Evaluating the Effect of Tranexamic Acid Local Injection on the Intraoperative Bleeding Amount and the Postoperative Edema and Ecchymosis in Primary Rhinoplasty Patients: A Randomized Clinical Trial.

BACKGROUND AND AIMS: The purpose of this study was assessing the effect of local injection of tranexamic acid (TXA) on the amount of bleeding during the primary rhinoplasty and edema and ecchymosis following the surgery. METHODS: In this randomized clinical trial, 50 patients applying for primary rhinoplasty were divided into two groups of intervention and observation. In the intervention group, 10 mg/kg of TXA was injected locally to the operation field. In the observation group, no medicine was injected. The same anesthesia technique was used during the operation for all the patients. Age, sex, blood pressure, bleeding amount during the operation, the amount of edema and ecchymosis on the first and seventh day after the surgery were noted. The data were analyzed by the SPSS software version 24 and using descriptive statistics of frequency and percentage of frequency and Fisher and Mann-Whitney's exact statistical tests. RESULTS: Our results showed that there was a significant difference between the amounts of bleeding during the surgery between two groups (P-value < 0.001). Also, the postoperative edema on the first and seventh day in intervention group was less than the observation group (P-value < 0.001). There were no complications during the surgery and in the follow-up of the patients. CONCLUSION: We revealed that local injection of TXA during the rhinoplasty procedure and decreased the intraoperative bleeding and postoperative ecchymosis and edema without any side effects and complications. LEVEL OF EVIDENCE III: 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Clinical Efficacy of Fat Injection on the Repair of Hand Flexor Tendon: A Randomized Clinical Trial.

Background: In recent years, special attention has been paid to minimally invasive and conservative methods in addition to conventional surgical methods to repair tendon damage. In this regard, the effect of fat injection and graft has been of great interest due to its potential in accelerating tissue repair. We aimed to assess the clinical efficacy of fat injection along with conventional approach in patients with flexor tendon injury. Methods: In this randomized clinical trial, 64 patients were randomly scheduled for tendon repair using the usual modified Kessler four-strand method alone or tendon repair using four-strand method and fat injection on the proximal and distal sides of the repair site in the Hazrat Fatemeh Hospital, Tehran Province, Iran in 2022 (IRCT20221206056723N1). Patients were followed-up for eight weeks regarding the function status of the repaired tendon (using Strickland grading test), range of motion (by physical examination) and flexion and extension gaps (by imaging). Results: In the eighth weeks after the treatment, the average Strickland score was significantly higher in the group receiving fat injection (P: 0.009 ). In the two pointed times, the mean range of motion was significantly higher and the mean flexion and extension gaps were significantly lower in those who received fat injection. None of the procedural side effects were observed in the fifth and eighth weeks after the treatment. Conclusion: Fat injection along with usual surgical treatment for tendon repair accelerates and improves tendon function and range of motion.

Investigating the effect of poly (ɛ-caprolactone) nanofibers scaffolds with random, unidirectionally, and radially aligned morphologies on the Fibroblast cell's attachment and growth behavior.

In the last decade, significant progress in tissue engineering, repairing, and replacing organs has been achieved. The design and production of scaffolds for tissue engineering are one of the main areas which have attracted the researcher's interest. In this regard, electrospinning is one of the most popular methods of nanoscale scaffold similar to extracellular matrix production. This paper reports the fabrication of scaffolds consisting of radially aligned PCL nanofibers by utilizing a collector composed of a central point electrode and a peripheral ring electrode. The chemical and physical properties were compared using SEM, FTIR, XRD, and DSC experiments, as well as biological performance using the MTT method and cell morphology with nanofibers with random and unidirectionally morphology. Results of this study showed greater physical and biological properties for radially aligned nanofibers which make them an excellent candidate for wound healing applications due to the guided cell growth on this type of nanofiber.

Oxidized carboxymethyl cellulose/gelatin in situ gelling hydrogel for accelerated diabetic wound healing: Synthesis, characterization, and in vivo investigations.

Diabetic wounds are chronic wounds that are currently affecting many patient's quality of life. These wounds are challenging because of the impaired healing cycle and harsh environment. In this study in situ gelling hydrogels based on oxidized carboxymethyl cellulose (OCMC) and gelatin (Gel) were used to hasten the healing rate due to their ease of application. The suggested system in this work is synthesized from entirely natural renewable biomaterials to not only achieve the best biocompatibility and biodegradability but also to develop a sustainable product. The rheological studies showed that the hydrogel is turned into a gel after about 30 s of the mixing process. Moreover, the hydrogel can absorb about ten times its weight, keeping the wound hydrated. In vitro biological investigations indicated optimal biocompatibility, antibacterial, and antioxidant activity for faster tissue regeneration. This product was tested in vivo on normal rats and diabetic mice models to treat full-thickness incisional wounds. Results showed that the OCMC-Gel hydrogel is able to hasten the healing rate in both non-diabetic and diabetic wounds. Pathological examinations of the regenerated skin tissue revealed that the OCMC-Gel treated groups developed much more than the control group.

