Efficacy of Combination Therapy with Apigenin and Synovial Membrane-Derived Mesenchymal Stem Cells on Knee Joint Osteoarthritis in a Rat Model.

Background: Osteoarthritis (OA) is a degenerative joint disease that causes a variety of adverse health effects. Considering the need to identify additional effective therapeutic options for OA therapy, we investigated the effect of co-injection of apigenin and synovial membrane-derived mesenchymal stem cells (SMMSCs) on OA in male rats' knee joints. Methods: The study was performed in 2019 at the Department of Pharmacology, Shiraz University of Medical Sciences, Shiraz, Iran. Anterior cruciate ligament transection (ACLT) was used to induce OA. For three weeks, male Sprague-Dawley rats (eight groups, n=6 each) were treated once-weekly with intra-articular injections of apigenin alone or in combination with SMMSC (three million cells), phosphate-buffered saline, or hyaluronic acid. After three months, the interleukin 1 beta (IL-1ß), tumor necrosis factor-alpha (TNF-α), superoxide dismutase (SOD), and malondialdehyde (MDA) levels were measured in the cartilage homogenate. The expression of extracellular matrix (ECM) components including collagen 2a1, aggrecan, IL-1ß, TNF-α, inducible nitric oxide synthase (iNOS), transcription factor SOX-9, and matrix metalloproteinases 3 and 13 were assessed using real-time polymerase chain reaction (RT-PCR) analysis. Radiological evaluation and histopathological assessment were used to evaluate the knees. Results: Levels of TNF-α (P=0.009), MDA (P>0.001), and IL-1ß (P<0.001) decreased and the level of SOD increased (P=0.004) in the apigenin 0.3 µM with SMMSCs group. RT-PCR analysis indicated that IL-1ß in the apigenin 0.3 µM with SMMSCs group reduced significantly (P<0.001). This group also exhibited increased expression levels of SOX-9, collagen 2a1, and aggrecan (P<0.001). Conclusion: Apigenin may have supplementary beneficial effects on cell therapy in a rat model of OA due to its possible effect on the reduction of oxidative stress, suppression of inflammation, and promotion of production of ECM components.

A Long-Standing Giant Mandibular Ameloblastoma and its Management with Microvascular Free Fibular Graft: a Case Report.

Ameloblastoma is one of the most common benign epithelial odontogenic tumors of jaws. We report a case of long-standing slow-growing giant ameloblastoma involving almost all of mandibular bone. The solid multicystic lesion was excised, and the histopathological examination showed the follicular type of ameloblastoma. Furthermore, the defect was reconstructed with microvascular osteocutaneous free fibular graft.

The Safety and Side Effects of Amide-Based Local Anesthetics in Rats with Acetaminophen-Induced Hepatic Injury.

BACKGROUND: The use of amide-based local anesthetics is generally considered to be safe. However, the literature on their safety in patients with hepatic injury is scarce. For the first time, the present study aimed to evaluate the effect and safety of five commonly used amide-based local anesthetics in the setting of hepatic failure. METHODS: A total of 96 Sprague-Dawley rats were studied from September 2015 to September 2016 in the Animal Laboratory Center, Shiraz University of Medical Sciences, Shiraz, Iran. They divided into three groups, namely a control, induced liver failure (LF), and non-LF groups. The rats were administered local anesthetic agents (lidocaine, prilocaine with felypressin, lidocaine with epinephrine, mepivacaine, articaine, and prilocaine). The effect of these drugs was evaluated by comparing the liver enzyme levels of the rats. The data were analyzed using SPSS software. The independent t test, one-way ANOVA, and the post hoc tests were used to compare groups. A P<0.05 was considered statistically significant. RESULTS: In non-LF rats, mepivacaine, lidocaine, and lidocaine with epinephrine caused a significant increase in aspartate aminotransferase (AST) level compared with the effect of prilocaine with felypressin and articaine. In non-LF rats, only mepivacaine resulted in a significant increase in AST level compared with lidocaine (P=0.007) and prilocaine with felypressin (P=0.044). In this group, only mepivacaine caused a significant increase in alanine transaminase (ALT) level compared with lidocaine (P=0.016). Whereas in the LF group, mepivacaine caused an increase in ALT level compared with the effect of both prilocaine with felypressin (P=0.009) and articaine (P<0.001). The use of mepivacaine in the LF group caused a significant increase in gamma-glutamyl transpeptidase level compared prilocaine with felypressin (P=0.039). CONCLUSION: Articaine and prilocaine with felypressin local anesthetics induced the least change in hepatic enzyme levels in rats with abnormal hepatic function.

