a minimally invasive bone collector was used for ostectomy and simultaneous harvest of bone dust. The device is externally 5mm in diameter and has a 160o cutting blade on its tip. Its collection chamber-capacity allows harvesting a maximum of 0.25 cc of bone graft at one time. Results: Comparison of preoperative and postoperative standardized photographs and physical examination revealed no dorsal asymmetry or irregularities in 17 of 18 patients. Conclusion: The device has the advantage of simultaneous surface ostectomy of nasal bones and graft harvesting and it is practical, safe and efficient for treating dorsal irregularities.

Aim: The term frontonasal dysplasia (FND) represents a spectrum of anomalies and its genetics have not been well defined. Recently, the critical role of the aristaless-like homeobox ( ALX) gene family on the craniofacial development has been discovered. In the present study, we aimed to propose a systematic surgical treatment plan for the ALX-related FNDs according to the genotypic classification as well as demonstrating their clinical characteristics to help surgeons diagnose the underlying pathology accurately. Design: Single-institution retrospective. Setting: Tertiary health care. Patients and Methods: Eighty-nine FND cases were evaluated. Eight of them had ALX1-related FND3, 3 had ALX3-related FND1, and 2 had ALX4-related FND2. Phenotype characteristics of ALX-related FNDs were evaluated, and relevant surgical interventions were assessed. Results: The ALX1-related FND3 phenotype is striking due to the involvement of the eyes in addition to the presence of hypertelorism, facial clefts, and nasal deformities. A widened philtrum and prominent philtral columns are remarkable features of the ALX3-related FND1, whereas the ALX4-related FND2 has more severe deformities: severe hypertelorism, brachycephaly, large parietal bone defects, broad nasal dorsum, and alopecia. Facial bipartition, box osteotomies, eyelid coloboma repair, cleft lip and palate repair, nasal reconstruction, and fronto-orbital advancement can be performed in ALX-related FNDs based on the characteristics of each subtype. Conclusions: This genetic classification system will help surgeon diagnose patients with FND with unique features and draw a roadmap for their treatment with a better surgical perspective.

The aim of this study was to present a novel ultrasound-guided minimally invasive technique for the treatment of extracapsular condylar fractures and evaluate its long-term outcomes. Seven patients with isolated extracapsular condylar fractures with a noncomminuted proximal segment were included in this study. Ultrasound was used for identification of the position of the bone segments and intraoperative confirmation of appropriate reduction. Reduction of the displaced segments was performed using threaded K-wires under ultrasonographic visualization. The bone segments were stabilized using an adjustable modified external fixator designed by us, which allows manipulation of the segments in three planes intraoperatively and postoperatively, if needed. The functional outcomes of patients were evaluated. Patients treated with ultrasound-guided percutaneous reduction and external fixation achieved normal occlusion with satisfactory mouth opening (35 mm) and had no pain during mandibular movements at long-term follow-up. None of the patients had any signs of facial nerve injury. Within the limitations of the study it seems that the poposed approch might be an alternative to the open approach in selected cases.

BACKGROUND Lateral pterygoid muscle activity is associated with the pathological mechanisms of some temporomandibular disorders. The authors aimed to define and demonstrate a novel, practical, and safe technique for botulinum toxin type A injection to the lateral pterygoid muscle based on their findings. Their secondary aims were to standardize the injection pattern according to the variations of the lateral pterygoid muscle and its surrounding anatomical structures, and to establish its advantages over intraoral injection. METHODS Twenty cadaver heads were dissected. The lateral pterygoid muscle and its surrounding structures were investigated for anatomical variations. Based on these findings, a standardized extraoral injection protocol was defined and compared with the intraoral technique for accuracy and safety. RESULTS The average depth of the lateral pterygoid plate from the skin surface was 49.9 ± 2.2 mm, and the mean width of the lateral pterygoid plate was 10.5 ± 3.9 mm. The extraoral injection approach based on the location of the maxillary tuberosity, tragus, and lateral pterygoid plate was consistent in all dissections for the accuracy of the intramuscular injection. In the intraoral approach, standardization of the entry point of the needle through the oral mucosa is difficult, which makes adjustment of the depth of the injection challenging while increasing the risk of neurovascular injury. CONCLUSIONS The clinical significance of the lateral pterygoid muscle makes it worthwhile to implement minimally invasive treatments before considering more invasive options. The authors define a safe, accurate, and reliable approach with ease of administration in patients with temporomandibular disorders.

