Introduction of inflammatory bowel disease biomarkers panel using protein-protein interaction (PPI) network analysis

AIM

In the present study, a protein-protein interaction network construction is conducted for IBD.

BACKGROUND

Inflammatory bowel diseases as serious chronic gastrointestinal disorders attracted many molecular investigations. Diverse molecular information is present for IBD. However, these molecular findings are not highlighted based on interactome analysis. On the other hand, PPI network analysis is a powerful method for study of molecular interactions in the protein level that provide useful information for highlighting the desired key proteins.

METHODS

Cytoscape is the used software with its plug-ins for detailed analysis. Two centrality parameters including degree and betweenness are determined and the crucial proteins based on these parameters are introduced.

RESULTS

The 75 proteins among 100 initial proteins are included in the network of IBD. Seventy-five nodes and 260 edges constructed the network as a scale free network. The findings indicate that there are seven hub-bottleneck proteins in the IBD network.

CONCLUSION

More examination revealed the essential roles of these key proteins in the integrity of the network. Finally, the indicator panel including NFKB1, CD40, TNFA, TYK2, NOD2, IL23R, and STAT3 is presented as a possible molecular index for IBD.

Sclerosing Mucoepidermoid Carcinoma of the Parotid Gland

INTRODUCTION

Mucoepidermoid carcinoma represents one of the most common malignant salivary gland tumors. However, the sclerosing morphologic variant is extremely rare with only 23 reported cases in the English-language literature since it was discovered in 1987.

CASE REPORT

Herein, we describe another case that was diagnosed in a 25-year-old woman presenting with a posterior auricular mass, as well as a review of the literature, which demonstrates that this is an extremely rare malignancy with no strict protocol for treatment.

CONCLUSION

Pathologists must be aware of recognizing low grade sclerosing mucoepidermoid carcinoma which has metastatic potential and is frequently misdiagnosed as a benign lesion.

Comparison of outcomes using diced cartilage with or without tensor fascia latae wrapping in rabbits

BACKGROUND

Diced cartilage has been associated with several advantages and rewarding results, leading to its widespread application in various forms in rhinoplasty, but the outcomes of diced cartilage with and without tensor fascia latae wrapping have not been widely reported in evidence-based articles.

OBJECTIVES

The authors compared changes in weight, size, and histology of both bare and fascia-wrapped diced cartilage in rabbits as a model for human surgical outcomes.

METHODS

One auricle from each of 15 rabbits was divided into 2 pieces, and both samples were diced. The tensor fascia latae of the rabbit was wrapped around 1 cartilage specimen from each rabbit (group A specimen); the other specimen received no wrapping (group B specimen). A group A specimen and a group B specimen were implanted into separate subcutaneous pockets in each rabbit. After 3 months, samples were removed from the recipient beds and weighed to compare pre- and postoperative weights. All specimens were examined for evidence of cartilage viability by histologic methods.

RESULTS

There was a significant decrease in the weight of cartilage in group A. A nonsignificant weight increase was observed in group B. Histologic analyses of 5 parameters revealed no significant differences between the 2 groups, except for a significantly greater amount of new cartilage formation in group B.

CONCLUSIONS

Any type of wrapping around diced cartilage may inhibit its access to surrounding nutrients. Dicing increases the absorption surface, which may result in some overgrowth, but wrapping may have a negative impact on the viability of the diced cartilage.

LEVEL OF EVIDENCE

4.

Straight septum, crooked nose: an overlooked concept

INTRODUCTION

Asymmetric facial skeletal growth is a common finding in the rhinoplasty patient population. This common abnormality affects all facial components, including the upper lateral cartilages (ULCs). The asymmetric growth also may produce uneven thickness, consistency, curvature, and elastic recoil of the ULC. Ignoring this asymmetry may have a marked impact on the outcome of any rhinoplasty operation, especially in the management of crooked noses.

MATERIALS AND METHODS

The files of 89 consecutive rhinoplasty patients who underwent surgery by a single surgeon were reviewed for deformities of the middle vault and to tabulate the procedures performed in each individual case.

RESULTS

Of the 89 rhinoplasty cases, 72 (81 %) had asymmetric ULCs. Approximately 30 % (27/89) of the cases had a straight septum with asymmetric ULCs which required appropriate correction.

CONCLUSIONS

Awareness of an asymmetric ULC in a crooked nose and an attempt to correct this condition in addition to straightening of the septum is key to decreasing postoperative residual or recurrent mid-vault deviation.

LEVEL OF EVIDENCE IV

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 .

Correction of cleft lip nose deformity with rib cartilage

BACKGROUND

Correction of cleft lip nasal deformities (CLND) is often unsatisfactory because of problems resulting from cartilage weakness and strong soft tissue forces. Therefore, strong cartilaginous support, such as rib cartilage, is mandatory.