The effect of kaempferol and apigenin on allogenic synovial membrane-derived stem cells therapy in knee osteoarthritic male rats.

BACKGROUND: Based on the anti-inflammatory and anti-oxidant properties of kaempferol and apigenin, we hypothesized that co-injection of these phytochemicals would increase the effectiveness of cell therapy in knee osteoarthritic rats. METHODS: Anterior cruciate ligament transection (ACLT) was used to induce osteoarthritis (OA). Animals were treated by weekly intra-articular injections of kaempferol (10 or 20 µM) and/or isolated MSCs from synovial membrane (SMMSCs) (3 × 106 cells), a mixture of apigenin (0.1 µM) and kaempferol alone or SMMSCs, hyaluronic acid or PBS (group size n = 6), for three weeks. After three months, the levels of IL-1ß, tumor necrosis factor alpha (TNF-α), superoxide dismutase (SOD) and malondialdehyde (MDA) were measured in the cartilage homogenate. Furthermore, relative expressions of collagen II2a1, aggrecan, IL-1ß, TNF-α, inducible nitric oxide synthase (iNOS), SOX-9, MMP-3 and MMP-13 were assessed using real-time PCR. Radiological evaluation, before/after treatments, and histopathological assessments were carried out to evaluate the knees. RESULTS: Non-toxic concentrations of kaempferol and apigenin determined to be 10, 20 µM and 0.1, 0.3 µM, respectively. In comparison with the OA group, the levels of TNF-α, IL-1ß and MDA significantly decreased in OA + MSCs + kaempferol + apigenin group and a significant increase in SOD level was observed. The levels of MMP-13, MMP-3, TNF-α, IL-1ß, iNOS were significantly decreased in the groups of OA + MSCs + A0.1 µM + K10 µM and OA + MSCs + K20 µM. Co-treatment of kaempferol and apigenin increased the gene expression levels of collagen IIa1, aggrecan and SOX-9 genes. CONCLUSION: We showed that kaempferol and apigenin potentially increase the efficiency of OA cell therapy in the rat model of ACLT-induced OA.

Oro-Antral Fistula Repair With Different Surgical Methods: a Retrospective Analysis of 147 Cases.

STATEMENT OF THE PROBLEM: An oro-antral fistula (OAF) creates a passage for oral microbes into maxillary sinus with numerous possible complications. PURPOSE: This retrospective study evaluates the success of three different surgical techniques of OAF repair. MATERIALS AND METHOD: Records of patients that were treated for OAF repair were retrieved and reviewed. Data recorded were patients' age, gender, etiology, size, location, duration, and method of repair. According to the surgical technique used to repair the OAF, patients were divided into three groups including buccal flap, palatal flap, and buccal fat pad. All of the patients were locally anesthetized with 2% lidocaine and 1/100000 or 1/80000 epinephrine. Then the edges of the fistula were excised and fistula wall was dissected in a stitched layer by three surgical methods. The three groups were compared concerning the success or failure of surgical technique based on complete closure of OAF after three months postoperatively. RESULTS: 147 patients (116 males and 31 females) with adequate records were included in the study. The surgical methods used in patients were, buccal flap in 59 (40.1%), buccal fat pad in 42 (40.8%), and palatal flap in 28 (19%) individuals. Success rates of these techniques were significantly different. Buccal fat pad was the most successful flap (98.3%), followed by buccal flap (89.8%), and palatal flap (85.7%). The most common cause of OAF in this group of patients was dental extraction. CONCLUSION: Buccal fat pad flap seems to be one of the best treatments for the closure of OAF lager than 5 mm.