Introduction The effect on hand-eye coordination and visuospatial skills made videogames popular for training in laparoscopic surgery. Although similar effects may be true for fiberoptic intubation (FOI), it has not been studied before. The aim of this study was to investigate the effect of playing videogames with gamepad on FOI skills. Methods After obtaining ethical approval and informed consent, 36 anaesthesia residents with no experience on fiberoptic intubation were divided into two groups. Group C (n = 18) consisted of the residents without any videogame experience with gamepad. Group PS (n = 18) played a videogame 30 minutes/day for five days. All residents performed their first nasal FOI on a patient undergoing orthognathic surgery with no known difficult intubation under general anaesthesia under supervision of an experienced anaesthesiologist. Intubation time, success rate, pre- and post-intubation SpO2 and etCO2 values were recorded. Results Intubation time was shorter (P = 0.017) and success rate at the first attempt was higher in Group PS (P = 0.045) compared to Group C. We performed multivariate linear regression analysis to investigate which independent variables (gender of residents, experience in anaesthesiology, dominant hand, study group and previous history of videogame experience) affected our dependent variable intubation time. Backward analysis revealed previous videogame playing history (previous players vs. non-players) was the only significant predictor of intubation time (P = 0.010). Conclusion Although we cannot reliably suggest using videogames as an educational tool for FOI, the results of our study showed that videogame playing history may provide an improvement in FOI time of novices in actual operating-theatre environment.

İpek, fibroin (lifli protein) ve serisin (globüler, zamklama proteini) olarak isimlendirilen iki ana proteinden oluşmaktadır. Fibroin tekstil üretiminde ve çeşitli biyomalzeme uygulamalarında kullanılırken, serisin tekstil endüstrisinde bir atık malzeme olarak kabul edilmektedir. Serisin, belirsiz bir yapıya sahip çok bileşenli bir protein olması nedeniyle, fibroinden daha az dikkat çekmiştir, ancak bu proteinin de biyolojik aktiviteye sahip olduğu ve biyouyumlu olduğu yapılan çalışmalarla gösterilmiştir. Serisin değişken amino asit bileşimi ve çeşitli fonksiyonel grupları ile biyomedikal uygulamalar için ilgi çekici biyoaktif özelliklere sahiptir. Antioksidan karakteri, nemlendirme yeteneği ve memeli hücreleri üzerindeki mitojenik etkisi nedeniyle, serisinin hücre kültürü ve doku mühendisliğinde yararlı olduğu son yıllarda yapılan çalışmalarla gösterilmiştir. Ayrıca, keratinositler ve fibroblastlar üzerindeki olumlu etkileri, başta yara bakım malzemeleri olmak üzere deri dokusu onarımı için serisin bazlı biyomalzemelerin gelişmesine yol açmıştır. Ek olarak, serisin, kemik benzeri hidroksiapatit nükleasyonunu indükleme kabiliyeti nedeniyle kemik doku mühendisliği için kullanılma potansiyeline de sahip olduğu gösterilmiştir. Filmler, süngerler ve hidrojeller gibi kararlı ipek serisin biyomalzemeleri, çapraz bağlama veya diğer polimerler ile karıştırılarak hazırlanmaktadır. Serisin aynı zamanda ilaç salımı için de kullanılma potansiyeline sahiptir, çünkü kimyasal reaktivitesi ve pH yanıtı, serisin bazlı nano-mikropartiküllerin, hidrojellerin ve konjuge moleküllerin üretimini kolaylaştırmakta ve ilaçların biyoaktivitesini arttırmaktadır. Bu çalışmada, önemli bir protein olan ipek serisinin özellikleri ve kullanım alanları özetlenmiştir. Silk consists of two main proteins called fibroin (fibrous protein) and sericin (globular, glued protein). While fibroin is used in textile production and various biomaterial applications, sericin is considered as a waste material in the textile industry. Sericin is a multicomponent protein with an indefinite structure and has received less attention than fibroin, but it has been shown to be biocompatible and has biological activity. Sericin has interesting bioactive properties for biomedical applications with variable amino acid composition and various functional groups. Because of its antioxidant character, its moisturizing ability and its mitogenic effect on mammalian cells, in recent years, it has been shown that sericin is useful in cell culture and tissue engineering. In addition, the positive effects on keratinocytes and fibroblasts have led to the development of sericin-based biomaterials for the repair of skin tissue, especially for wound care materials. In addition, sericin has the potential to be used for bone tissue engineering because of its ability to induce bone-like hydroxyapatite nucleation. Stable silk sericin biomaterials such as films, sponges and hydrogels are prepared by cross-linking or mixing with other polymers. Sericin also has the potential to be used for drug release because its chemical reactivity and pH response facilitate the production of sericin-based nano-microparticles, hydrogels and conjugated molecules, and increase the bioactivity of drugs. In this study, the properties and usage areas of silk sericin, which is an important protein, are summarized.