OBJECTIVES

The authors describe placement of rib cartilage grafts to create a more symmetric and aesthetically acceptable repair of CLND with improved nasal air flow.

METHODS

Two groups of patients, including those with unilateral and bilateral CLND, underwent operations with different sources of autologous cartilage. Group 1 received grafts from the septum and ear, whereas group 2 received grafts from the septum and ribs. Results were evaluated by 2 independent physicians who rated improvement between pre- and postoperative photographs.

RESULTS

There were significant differences in postoperative improvement between patients who received septal/ear cartilage grafts and those who received septal/rib cartilage grafts in both unilateral and bilateral cases (P = .028 and P = .043, respectively).

CONCLUSIONS

The authors' results demonstrate that rib cartilage has a positive effect on the aesthetic outcome of CLND operations and provides a strong support structure for correcting this deformity with minimal postoperative complications.

Anterior scoring approach for prominent ear anomaly: a modified Chongchet technique

BACKGROUND

One of the most common facial anomalies is the presence of a prominent ear. Numerous surgical techniques have been introduced in the literature for correction of this anomaly, which include suturing and sculpturing the ear cartilage. However, each has different complications. The modified Chongchet technique is one of the less invasive methods and can correct the above abnormality with satisfying results.

METHODS

From July 2001 to March 2011, 19 cases of prominent ear were corrected using the modified Chongchet technique. The mean follow-up period was approximately 4.5 years. We employed an anterior approach and partial-thickness scaphal cartilage scoring in these cases.

RESULTS

We observed no recurrences and no sharp cartilage protrusions following the surgeries. Additionally, all patients expressed satisfaction with the results. 

CONCLUSION

We propose that the modified Chongchet approach is less aggressive and has improved surgical outcomes. One of the adverse effects of this procedure is unpredictable warping of the cartilage, which may result in asymmetry.

Diced ear cartilage with perichondrial attachment in rhinoplasty: a new concept

BACKGROUND

Diced cartilage is a valuable material that has recently been added to the graft options in rhinoplasty. Shaping, fixation, and resorption are the main concerns with this material. Perichondrially attached diced conchal cartilage may be a new possibility to solve some of these problems.

OBJECTIVES

The authors evaluate the outcome of perichondrially attached diced cartilage in a rabbit model and compare the results with injectable cartilage grafting.

METHODS

Ear cartilage was removed from 1 auricle in each of the 16 rabbits included in this study; samples were divided in 2 pieces. After precise weighing, both segments were diced. The perichondrium was left attached to 1 of the pieces. Both segments were inserted in 2 separate pockets in the dorsum of the animal. After a 3-month period, both samples were removed and measured for growth/resorption.

RESULTS

At the beginning of this study, the difference in weight between groups was statistically insignificant (P = .213), but 3 months after insertion, significant growth was observed in the perichondrial group (P = .019).

CONCLUSIONS

The vascularization and significant growth in weight of the perichondrially attached diced cartilage samples are evidence of the viability of this material. The structural integrity and solid framework afforded by this option suggest that the material should be used more frequently in nasoskeletal augmentation.

Acid burn violence in Iran

Background. Acid assault is one of the most brutal of crimes. This crime is not meant to kill but to punish the victim or to destroy the victim's social life. This violent act usually occurs in third-world countries. The aim of this paper is to assess the epidemiological factors that steer a person toward such a violent act. Method. From May 2004 to October 2010, the charts of victims of acid violence referred to the Motahari Burn Center in Iran were reviewed. During this 6-yr period, 59 patients were included in this retrospective study. We identified the aetiology and the extent of the damage that was produced as a result of throwing corrosive chemicals onto the victim's body for the purpose of revenge. Results. The cases reviewed concerned 51% male patients and 49% female. The face and upper body were the most commonly injured areas, and the most common assailant was a close family member. Conclusion. The authors believe that lack of information about the catastrophic outcome of this action, plus the widespread availability of strong, destructive chemicals, are the main reasons for the rising incidence of this crime.

Epidural anesthesia as a thromboembolic prophylaxis modality in plastic surgery

BACKGROUND

Epidural anesthesia (EA) is known to reduce postoperative thromboembolic complications, but the mechanisms are poorly understood. Review of the literature revealed no reports about the ability of epidural anesthesia (EA) to reduce the risk of venous thromboembolism (VTE) in abdominal contouring surgery and/or liposuction. Most medical publications in this field are based on orthopedic cases.

OBJECTIVES

The authors investigate the hypothesis that the differential nerve-blocking effect of bupivacaine, which spares motor function and permits leg movement during the operation, is the most important mechanism by which EA prevents thromboembolism.

