Enhancing the wound healing process through local injection of exosomes derived from blood serum: An in vitro and in vivo assessment.

Introduction: The skin plays a crucial role as a protective barrier against external factors, but disruptions to its integrity can lead to wound formation and hinder the natural healing process. Scar formation and delayed wound healing present significant challenges in skin injury treatment. While alternative approaches such as skin substitutes and tissue engineering exist, they are often limited in accessibility and cost. Exosomes have emerged as a potential solution for wound healing due to their regenerative properties. Methods: In this study, exosomes were isolated from human blood serum using a kit. The exosomes were characterized, and their effects on cell migration were assessed in vitro. Additionally, the wound healing capacity of exosomes was evaluated in vivo using a rat full-thickness wound model. Results: Our in vitro findings revealed that exosomes significantly promoted cell migration. In vivo experiments demonstrated that the injection of exosomes at different areas of the wound accelerated the wound healing process, resulting in wound closure, collagen synthesis, vessel formation, and angiogenesis in the wound area. These results suggest that exosomes have a promising therapeutic potential for expediting wound healing and minimizing scar formation. Conclusions: The findings of this study highlight the potential of exosomes as a novel approach for enhancing wound healing. Exosomes showed positive effects on both cell migration and wound closure in in vitro and in vivo studies, suggesting their potential use as a regenerative therapy for skin injuries. Further research is needed to fully understand the mechanisms underlying the beneficial effects of exosomes on wound healing and to optimize their application in clinical settings.

Liposuction versus Periareolar Excision Approach for Gynecomastia Treatment.

Background: Gynecomastia (GM) is the increased fibroglandular tissue in the male breast by more than 2 cm, which is palpated under the nipple and areola. An ideal surgical approach aims to reduce the breast size, reach an acceptable breast shape, resect excessive glandular tissue, fatty tissue, and skin fatty tissue and excess skin, relocate the nipple-areolar complex, and avoid scars. Based on its importance, we aimed to compare outcomes of liposuction with and without periareolar incision in patients with GM. Materials and Methods: This was a randomized clinical trial on patients referred for plastic surgery. Patients with GM were allocated into two treatment groups. Group A underwent liposuction without any areolar skin incision and group B had liposuction with the areolar skin incision. Patients were followed-up after surgery. Data were analyzed by Statistical Package for the Social Sciences (SPSS) version 20. Results: Sixty patients aged between 20 and 27 years old participated in this study. Three hematomas, two surgical site infections, one nipple hypopigmentation after surgery, and one seroma formation were noted in group B. On the other hand, one hematoma and one seroma formation were noted in group A. The patients in group A were highly satisfied after the liposuction without skin incision procedure compared with group B (P = 0.01). Conclusions: The management of GM by liposuction, either with the periareolar excision technique or without skin incision, allows the effective removal of fat and glandular tissue of the male breast. Although there was no significant difference regarding postoperation complications between groups, patients' satisfaction should be considered.

LP-MAB: Improving the Energy Efficiency of LoRaWAN Using a Reinforcement-Learning-Based Adaptive Configuration Algorithm.

In the Internet of Things (IoT), Low-Power Wide-Area Networks (LPWANs) are designed to provide low energy consumption while maintaining a long communications' range for End Devices (EDs). LoRa is a communication protocol that can cover a wide range with low energy consumption. To evaluate the efficiency of the LoRa Wide-Area Network (LoRaWAN), three criteria can be considered, namely, the Packet Delivery Rate (PDR), Energy Consumption (EC), and coverage area. A set of transmission parameters have to be configured to establish a communication link. These parameters can affect the data rate, noise resistance, receiver sensitivity, and EC. The Adaptive Data Rate (ADR) algorithm is a mechanism to configure the transmission parameters of EDs aiming to improve the PDR. Therefore, we introduce a new algorithm using the Multi-Armed Bandit (MAB) technique, to configure the EDs' transmission parameters in a centralized manner on the Network Server (NS) side, while improving the EC, too. The performance of the proposed algorithm, the Low-Power Multi-Armed Bandit (LP-MAB), is evaluated through simulation results and is compared with other approaches in different scenarios. The simulation results indicate that the LP-MAB's EC outperforms other algorithms while maintaining a relatively high PDR in various circumstances.