Current tissue engineering and regenerative medicine applications provide treatment options for acquired and congenital defects of several tissues including cartilage, skin, bone, nervous, and adipose tissue. Preclinical and clinical studies have made a significant progress and their results are promising. Combination of cells, scaffolding materials, chemical signals, and gene manipulation should be balanced to be able to design nano/microenvironments for tissue regeneration which will eventually result in improved clinical outcomes. Being able to design nano/microenvironments with growing biomaterial nanotechnology and to control every single parameter required for tissue regeneration will allow us better manipulate tissue specific interactions between signal molecules and cells. Tissue engineering and regenerative principles will be refined with more systematic studies and interdisciplinary approach which is key to determine the best biomolecular delivery methods, the most effective scaffold properties, and cell types.

In this study, silver nanoparticles coated with sericin (S-AgNPs) were adsorbed on poly (ethylene terephthalate)-g-poly(hydroxyethylmethacrylate) (PET-g-HEMA) nanofibers and the use of the obtained material as wound dressing was investigated. PET fibers were firstly grafted with HEMA for varying hydrophobic nature of PET. A wound dressing material was obtained from polymer solution of this copolymer with electrospinning under certain conditions. Then, negatively charged S-AgNPs were adsorbed on the surface of the nanofiber membranes. Scanning electron microscope (SEM), UV–Vis, X-ray fluorescence (XRF), thermal, mechanical, antibacterial and cytotoxicity analyzes of the modified membranes have been examined. It was found that the modified nanofibers with S-AgNPs had antimicrobial effects on gram positive and gram negative bacteria. The viability rates of the cells incubated with the modified material extract did not decrease below 70% after 1 and 3 days incubation in MTT test. In-vivo studies aimed at evaluating the performance of modified nanofiber surface were performed using Sprague-Dawley male rats. The healing process of deep burn wounds created in rats with different materials was monitored during the 21 days and it was found that the produced nanofibers was more effective in wound healing than the control group and had a healing rate close to a commercially used cover material. © 2020 Elsevier B.V. Türkiye Bilimsel ve Teknolojik Araştirma Kurumu, TÜBITAK: 218S449 The present work was financially promoted by the Scientific and Technological Research Council of Turkey (Project Number: 218S449 ).

Reduction rhinoplasties, regardless of the methods used (structural or preservation), can cause a reduction in the internal nasal volume, which may lead to breathing problems. In 1977, Webster proposed preserving a little triangle in the beginning of the lower lateral osteotomy line to prevent breathing problem. However, its importance is still controversial.and methods: This prospective randomized controlled study (level of evidence 1) included 46 patients without nasal breathing problem. High-to-low (Webster's triangle preservation) osteotomy (control group, n = 23) and low-to-low osteotomy (study group, n = 23) were performed. All operations were performed according to the proposed volumetric rhinoplasty steps (examination/measurement, prevention and treatment). Nasal obstruction symptom evaluation (NOSE) test, visual analog scale, acoustic rhinometry, rhinomanometry, peak nasal inspiratory flow (PNIF), and three-dimensional measurements were performed in all patients. Breathing tests were repeated before and 6 months after surgery with and without xylometazoline administration.No statistically significant difference in NOSE and visual analog scale scores was found between the two groups. Acoustic rhinometry, PNIF, and rhinomanometry findings showed no statistically significant breathing difference between the two groups.In reduction rhinoplasties, a decrease in the internal volume may be expected as directly proportional with the reduction amount. The decrease in the internal volume may create nasal breathing problems. To prevent it, nasal airflow should be adjusted according to new anatomy. In this study, we discussed "volumetric rhinoplasty" steps to prevent breathing problems in reduction rhinoplasty. Following these steps, not preserving Webster's triangle (low-to-low osteotomy) has no effect on the nasal airway.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