The Effect of Rainbow Trout (Oncorhynchus mykiss) Collagen Incorporated with Exo-Polysaccharides Derived from Rhodotorula mucilaginosa sp. on Burn Healing.

Burn is one of the physically debilitating injuries that can be potentially fatal; therefore, providing appropriate coverage in order to reduce possible mortality risk and accelerate wound healing is mandatory. In this study, collagen/exo-polysaccharide (Col/EPS 1-3%) scaffolds are synthesized from rainbow trout (Oncorhynchus mykiss) skins incorporated with Rhodotorula mucilaginosa sp. GUMS16, respectively, for promoting Grade 3 burn wound healing. Physicochemical characterizations and, consequently, biological properties of the Col/EPS scaffolds are tested. The results show that the presence of EPS does not affect the minimum porosity dimensions, while raising the EPS amount significantly reduces the maximum porosity dimensions. Thermogravimetric analysis (TGA), FTIR, and tensile property results confirm the successful incorporation of the EPS into Col scaffolds. Furthermore,the biological results show that the increasing EPS does not affect Col biodegradability and cell viability, and the use of Col/EPS 1% on rat models displays a faster healing rate. Finally, histopathological examination reveals that the Col/EPS 1% treatment accelerates wound healing, through greater re-epithelialization and dermal remodeling, more abundant fibroblast cells and Col accumulation. These findings suggest that Col/EPS 1% promotes dermal wound healing via antioxidant and anti-inflammatory activities, which can be a potential medical process in the treatment of burn wounds.

Comparative Effects of Recove® and Nitrofurazone 0.2% on the Treatment of First and Second-Degree Burns: a Double-Blind Randomized Clinical Trial.

Background: Burns are among the major health challenges of all societies and more than any other trauma incur physical, mental, social, and economic burdens on the patient and society. This study was conducted to assess whether Recove® burn ointment is capable of alleviating the pain, preventing the formation of new blisters and controlling the microbial contamination of the wound. Methods: We, therefore, compared its efficacy to ​​nitrofurazone 0.2% cream. This randomized clinical trial was conducted on individuals who had two burn injuries in their body at the same time in the Motahari Burn Hospital, Tehran Province, from June to October 2016. Sampling was carried out with a non-random method using available samples. The intervention in experimental and control groups was Recove® and nitrofurazone, respectively. The effect of interventions on pain relief, the formation of new blisters and prevention of infection at the burn wound were evaluated. In our double-blind study, blindness was applied to the patients and the person evaluating the outcomes. Results: Both Recove® and nitrofurazone interventions significantly alleviated pain (P < 0.01), but Recove ®showed more effectiveness (P=0.01). Similarly, in terms of new blister formation, the experimental group receiving Recove® showed less new blister formation over 24 hours after treatment compared to nitrofurazone group (P=0.03) and with respect to antimicrobial activity, there was no significant difference between Recove® and nitrofurazone (P=0.12). Conclusion: Recove® was effective on pain reduction, prevention of new blisters formation as well as infection. Therefore, it seems that Recove® could be considered as a new and efficient treatment for burn.

Animal Kernicterus Models: Progress and Challenges.

Kernicterus is a leading cause of neonatal death throughout the world, especially in low-middle-income countries. It is developed by an unconjugated hyperbilirubinemia in the blood and brain tissue, triggering pathological processes that spawn neurotoxicity and neurodegeneration. However, the biological mechanism (s) of bilirubin-induced neurotoxicity and Kernicterus development remain to be well elucidated. Likewise, a practical therapeutic approach for human Kernicterus has yet to be found. Undoubtedly, animal models of Kernicterus can be helpful in the identification of underlying biological processes of hyperbilirubinemia evolution to Kernicterus, as well as the evaluation of various treatments efficacy in preclinical studies. More importantly, establishing an animal model that can mimic the Kernicterus and its behavioral, neuro-histological, and hematological manifestations is a severe priority in preclinical studies. So far, several Kernicterus animal models have been established that could partially mimic one or more clinical and paraclinical signs of human Kernicterus. The present study aimed to review all methods modeling Kernicterus with a focus on their potentials and shortcomings and subsequently provide the optimal methods for an ideal Kernicterus animal model.