Oral and maxillofacial trauma in motorcyclists in an Iranian subpopulation.

BACKGROUND/AIMS: Road traffic accidents are considered a major cause of oral and maxillofacial trauma. Given that many traumatic injuries and deaths involve motorcyclists, the aim of this study was to investigate this vulnerable group in terms of oral and maxillofacial injuries following accidents. MATERIALS AND METHODS: This cross-sectional study was conducted on 330 patients with oral and maxillofacial injuries at Shahid Rajaee Hospital in Shiraz, Iran, from April to September 2017. A questionnaire with questions regarding age, gender, helmet use, and driver's license was completed for all the patients and their injury type (including dental injuries). Data were analyzed using descriptive statistics and the chi-squared test with a significance level of 95%. RESULTS: Of the 330 patients, 291 (88.2%) were male and 39 (11.8%) were female. There were 283 (85.75%) patients aged 21-30 years, and their mean age was 27.2 ± 6.5. Most of them (287, 87%) had not been wearing helmets at the time of the accident. Dental injuries were observed in 168 (50.9%) of the patients. Uncomplicated crown fractures were diagnosed in 25.4% of the patients, luxation injuries in 23.2%, and avulsion in 18.9%. Only 19.9% of the patients under the age of 25 had suffered facial injuries. CONCLUSION: Most injuries in motorcycle accidents were dental trauma in men due to not wearing a helmet. Dental injuries had the highest frequency of damage.

Do Different Modes of Delivering Postoperative Instructions to Patients Help Reduce the Side Effects of Tooth Extraction? A Randomized Clinical Trial.

PURPOSE: Postoperative instructions that are properly delivered can decrease postextraction side effects, such as stress, anxiety, and pain, in patients undergoing dental extraction. This study examined the role of the mode of delivering postoperative instructions in decreasing the side effects of dental extraction and increasing patient satisfaction after the procedure. MATERIALS AND METHODS: This randomized clinical trial was conducted on a population of 120 patients presenting to the oral and maxillofacial outpatient clinic affiliated with the Shiraz University of Medical Sciences (Shiraz, Iran) in 2015. The patients were randomly assigned to 3 groups of 40 per group. The first group received only verbal instructions after their surgical procedure. The second group received only written instructions. The third group received verbal and written instructions. Details on the patient's age, gender, and formal education were recorded before the operation using a questionnaire. The second part of the questionnaire was completed by patients 1 week after their tooth extraction and recorded their postoperative pain, bleeding, swelling, and satisfaction. Data were analyzed using the Mann-Whitney test, Kruskal-Wallis test, χ2 test, and analysis of covariance at a significance level of 95%. RESULTS: Of the 120 participants, 77 were women and 43 were men; the participants' mean age was 36.45 ± 10.69 years. The results showed that the mode of delivering instructions had a marked relation with pain and patient satisfaction. Pain intensity was significantly higher in the verbal instructions group compared with the written instructions (P = .002) and verbal plus written instructions (P = .000) groups. CONCLUSION: The mode of delivering postoperative instructions meaningfully affected pain intensity and general patient satisfaction. Patients who received verbal instructions reported the most intense pain and the least satisfaction, and patients who received verbal and written instructions were the most satisfied.

Comparison of the Marginal Bone Loss in One-stage versus Two-stage Implant Surgery.