GUN GOK, Zehra/0000-0001-6426-0395; Gunay, Kubra/0000-0002-3522-873X WOS: 000519111900003 In this work, a kind of amine-type PET fibers was synthesized by reacting hexamethylenediamine (HMDA) with methacrylic acid-g-poly(ethylene terephthalate) (PET-g-MAA) fibers for the adsorption of silk sericin-capped silver nanoparticles (S-AgNPs) to produce antimicrobial fibers. Firstly, PET fibers were grafted MAA by using free radical polymerization technique and HMDA was covalently connected to the grafted PET fibers. Then, for S-AgNPs synthesis, 10 mL of AgNO3 solution (1 mM, 5 mM and 10 mM) was mixed with 10 mL of 1% sericin solution at pH 11. The obtained solution was stirred at room temperature for 24 h. The color change from transparent to yellow-brown indicated the formation of S-AgNPs. AgNPs formation was also determined by measuring the absorbance spectra of S-AgNPs between 300 and 600 nm using UV-Vis spectrophotometer. To determine the antimicrobial properties of S-AgNPs, agar-well diffusion tests were performed. 5 mM and 10 mM S-AgNPs groups showed antimicrobial activity on Escherichia coli and Staphylococcus aureus. After characterization of the synthesized S-AgNPs with UV-Vis spectrophotometer, Zetasizer, FTIR and TEM, the modified PET fibers were coated with S-AgNPs (5 mM and 10 mM). The S-AgNPs coated PET fibers were characterized by FTIR, SEM and X-ray fluorescence spectroscopy. The antimicrobial activities of the obtained PET fibers were investigated on S. aureus and E. coli bacteria by using disk diffusion test. It was found that the S-AgNPs coated modified PET fibers exhibited antimicrobial activities toward both gram-positive and gram-negative bacteria. The resulting polymeric PET fibers containing nano-silver can be used as an antimicrobial surface for many applications such as wound dressing. Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [218S449]; TUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) The work was supported by The Scientific and Technological Research Council of Turkey (TUBITAK) under the project number 218S449. The authors are grateful to TUBITAK for their support.

inal, murat/0000-0003-3384-5627; GUN GOK, Zehra/0000-0001-6426-0395 WOS:000522676800001 Nanofiber production was investigated from poly(ethylene terephthalate) (PET) polymers functionalized with hydroxyethyl methacrylate (HEMA) by grafting of HEMA monomers onto the PET fibers. HEMA grafted PET (PET-g-HEMA) copolymers were analyzed by scanning electron microscopy, Fourier transform infrared spectroscopy, nuclear magnetic resonance spectroscopy. PET and PET-g-HEMA were dissolved in trifluoroacetic acid and nanofibers were obtained by electrospinning. It was found that the PET and PET-g-HEMA polymers having grafting yield 20 and 55% could be converted to continuous, smooth, and beadles nanofibers. For characterization of the nanofiber membranes, thermogravimetric analysis, differential scanning calorimeter analysis, surface contact angle measurement, porosity analysis, and mechanical tests were applied. When compared with the original PET nanofibers, the thermal properties and degradation process of PET-g-HEMA nanofibers changed according to the amount of HEMA present in the structure of nanofibers. The contact angles of the nanofibers obtained from PET-g-HEMA polymers decreased whereas the water retention ability of the nanofibers increased compared to original PET nanofibers. The porosity of PET-g-HEMA nanofibers was found be high compared to PET nanofibers and whereas the mechanical properties of PET was higher than PET-g-HEMA nanofibers. The obtained nanofibers can be used in many fields such as biomaterial applications. TUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [218S449] TUBITAK, Grant/Award Number: 218S449