Evaluation of Clinical Outcomes and Satisfaction of Rhinoplasty with or without Smasectomy with the Aim of Thinning the Nasal Tip in Patients with Thick Nasal Skin.

Background: Rhinoplasty is one of the most common plastic surgeries and a challenging procedure for people with thick nasal skin. There are several techniques to improve the outcome of the operation. Methods: Our study is a double-blind randomized controlled trial conducted in Esfahan, Iran in 2020. Seventy participants were equally divided into two groups (35 people). In the control group, only rhinoplasty was performed without SMASectomy and in the intervention group, rhinoplasty was performed with SMASectomy. The results were obtained and the satisfaction of patients and physicians was collected through patient examination and a questionnaire. Statistical analysis of data was calculated by SPSS software version 23 at a significance level of less than 0.05. Results: The mean total skin thickness before surgery in the two groups was equally, which showed a significant difference between the two groups at after 12 months (P <0.05). Comparison of 3, 6 and 12 months after rhinoplasty in the two groups showed that the percentage of patient, doctor, hairdresser and nurse satisfaction, in 12 months after rhinoplasty, in the intervention group compared to the control group had a significant increase (P <0.05). Furthermore, in the control group 2.85% and in the intervention group 5.71% bleeding was observed. No other complications were observed in any of the groups. Conclusion: Overall, SMASectomy, which is performed simultaneously with rhinoplasty, is considered as an important technique in rhinoplasty. As we observed in our study, the complications of these surgeries in patients were very small.

The effect of case-based teaching and flipped classroom methods in comparison with lecture method on learning and satisfaction of internship students in surgery.

INTRODUCTION: Teaching is one of the most important needs of human societies, and selecting the best method of teaching is so important to improve the teaching as well as learning of students. The purpose of this study was to determine the effect of case-based teaching (CBT) and flipped classroom methods in comparison with lecture method on students' learning and satisfaction at internship of Department of General Surgery, Isfahan University of Medical Sciences. MATERIALS AND METHODS: This experimental study was performed on fifty medical surgery internship students in Isfahan University of Medical Sciences in 2017. Students were randomly divided into two groups of control group and intervention group. The data were collected by a posttest after holding every class and a researcher-made form for evaluating students' satisfaction after the end of the project. The results of this study were analyzed by SPSS 21 software using descriptive statistical methods (mean and standard deviation) and paired t-test. RESULTS: The comparison of the mean posttest scores in the three classes showed that the mean scores of the students in the intervention group in the first and second sessions unlike the third session were higher than that in the control group; this difference was statistically significant in the first session (P = 005) and the third session (P = 0.002). Students' satisfaction with case-based learning method (4.03 ± 0.87) was higher than that of lecture method (2.88 ± 0.78). CONCLUSION: In CBT and flipped classroom, students' learning and the quality of teaching were improved. In addition, students were more satisfied with this method in comparison with the lecture method. However, it should be noted that the success of using this teaching method depends on choosing the appropriate subject.

Comparison between Wrapping Dice Cartilage with Temporal Fascia and Wrapping in Alloderm for Dorsal Nasal Augmentation.

BACKGROUND: Dorsal augmentation of the nose for aesthetic and reconstructive purposes is an important issue in rhinoplasty surgery. This study aimed to compare the two methods of dice cartilage wrapping for dorsal augmentation of the nose including temporalis fascia and alloderm. METHODS: In a clinical trial study, 50 patients who needed to augment the nasal dorsum, were enrolled and randomly allocated to two equal groups. In the first group, diced cartilage graft of the patient was wrapped in temporalis fascia and in the second group, a thin sheet of alloderm was used for this purpose. After one year follow up, satisfaction of patients and the expert panel were compared in two groups. Also mean increase in dorsal height was measured and compared in two groups. RESULTS: The mean increase of dorsal nasal height one year after surgery in the alloderm and temporalis fascia was 3.13±0.49 and 3.42±0.33, respectively and in the fascia group was significantly higher (p=0.02). The mean of patients' satisfaction in the two groups of alloderm and temporal fascia groups was 7.48±0.92 and 8.04±0.89, respectively (p=0.03). The mean satisfaction of expert panel in the two methods was 7.56±0.81 and 7.7±0.63, respectively (p=0.5). CONCLUSION: The use of temporal fascia for covering the diced cartilage in augmentation of nasal dorsum had better results than the alloderm. Patients satisfaction and mean dorsal height was higher in temporal fascia group.