METHODS

From June 1992 to August 1995, 24 cases of abdominoplasty were performed under general anesthesia (Group 1). From September 1995 to December 2009, 371 cases of concurrent abdominoplasty and liposuction were performed under EA (Group 2). Eighteen cases (4.8%) from Group 2 were ultimately excluded from the study because of unsuccessful EA. All surgeries were performed by the senior author (FH).

RESULTS

One thromboembolic event (pulmonary embolism [PE]) occurred in Group 1 (4%). No cases of deep vein thrombosis (DVT) or PE occurred among Group 2 patients.

CONCLUSIONS

Together, differential epidural nerve blocks and purposeful intraoperative movement of lower-limb muscles represent an effective prophylactic mechanism that may prevent devastating DVT and resultant PE.

The clinical manifestation, evaluation and surgical management of sphenoid sinus mucoceles: a case series and literature review

OBJECTIVE

This study was designed to describe clinical manifestation, treatment and outcomes in patients with sphenoid sinus mucocele presenting to Amiralam Hospital, Tehran, Iran.

METHODS

A review of 43280 medical records covering a period of 10 years included just 12 patients with sphenoid sinus mucocele presenting to our teaching centre.

RESULTS

The mean age of the patients was 35 years (ranging from 19 to 52 years). Headache was the most frequent symptom in 9 of the 12 patients. Visual disorders were noted in five patients. Two patients underwent external ethmoidectomy accompanied by intranasal sphenoidotomy while transseptal sphenoidotomy was performed for five patients and five patients underwent endoscopic endonasal sphenoidotomy. Wide spectrum antibiotics were given to all the patients for 3 to 5 days in order to prevent any iatrogenic infection. All patients did well after surgery without postoperative complications.

CONCLUSIONS

Sphenoid sinus mucocele should be considered in the differential diagnosis of cystic lesions presenting as visual disturbance. Retro-orbital headache with or without visual symptoms is a leading symptom. CT and MRI are essential in the diagnosis of sphenoid disease.

Epidemiologic and clinicopathologic characteristics of tongue cancer in Iranian patients

Oral cancer is considered a great threat to public health. Tongue cancer accounts for nearly 30% of all oral cancers and usually seen in 50 to 60 year old men. Oropharyngeal cancers account for 3% of all cancers in Iran; as reported in 2003. The present study was designed to assess the epidemiologic and clinicopathologic characteristics of tongue cancer patients in two Tehran's referral university hospital between the years 2003 and 2008. In a retrospective study 87 files of patients, diagnosed with tongue cancer who were referred to Imam Khomeini and Loghman Hospitals and Iranian Cancer Institute in Tehran-Iran from 2003 to 2008 were reviewed. Participants were selected from all the patients who had a record of their specimens in the pathology ward registry and their tongue cancer diagnosis was confirmed by a expert pathologist. Patients characteristics (age, gender and presence of risk factors) and chief complain at the time of diagnosis and their tumor related data (type of cancer, staging, grading, morphology and location of tumor) were recorded. Tongue cancer was most frequently seen in the eighth decade of life among both men and women, but had the lowest frequency among patients with less than 40 years of age. Squamous cell carcinoma had the highest prevalence in our patients. Tongue cancer was the most common cancer of oral cavity among Iranian patients and similar epidemiologic and clnicopathological characteristics of the disease were found in our patients. Assessing variables such as socioeconomic levels and religious believe require further studies with large sample sizes.

Does post septoplasty nasal packing reduce complications?

The main issues in nasal surgery are to stabilize the nose in the good position after surgery and preserve the cartilages and bones in the favorable situation and reduce the risk of deviation recurrence. Also it is necessary to avoid the synechia formation, nasal valve narrowing, hematoma and bleeding. Due to the above mentioned problems and in order to solve and minimize them nasal packing, nasal splint and nasal mold have been advised. Patients for whom the nasal packing used may faced to some problems like naso-pulmonary reflex, intractable pain, sleep disorder, post operation infection and very dangerous complication like toxic shock syndrome. We have two groups of patients and three surgeons (one of the surgeons used post operative nasal packing in his patients and the two others surgeons did not).Complications and morbidities were compared in these two groups. Comparing the two groups showed that the rate of complication and morbidities between these two groups were same and the differences were not valuable, except the pain and discomfort post operatively and at the time of its removal. Nasal packing has several risks for the patients while its effects are not studied. Septoplasty can be safely performed without postoperative nasal packing. Nasal packing had no main findings that compensated its usage. Septal suture is one of the procedures that can be used as alternative method to nasal packing. Therefore the nasal packing after septoplasty should be reserved for the patients with increased risk of bleeding.

