The neuroprotective effect of mesenchymal stem cells in colistin-induced neurotoxicity.

Colistin is an effective antibiotic against multidrug-resistant gram-negative bacterial infections; however, neurotoxic effects are fundamental dose-limiting factors for this treatment. Stem cell therapy is a promising method for treating neuronal diseases. Multipotent mesenchymal stromal cells (MSC) represent a promising source for regenerative medicine. Identification of neuroprotective agents that can be co-administered with colistin has the potential to allow the clinical application of this essential drug. This study was conducted to assess the potential protective effects of MSC, against colistin-induced neurotoxicity, and the possible mechanisms underlying any effect. Forty adult female albino rats were randomly classified into four equal groups; the control group, the MSC-treated group (A single dose of 1 × 106/mL MSCs through the tail vein), the colistin-treated group (36 mg/kg/d colistin was given for 7 d) and the colistin and MSC treated group (36 mg/kg/d colistin was administered for 7 d, and 1 × 106/mL MSCs). Colistin administration significantly increased GFAP, NGF, Beclin-1, IL-6, and TNF-α immunreactivity intensity. MSC administration in colistin-treated rats partially restored each of these markers. Histopathological changes in brain tissues were also alleviated by MSC co-treatment. Our study reveals a critical role of inflammation, autophagy, and apoptosis in colistin-induced neurotoxicity and showed that they were markedly ameliorated by MSC co-administration. Therefore, MSC could represent a promising agent for prevention of colistin-induced neurotoxicity.

The Management of Blood Loss in Non-Syndromic Craniosynostosis Patients Undergoing Barrel Stave Osteotomy.

AIM: Barrel stave osteotomy is a widely used procedure in neurosurgery for the majority of craniosynostosis patients. Both in the intraoperative and postoperative periods, there is inevitable leakage type bleeding from the bones undergoing osteotomy. A number of studies have been performed in order to prevent this complication but a concise procedure is still lacking. MATERIAL AND METHODS: Synostectomy and parietotemporal barrel stave osteotomy were applied to 143 patients who were operated on with a diagnosis of craniosynostosis between the years 2005-2013. At the beginning to osteotomy, 5 ml/kg erythrocyte suspension (ES) was given for probable blood loss. Whole blood count was performed at the postoperative 1st and 6th hours and cases with hemoglobin levels below 10 or with hematocrit levels which had decreased more than 5% between the 1st and 6th hours were administered erythrocyte transfusion. RESULTS: Of the patients, 100 were boys and 43 were girls. Of these, 98 had metopic, 30 had sagittal, 9 had metopic+sagittal, 4 had unilateral, 2 had bilateral and 6 had coronal synostosis. All the cases were administered intraoperative erythrocyte suspension. The preoperative amount of administered mean erythrocyte was 8.61 ml/kg. In the postoperative period, 92 patients were administered erythrocyte suspension. The postoperative amount of administered mean erythrocyte suspension was 7.98 ml/kg. CONCLUSION: For an operated infant with craniosynostosis who is operated on in the first year of life, undergoing osteotomy and inevitable bone-borne blood losses are very important and these have to be replaced immediately.

Indirect laryngoscopic assessment for the diagnosis of difficult intubation in patients undergoing microlaryngeal surgery.

BACKGROUND: The aim of this study is to investigate the feasibility of using indirect laryngoscopy for the diagnosis of difficult intubations in patients who are undergoing microlaryngeal surgery. METHODS: In the pre-anesthetic examination the thyromental distance, sternomental distance, interincisor distance, neck circumference, modified Mallampati scores, and Wilson risk scores were measured. An otolaryngologist conducted an indirect laryngoscopic assessment. Direct laryngoscopic profiles were classified according to their Cormack-Lehane scores. RESULTS: Forty patients underwent microlaryngeal surgery. Their mean ages, neck circumferences, Cormack-Lehane scores of the patients who had intubation difficulties were statistically significantly higher than those who did not have intubation difficulties (p < 0.05). The significant differences between the indirect laryngoscopic assessment distributions of patients who either had or did not have intubation difficulty were assessed (p < 0.05). CONCLUSIONS: Indirect laryngoscopic assessment is a simple and valuable technique that can be used for the diagnosis of difficult intubation in patients who are undergoing microlaryngeal surgery.