Supporting-emotional needs of Iranian parents with premature infants admitted to Neonatal Intensive Care Units.

BACKGROUND: Having an infant in the neonatal intensive care unit (NICU) is a stressful and painful experience. Unlike to normal births, this birth is associated with admission and separation of infant from parents. The aim of this study was to compile the supporting-emotional needs of Iranian parents who have a premature infant admitted in (NICU). METHODS: This study was performed using qualitative research approach. Twelve participants including 9 parents whose infant had been hospitalized in NICU; two nurses and one physician were also selected for sampling purposes. Data were gathered using semi-structured interview. Data were analyzed by inductive content analysis approach. RESULTS: Four subcategories emerged from data analysis expressed supporting-emotional needs of parents of premature infants admitted in NICU. These subcategories were: Need for interaction with infant, Need to medical team's empathy, need to exchange support with spouse, and Need to get help from others. CONCLUSION: In order to develop mutual bonding with infant and attain parental roles, parents need to be close their neonate, also receive empathy and support to find a way to meet their needs. Participants in this study announced that resolving these needs can help parents to feel more confidence in infant's care and reduce their negative feelings.

Parental self-support: A study of parents' confront strategy when giving birth to premature infants.

BACKGROUND: This study aimed to understand the confront strategies of parents of premature infants hospitalized in NICU. METHODS: This study was performed using qualitative content analysis approach. Twelve participants including nine parents whose infants were hospitalized in NICU, two nurses and one physician, all selected by purposive sampling method were interviewed by a female expert occupational therapist. Data were gathered by semistructured interviews. Data were analyzed by inductive content analysis approach. RESULTS: One category, six subcategories and twenty one themes emerged from data analysis expressed confront strategies of parents of premature infants admitted in NICU. These categories were: taking assurance, stop thinking to bad things, diverting mind, taking supports, emotional expression, complaining from staff. CONCLUSION: Premature infant's parents announced that they do not receive adequate formal support to manage their feelings and needs. So, they seek for other informal resources of support and apply some special strategies including self-support.

Epinephrine's effect in varying concentrations on the end artery organ in an animal model.

OBJECTIVE: To determine the concentration of epinephrine that causes end artery necrosis and ischemia. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Animal Laboratory of Khordad Hospital, Tehran, Iran, from September 2007 to June 2008. METHODOLOGY: This study was done on 54 ear flaps from 9 rabbits [9 (rabbits) x2 (ears) x3 (splits) =54] divided into three groups of 18 ear flaps each. Nine of the ear flaps were randomized as control and nine of them were randomized as study group. The different concentrations of epinephrine and lidocaine 1% were injected in study groups but only 1% lidocaine was injected in control groups. Study group 1 received 1/200000, group 2 received 1/100000 and group 3 received 1/500000 concentration of epinephrine respectively. RESULTS: There was no evidence of necrosis in the control and study groups 1 and 2. However, 4 out of 9 of the ear flaps showed clear evidence of tissue necrosis in group 3. CONCLUSION: Injecting epinephrine in 1/200000 and 1/100000 concentrations had no side effect for the end artery of the rabbit ear flaps, but 1/50000 concentration is shown that it can cause tissue necrosis. Further studies need to be done in order to find out the effects of epinephrine with the same concentrations on the human end artery.

Adverse effects after use of polyacrylamide gel as a facial soft tissue filler.