STATEMENT OF THE PROBLEM: Dental implant is one of the best choices for reconstruction of aesthetic and function. High success rate of these treatments are related to some considerations such as case selection, implant system selection and surgical methods. One-stage or two-stage surgical approaches are routine surgical methods in dental implant treatments. The minimum rate of bone loss around fixtures is the most important criteria for evaluation of implant treatment success that can be affected by different methods of surgery. PURPOSE: This experimental study has been done to compare the crestal bone loss at mesial and distal surface of implants installed through either one-stage or two-stage surgical approach. MATERIALS AND METHOD: In the present randomized clinical trial, 310 Astra Tech implant system were divided into two unequal groups to be used for 140 patients. One hundred and seventy implants were inserted through one-stage and 140 through two-stage surgical approach. The baseline parallel periapical radiography was provided immediately after the surgery. Six months after the functional loading, another radiographic image was provided by using the same technique and machine. Marginal bone loss was calculated by using Adobe Photoshop CS5 software. Data were statistically analyzed with SPSS software. p values less than 0.05 were considered as significant. RESULTS: The mean Bone loss on the mesial and distal surfaces of implants inserted through one-stage surgery and two-stage surgery was 0.76±0.04 and 0.842±0.04 mm respectively. No notable marginal bone change was observed between the maxilla (0.860mm) and mandible (0.729mm). Moreover, p Value was>0.05 in all samples, indicating no significant difference in the crestal bone loss. CONCLUSION: Accordingly, one-stage surgical technique may provide better esthetic and function for dental implants. There is no significant difference between the two approaches concerning the marginal bone loss.

Malignant peripheral nerve sheath tumor of the infratemporal fossa.

Malignant peripheral nerve sheath tumor is a rare pathologic lesion in a patient without neurofibromatosis diseases. The patient is a 36-year-old man without any congenital or systemic diseases who presented with a firm and painful mass on the left preauricular and temporomandibular joint area with paresthesia of temporal region. Clinical diagnosis of this tumor was made with delay owing to the lack of initial sign and symptoms and its location.

The effect of maxillary multidirectional movement on nasal respiration.

PURPOSE: Deformities of the maxilla may exist on all planes, and we treat these problems by mobilizing and repositioning the maxilla on all planes. Some authors have examined the effects of maxillary movement on the nasal airway. In clinical, practice, active anterior rhinomanometry is the most reliable and frequently used method to assess nasal respiratory function. The purpose of this study was to evaluate changes in nasal airflow and nasal airway resistance after maxillary movement performed by active anterior rhinomanometry. MATERIALS AND METHODS: We studied 25 patients (18 female patients and 7 male patients; aged 16-30 years) in this clinical trial. Three days before surgery and 6 months after surgery, after a rest period of 30 minutes, active anterior rhinomanometry with a tube was performed at a fixed transnasal pressure of 150 Pa. The surgical treatment plan included bimaxillary surgery consisting of a 1-piece Le Fort I osteotomy combined with a bilateral sagittal split osteotomy. Mean and median total nasal airflow and nasal resistance rate were calculated before surgery and after surgery and compared by use of SPSS software (version 11.5; SPSS, Chicago, IL) and paired t test. RESULTS: An increase in nasal airflow (P = .009) and a decrease in nasal resistance (P = .022) were observed in the maxillary impaction and advancement group. In the maxillary impaction and setback group, there was a significant difference in nasal resistance changes (P = .027); however, postsurgical nasal airflow compared with presurgical values showed no statistically significant difference (P = .244). CONCLUSION: Impaction and advancement of the maxilla can improve nasal respiratory function, but maxillary impaction and setback reduce nasal respiratory function. Hence candidates for maxillary impaction and setback must be informed about decreased nasal respiratory function.

Parotid duct repair with suturing and anastomosis using tissue adhesive, evaluated by sialography: an experimental study in the dog.