Temporomandibular disorders and related pain are commonly seen in clinical practice. Due to its recurrent nature, they adversely affect a patient's social life. Current knowledge on the temporomandibular joint (TMJ) innervation is debatable and insufficient to ensure optimal treatment for the underlying pathology. This study aimed to elucidate the pathophysiology of temporomandibular pain by revealing the TMJ innervation topography, its variations, and its relationships with the surrounding anatomical structures. This will aid in creating a guide for temporomandibular, infratemporal, and preauricular interventions.A total of 20 cadaver half heads, 10 fresh frozen and 10 embalmed, were used. The TMJ nerves were dissected together with the surrounding anatomical structures.We showed that the TMJ is mainly innervated by the auriculotemporal nerve posteriorly, the masseteric nerve anteriorly, the posterior deep temporal nerve anteromedially, and the TMJ branch originating directly from the mandibular nerve medially, and that there are variations in these innervation pathways. Additionally, we emphasized how these nerves might be affected in certain clinical conditions based on their anatomical relationships and pathophysiological mechanisms. To our knowledge, this is the first study showing the existence of a branch of the mandibular nerve directly innervating the TMJ.In light of our findings, elucidating TMJ pain based on the anatomical characteristics of the region will allow precise treatment algorithms and better clinical outcomes in these patients. Based on this study, new clinical studies and interventions can be designed to reduce healthcare costs and alleviate the burden of temporomandibular disorders.

Massive intraosseous vascular malformations, a relatively rare entity in the vascular malformation spectrum, deserves attention as involving the membranous bones of the craniofacial skeleton and may lead to severe life-threatening hemorrhages and even death. The main aim of this study was to summarize the 25 years of clinical experience with these vascular malformation osseous patients, focus on the molecular and genetic aspect of the clinical entity, and to emphasize the certain challenging conditions in the treatment of these patients. All the patients appeared to be unaffected at birth, whereas initial symptoms occasionally began with painless swelling in the mandible in early childhood. The disease was progressive in behavior especially in the pubertal ages and was specifically involving the maxilla and mandible of the craniofacial skeleton in all the patients. Calvarium and cranial base were the second most common involved regions among these patients (62.5%). Clavicular (50%), costal (25%), and vertebral (25%) involvements were also a significant manifestation of the disease. Tissue samples obtained from the affected individuals and the blood samples from their families were matched, revealing a loss of function mutation in the ELMO-2 gene of chromosome 20 leading to developmental abnormality of the vascular structures via RAC1 signaling and leading to abnormally enlarged vessels in the intraosseus portion of the membranous bone. Immunohistochemical staining revealed positive CD31 and smooth muscle actin staining but negative proliferation and maturity markers such as Ki-67, desmin, h-caldesmon, and myofibroblast-like desmin. The follow-up of 3 of 5 patients ended up with mortality (60%). vascular malformation osseous is intraosseous vascular malformation with aggressive biological behavior associated with ELMO-2 gene mutation. Further studies for obtaining prenatal diagnosis and achievement of gene therapy should take place. As the disease rapidly progresses as the affected individual grows, surgical interventions should be taken into consideration before the initiation of complications.

Bolgen, Nimet/0000-0003-3162-0803; Meydanli, E. Elif Guzel/0000-0001-9072-3322; Cetinkaya, Duygu Uckan/0000-0003-3593-6493; KILIC, Emine/0000-0003-2984-7638; Weeks, Jason/0000-0001-5537-6927 WOS: 000463175200003 PubMed: 30942631 Repair of cranial bone defects is an important problem in the clinical area. The use of scaffolds combined with stem cells has become a focus in the reconstruction of critical-sized bone defects. Electrospinning became a very attracting method in the preparation of tissue engineering scaffolds in the last decade, due to the unique nanofibrous structure of the electrospun matrices. However, they have a limitation for three dimensional (3D) applications, due to their two-dimensional structure and pore size which is smaller than a cellular diameter which cannot allow cell migration within the structure. In this study, electrospun poly(epsilon-caprolactone) (PCL) membranes were spirally wounded to prepare 3D matrices composed of nanofibers and macrochannels. Mesenchymal stromal/stem cells were injected inside the scaffolds after the constructs were implanted in the cranial bone defects in rats. New bone formation, vascularisation and intramembranous ossification of the critical size calvarial defect were accelerated by using mesenchymal stem cells combined 3D spiral-wounded electrospun matrices. Turkish Academy of SciencesTurkish Academy of Sciences This study was performed in the context of the EU-FP6-NoE Expertissues Project. Erhan Piskin is supported by Turkish Academy of Sciences as a Honorary Member. This study was a part of PhD thesis of smail Alper isoglu. The thesis was supervised by Erhan Piskin.