BACKGROUND: Although the "perfect" filler material to correct soft tissue facial defects, wrinkles, and scars has not yet been found, ideal characteristics for such a substance may be considered as the following: permanent, inert, malleable, easily injectable, quick to metabolize, not prone to infection, affordable, removable, nonmigratory, and not associated with any disorder or disease state as shown by clinical and paraclinical studies. OBJECTIVE: The authors present an evaluation of patients undergoing treatment for facial wrinkles or soft tissue defects by injection of polyacrylamide hydrogel (PAAG) and analyze outcomes on the basis of the incidence of moderate to severe complications. METHODS: A retrospective study was performed, including history taking, physical examination, and follow-up of 542 patients who received facial injections of PAAG. RESULTS: Of 542 patients, 42 (7.7%) experienced complications such as swelling, abscess formation, lumpiness, change in facial appearance, change in gel location after injection, and sensitivity. CONCLUSION: The authors recommend that complications from treatment with PAAG be studied further before widespread use of this soft tissue filler.

The distally based neurocutaneous sural flap: a good choice for reconstruction of soft tissue defects of lower leg, foot and ankle due to fourth degree burn injury.

OBJECTIVE: Debridment of fourth degree burn wound usually leads to soft tissue loss. If these wound are on distal one-third of lower leg and ankle, a simple wound changes to a complex problem. Options are available for these conditions, but each of them have advantages and disadvantages. The distally based neurocutaneous sural flap is one recent flap available for this problem which has excellent results and decreased disadvantages. METHODS: Between 2000 and 2004, all patients with acute fourth degree burns or unstable scar on the distal third of lower leg, foot or ankle that referred to our hospital were scheduled for reconstruction by sural flap. The success rate and ability of the flap to create stable durable coverage at these sites were evaluated. RESULTS: Fifteen patients from 1.5 to 75 years old were included to this study. We had excellent result with this type of flap in 14, we had 100% success rate without necrosis. Only in one patient (a 75 years old man with a history of diabetes mellitus) we had a 0.5cm necrosis of distal margin of flap which healed completely after one session of debridement. All patients were completely satisfied with this flap. CONCLUSION: Because of few drawbacks of this flap and high success rate and relative simple operative technique, we recommend sural flap as a prime option for repair of fourth degree burn, at distal leg, foot and ankle.

The comparison of diphenhydramine HCl and Nedocromil sodium in prevention of abdominal postoperative adhesion formation in rat models: an experimental study.

BACKGROUND: The purpose of this study was to determine the effects of diphenhydramine HCl and Nedocromil sodium for the prevention of postsurgical adhesion formation in rat model. METHODS: Sixty adult female rats were anesthetized by 5mg/kg ketamine hydrochloride. After opening the abdominal wall, a 2 cm(2) peritoneal layer was excised from the left abdominal wall and 10 longitudinal incisions of 2 to 3 cm in length were made on the right parietal peritoneum. The abdominal wall was closed with 4/0 atraumatic continuous nylon sutures. Group I was the control group, group II was given 10mg/kg diphenhydramine HCl, group III was given 100mg/kg Nedocromil sodium, and group IV was administered both drugs in the above doses. All the drugs were instilled into the peritoneal cavity after abdominal closure except Nedocromil sodium which was administered in two separate doses 30 min before surgery and just after abdominal closure. Relaparatomy was performed 2 weeks after the initial surgery and abdominal adhesions were scored. Kruskal-Wallis and Mann-Whitney U-test were used for the statistical evaluation. RESULTS: The mean+/-S.D. (median) of adhesion scores were 2.5+/-0.90 (2.0), 1.58+/-0.99 (1.0), 0.92+/-0.86 (1.0) and 1.75+/-0.75 (2.0) in group I, II, III and IV, respectively. There were significant differences between the scores of groups I and II (P=0.033), groups I and III (P<0.001), and groups I and IV (P=0.033). CONCLUSION: Both diphenhydramine HCl and Nedocromil sodium reduced postoperative abdominal adhesions separately and in combination with each other in our study. Average score of adhesion formation was lowest in the group that was administered Nedocromil sodium. More research is needed in order to discover any positive effect of these drugs as antiadhesive agents in humans.