PURPOSE: The most common method of parotid duct anastomosis is suturing. In addition to the postoperative complications in suturing (ie, anastomosis leakage, fistula formation, and infection of maxillofacial spaces), the surgical duration and suturing difficulties arise as major problems. The efficacy of fibrin glue in parotid duct anastomosis was evaluated and compared with suturing in 15 dogs. MATERIALS AND METHODS: Fifteen dogs (of the same breed and gender) were studied in this experimental trial. Intravenous cephalothin (1 g) and intramuscular dexamethasone (8 mg) were administered preoperatively for all cases, but no drug was administered postoperatively. Extraoral transverse incisions were made in buccal regions bilaterally to expose parotid ducts and transection was performed in similar areas (right and left). Next, the right transected duct was repaired with 7-0 nylon sutures, and then the left anastomosis was performed, using fibrin glue. At 10 days after the operation, clinical evaluations and sialography were used to evaluate the quality of the anastomosis repair, ductal leakage, and fistula. RESULTS: The ductal fistula was found on the right in 2 cases (13.33%) and on the left (20%) in 3 cases. Aspiration was positive in the right parotid duct in 2 cases (13.33%) and in the left parotid duct (33.33%) in 5 cases. Also, right ductal leakage was seen in 4 cases (26.66%) and left ductal leakage in 7 cases (46.66%), using sialography. CONCLUSIONS: The results of this study suggest that the efficacies of fibrin glue and suturing in parotid duct anastomosis are similar, but the use of fibrin glue had a number of advantages, including shortening of the operative time and the possibility of stent removal intraoperatively.

Tissue adhesive and suturing for closure of the surgical wound after removal of impacted mandibular third molars: a comparative study.

OBJECTIVE: The most common method of wound closure in oral surgery is suturing. The efficacy of cyanoacrylate in postoperative pain and bleeding was evaluated and compared with suturing. MATERIALS AND METHODS: Sixteen patients with similar bone impaction and inclination of mandibular third molars on the right and left sides were studied in this controlled clinical trial. The third molar surgery was carried out in 2 stages, 4 weeks apart, under local anesthesia. After bone removal and tooth resection, the right flap was closed with 3-0 silk sutures and the left flap with cyanoacrylate. A visual analogical scale was used to evaluate the severity of pain and bleeding on postoperative days. RESULTS: The data analysis showed that postoperative bleeding with cyanoacrylate method was less significant than with suturing on the first and second days after surgery (P < .05). There was no significant difference in the severity of pain between the 2 methods (P > .05). CONCLUSION: This study suggested that the efficacies of cyanoacrylate and suturing in wound closure were similar in the severity of pain, but use of cyanoacrylate resulted in better hemostasis.

The association between blood groups and maxillofacial deformities.

BACKGROUND: Blood group is a genetic characteristic which is associated with some diseases and deformities. Multifactorial characteristics of facial development make it difficult to predict a genetic pattern in a specific maxillofacial deformity, but epidemiological evaluations can reveal relationships between such deformities and some genetic characteristics or accompanied diseases, and this will help to recognise and treat them. The aim of this study is evaluation of the relationship between blood groups and maxillofacial deformities. MATERIALS AND METHODS: In this study, blood groups of 190 patients with maxillofacial deformities who had had orthognathic surgery in Alzahra hospital, Isfahan, were compared with the general Iranian population. RESULTS: Among 190 patients, 93 cases (49%) were men and 97 cases (51%) were women. Fifteen cases (8%) were < 20 years old, 130 cases (68%) were 20-30 years old, and the others (45 cases, 24%) were > 30 years old. The blood group distribution in our samples was as follows: blood group O = 76 cases (40%), blood group A = 58 cases (30%), blood group B = 41 cases (22%), and blood group AB = 15 cases (8%). Among these patients, 31 cases (16%) had maxillary deformities and 27 cases (14%) suffered from mandibular deformities while the other 132 cases (70%) had bimaxillary problems. The Chi-square test showed statistically significant differences between the blood group distribution of the patients of this study and the normal Iranian population (P < 0.001). CONCLUSION: It was shown that among different blood groups; those with blood group B have a greater likelihood of association with maxillofacial deformities. On the other hand, the probability of the association of such deformities was the least with blood group A.