WOS: 000462355600005, PubMed: 30688157, In the present study a combination of Transforming Growth Factor Beta 3 (TGF-beta 3) and Bone Morphogenetic Protein-2 (BMP-2) loaded gelatin films sandwiched between poly (L-lactide) (PLLA)/poly (epsilon-caprolactone) (PCL) matrices were produced to enhance bone formation in alveolar bone defects. Osteogenic properties of tissue constructs were tested in alveolar bone defect model in rats. Bone healing was assessed by osteogenic gene expression levels of bone sialoprotein (BSP), alkaline phosphatase (ALP), osteonectin (ON, SPARC), osteocalcin (OC), runt-related transcription factor 2 (RUNX2), bone specific alkaline phosphatase (BALP) activity, histomorphometry and microtomography. Increase in osteogenic gene expression levels and BALP activity results showed that new bone formation was significantly accelerated in TGF-beta 3 + BMP-2 loaded scaffold group compared to growth factor free and only BMP-2 loaded groups. The micro-computed tomography (mu-CT) data from the 4(th) months revealed that (TGF-beta 3+ BMP-2) loaded scaffolds displayed increased bone formation and was able to fulfill 84% of the defect area (p < 0.05). Accelerated bone formation in the S-GF-B-T group compared to that of the S-GF group at the end of the 4th month was further verified via histomorphometric analysis (p = 0.008). Gene expression, BALP activity, microtomography and histomorphometry analysis indicated that (TGF-beta 3 + BMP-2) loaded PLLA/PCL scaffolds increased the new bone formation. BMP-2 loaded scaffolds were less effective than combination of TGF-beta 3 and BMP-2 loaded scaffolds. These findings demonstrated that focusing on the PLLA/PCL hybrid scaffolds combined with (TGF-beta 3 + BMP-2) may lay the groundwork for future therapy-oriented efforts to enhance bone formation in alveolar defects., Turkish Scientific and Technological Research Council (TUBITAK) [108S336, SBAG-4083], We thank Professor Hamdi H. Alkan, MD to provide using the mu-CT facility. This study was funded by the Turkish Scientific and Technological Research Council (TUBITAK) Project No: 108S336 (SBAG-4083). Erhan Piskin is a full member of Turkish Academy of Sciences.

BACKGROUND Apert foot anomalies may cause severe problems such as pain and development of callus formation related to weight redistribution, problems with footwear, and gait disturbances that may limit their daily activities. The main purpose of this study was to review our experience with distraction osteogenesis for the correction of brachymetatarsia and the great toe angulation of the patients with Apert syndrome. METHODS This study retrospectively reviewed 7 patients (14 extremities) followed up for Apert syndrome who underwent distraction for the correction of bilateral congenital brachymetatarsia and angulation of the great toe between 2004 and 2008. Correction of the metatarsal inclination angle, the medial angulation of the great toe, the percentage of lengthening, and lengthening rates of distracted bones were evaluated. RESULTS Patients ranged in age from 4 to 8 years at the distraction operation, with a mean age of 5.4±1.3 years, and the average length of follow-up was 86.6±21.0 months. The length of the first metatarsal bone increased significantly from the average length of 32.6±5.7 mm to an average of 46.7±6.5 mm (P

Objective To determine the efficacy of a newly developed scaffold (col/β-TCP) in a preclinical rat model as compared with the gold standard treatment (autograft) and control scaffolds (PLLA/PCL). Design Fifty-six Sprague-Dawley rats were randomized into four experimental groups, and critical-sized alveolar defects (7 × 4 × 3 mm) were created in each animal. Group A was the blank defect group, group B received autograft, group C received col/β-TCP scaffolds, and group D received PLLA/PCL blend scaffolds to fill the bone defects. New bone formation was assessed radiomorphometrically, histomorphometrically, and molecular-biologically at 1 and 4 months following surgery. Results Radiomorphometrically, the best new bone volume rate at 1 month (43.7%) and 4 months (45.4%) was observed in the autograft group, and the difference was significantly higher than in the other three groups ( P ≤ .005, P ≤ .001, P ≤ .001 for 1 month and P = .004, P ≤ .001, P ≤ .001 for 4 months). Even though the new bone volume rate in the col/β-TCP group (21.5%) was higher than that of the PLLA/PCL group (18.2%), the difference was not significant ( P = .08). Molecular-genetic analysis revealed significantly higher BSP and ALP gene expression levels in the autograft and col/β-TCP groups than in the blank defect group ( P = .002 and P = .004). Conclusion The engineered tissue scaffolds described herein have great potential as an alternative treatment option when cost, donor region morbidity, and duration of hospitalization are considered.

BACKGROUND/AIM The aim of this study was to compare electrospun caprolactone (EC) and poly(lactic acid-e-caprolactone) (PLCL) nerve conduits with nerve graft in a rat sciatic nerve defect model. MATERIALS AND METHODS A total of 32 male Wistar albino rats were divided into 4 groups, with 8 rats in each group. A nerve defect of 1 cm was constructed in the left sciatic nerve of the rats. These defects were left denuded in the sham group, and reconstructed with nerve grafts, PLCL, and EC nerve conduits in the other groups. After 3 months, nerve regenerations were evaluated macroscopically, microscopically, and electrophysiologically. The numbers of myelinated axons in the cross-sections of the nerves were compared between the groups. RESULTS Macroscopically, all nerve coaptations were intact and biodegradation was detected in nerve conduits. Electromyographic assessment and count of myelinated axons in the cross-sections of the nerves displayed the best regeneration in the nerve graft group (P < 0.001) and similar results were obtained in the PLCL and EC nerve conduit groups (P = 0.79). Light and electron microscopy studies demonstrated nerve regeneration in both nerve conduit groups. CONCLUSION EC nerve conduits and PLCL nerve conduits yielded similar results and may be alternatives to nerve grafts as they biodegrade.

Neurofibromatosis type 1 (NF1) is a common autosomal dominantly inherited disorder that affects both the skin and the nervous system. NF1 occurs due to the mutations in the NF1 gene. Neurofibromas are the most common Schwann cell-based tumors in NF1 patients, which are mainly categorized into dermal and plexiform neurofibromas. Studies on different tumor types demonstrate that CXCR4 expression increases in tumor tissues and is linked to metastasis and cancer progression. In the present study, we aimed to analyze the gene expression of CXCR4, and its ligand CXCL12, in human neurofibromas. Eight NF1 patients aged between 5 and 37 (2 males, 6 females) were selected. The patient group comprised 1 plexiform neurofibroma, 1 pheochromocytoma, and 6 dermal neurofibromas. Following pathological examination and diagnosis, tumors were co-stained with antibodies against Schwann cell marker S100 and target molecule CXCR4. CXCR4 expression in Schwann cell-based tumors was detected at the protein level. RNA isolated from the same tumors was used for RT-PCR-based studies to measure the quantitative expression of CXCR4 and CXCL12. CXCR4 gene expression increased 3- to 120-fold and CXCL12 gene expression increased 33- to 512-fold in all human Schwann cell-based tumors. In order to validate the role of CXCR4 and its relationship with CXCL12 in NF1, future studies should be performed with additional tumors and different tumor types.

This study was aimed at comparing the osseointegration of titanium (Ti)-based Küntscher nails (K-nails) and plates with modified nanostructured and hydroxyapatite-coated surfaces in a rat femur model. Material surfaces were first modified via a simple anodization protocol in which the materials were treated in hydrogen fluoride (1% w/w) at 20 V. This modification resulted in tubular titanium oxide nanostructures of 40-65 nm in diameter. Then, hydroxyapatite-deposited layers, formed of particles (1-5) μm, were produced via incubation in a simulated body fluid, followed by annealing at 500°C. Both surface modifications significantly improved cell proliferation and alkaline phosphatase (ALP) activity as compared to the control (non-modified Ti implants). The controls and modified nails and plates were implanted in the femur of 21 male Sprague-Dawley rats. The implants, with surrounding tissues, were removed after 10 weeks, and then mechanical tests (torque and pull-out) were performed, which showed that the modified K-nails exhibited significantly better osseointegration than the controls. Histologic examinations of the explants containing plates showed similar results, and the modified plates exhibited significantly better osseointegration than the controls. Surface nanostructuring of commercially available titanium-based implants by a very simple method - anodization - seems to be a viable method for increasing osseointegration without the use of bioactive surface coatings such as hydroxyapatite.

[No abstract available]

Over recent years, several tissue engineering techniques are used for bone regeneration. In this study gelatin-hydroxyapatite (Gelatin-HA) cryogel scaffolds were used with/without bone morphogenetic protein-2 (BMP-2) and transforming growth factor beta-1 (TGF-beta 1) to heal critical sized bone defects. Release of growth factors from the cryogels were performed up to 28 days in vitro. Moreover, in vivo study were performed by 6 groups and results were evaluated by micro computerized tomography (mu-CT) and histology on 2 months and 4 months after surgery. Gene expression studies were also performed on 2 weeks and 4 weeks after surgery. Collagen type I (Col I), alkaline phosphatase (ALP) and osteocalcin (OSC) gene expression levels were analyzed. According to histology and mu-CT results, there was a significant bone healing in the BMP-2 containing gelatin-HA cryogel group (Group I) as compared to other groups except autograft applied group (Group IV). Moreover, significant increases were observed for Col I, ALP and OSC in Group I and Group IV. However there was no significant increase in the group of BMP-2 and TGF-beta 1 applied together (Group II). The results reveal that combination of gelatin-HA cryogels with BMP-2 is a promising candidate for healing in critical sized craniofacial bone defects. (Less)

Peynircioglu, Bora/0000-0002-1457-4721 WOS: 000338031200007 PubMed: 23904047 The purpose of this study was to investigate the efficacy and safety of intraarterial transcatheter administration of polidocanol as an alternative treatment for peripheral arteriovenous malformations (AVMs). The study comprised 10 patients (six males and four females) with a mean age of 28.8 years (range 8-52 years). All patients had trunk or extremity AVMs. Following the administration of general anesthesia or intravenous (IV) sedation, the patients underwent staged intraarterial polidocanol sclerotherapy with or without additional embolizations for their AVMs. The administration of polidocanol was executed by intraarterial infusion through a microcatheter or by direct percutaneous entry into the nidus under ultrasound guidance. A total of 19 sessions were accomplished in 10 patients. Polidocanol was used alone in six of the 19 sessions. In 13 sessions, polidocanol was used in combination with another agent (including n-butyl cyanoacrylate (NBCA), lipiodol, and ethanol) and/or coils. In two sessions, polidocanol was administered percutaneously under ultrasound guidance directly into the nidus documented by arteriography. No major complications occurred. Intraarterial transcatheter administration of polidocanol alone or in combination with other agents is a safe and effective alternative treatment for peripheral AVMs.

Cetinkaya, Duygu Uckan/0000-0003-3593-6493; Meydanli, E. Elif Guzel/0000-0001-9072-3322; Bayram, Cem/0000-0001-8717-4668; Bolgen, Nimet/0000-0003-3162-0803; Bolgen, Nimet/0000-0003-3162-0803; KORKUSUZ, PETEK/0000-0002-7553-3915; KILIC, Emine/0000-0003-2984-7638 WOS: 000329845100010 PubMed: 23477355 HEMA-Lactate-Dextran cryogel scaffolds were produced by cryogelation. Mesencyhmal stem cells (MSC) were isolated from rat bone marrow. Critical sized cranial bone defects were created in rat cranium. Stem cells were injected inside the macropores of the cryogel scaffolds prepared from HEMA-Lactate-Dextran possessing the same dimensions with the defect and placed in the cranial bone. The cryogels placed in the defect without stem cells served as control. After selected time intervals the experimental sites were removed from the animals and new bone formation and tissue integration were investigated by histological analysis. The in vivo results exhibited osseous tissue integration within the implant and mineralized functionally stable bone restoration of the cranial defects. Tissue formation started in the macrospores of the scaffold starting from periphery to the center. A significant ingrowth of connective tissue cells and new blood vessels allowed new bone formation. Histological data demonstrated that new bone per total defect area ratio, were not significantly different in "scaffold-stem cells" group compared to that of "scaffold only" group on all time points. However, the blood vessel density was significantly higher in "scaffold-stem cells" group comparing to that of the "scaffold only" group on day 30. "Scaffold-stem cells" given group gave better tissue response score when compared to "scaffold only" group on day 180. Turkish Academy of Sciences (TUBA)Turkish Academy of Sciences This study was performed in the context of the EU-FP6-NoE Expertissues Project. Erhan Piskin was supported by the Turkish Academy of Sciences (TUBA) as a full member.