Neuro-otologic manifestations of multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) has numerous neurologic signs and symptoms, including hearing impairment. The reports concerning the type and severity of hearing loss in MS patients vary and little is known about an association of the disease characteristics with changes in hearing status.

OBJECTIVE

To find the otologic and neuro-otologic manifestations of MS with the use of routine hearing assessment tools.

METHODS

The presence of neuro-otologic signs and symptoms were studied in 30 patients diagnosed with MS. Patients underwent pure tone audiometry, speech audiometry and acoustic brain stem response (ABR) tests. The results were compared with 30 healthy age and sex matched controls.

RESULTS

The most common finding was sensory-neural hearing loss followed by dizziness and nystagmus. The shape of the audiogram and severity of hearing loss was associated with both chronicity and disease activity. There were abnormal latencies in ABR waves which were more significant with high velocity stimulus.

CONCLUSION

Hearing status deserves careful attention in MS patients. It may be used as a diagnostic means or an indicator for evaluating the characteristics of the underlying disease.

Applied anatomy of the nasal lower lateral cartilage: a new finding

BACKGROUND

In most references to the nasal anatomy, the shape of the lower lateral cartilage (LLC) is described as a two-dimensional structure. However, the authors have found different forms of LLC in at least 40% of their open rhinoplasty cases during the past 20 years. This cartilage was found to have a three-dimensional hemispheric appearance and to be connected to the upper lateral cartilage (ULC) at the scroll area by an inward limb of this hemisphere. This inward limb may have an important role in producing asymmetry and flare of the nostril.

METHODS

The LLC of 286 patients was evaluated during open rhinoplasty over a 2-year period, with a focus mainly on the shape of this structure, especially at the LLC-ULC junction (scroll area).

RESULTS

A dome-shaped appearance of the LLC was noted in 40.9% of cases, and 11.5% of cases had bilateral LLC variation. This different anatomic form was seen mostly in patients with a strong bulbous nasal tip, although it was observed less frequently also in patients with narrow nasal tips.

CONCLUSION

At least one-third of the LLCs analyzed had a medial wall in addition to the lateral wall, which significantly increased the flare and recoil force of this structure. This makes this cartilage more redundant to reshaping procedures (straightening). Thus, special attention must sometimes be paid to this common anatomic variation to produce symmetric nostrils and to obtain a more aesthetically acceptable alar tip.

Use of overinflated tissue expanders in the surgical repair of head and neck scars

BACKGROUND

Successful inflation of a tissue expander (TE) and coverage of the face with tissue of similar colour and texture is usually limited by the amount of skin generated during the reconstruction process. Overexpanding the TE device generates an increased flap size and an overall better reconstructive outcome.

PATIENTS AND METHODS

A total of 86 TEs were inserted into 48 burn patients with head and neck burn scars. In each case, a TE was inserted with subsequent overexpansion to 2-4 times the manufacturer's stated maximum volume.

RESULTS

Using the above technique, we gained more transferable skin, which was then used to cover the defects. The rates of major and minor complications were the same as those obtained in previous studies. Illustrations of several representative cases are also included.

CONCLUSIONS

Overinflation of smaller TEs minimises complication rates typically associated with this procedure. Cutaneous overexpansion can usually achieve the desired flap dimensions by overinflation of the implant well beyond the manufacturer's stated maximum volume, thus ensuring its success and allowing for better coverage of the defects.

Management of the thick-skinned nose: A more effective approach

A bulky nose is a challenging issue to manage, and surgeons have not found the ultimate solution to this problem in the evolution of rhinoplastic surgery. Because of the multiplicity of techniques and controversies published in the literature, it has become confusing for the operating surgeon to find the most appropriate and effective way of solving this frustrating dilemma. The subcutaneous fat is the thickest in the supratip area, and the soft tissue thickness over the tip of the nose varies considerably from patient to patient. The focus of this study was to find a method for reducing the overlying soft tissue of the tip for better re-draping of skin over the nasal skeleton. The hallmark of this technique is to undermine the nasal skin in two layers. We believe that soft tissue trimming in biplane dissection can minimize the thickness of the tip skin in a relatively safe and homogeneous way. With this report we introduce a new method of dissection of nasal soft tissue and of trimming it in different areas of the nose for different purposes. In the authors' opinion, this approach is one of the most effective ways of handling unpliable, thick nasal skin.

Prevention of Hanging Columella in Open Rhinoplasty

In this article we discuss the anatomy of the nasal base and explain the causes of postoperative hanging columella, distinguishing this entity from similar deformities with which it can be confused. We suggest measures that could be helpful in preventing this deformity. We performed external-approach rhinoplasty with the dome suturing method in 82 consecutive patients (64 women and 18 men) from 17 to 44 years of age (mean age, 22 years). Comparative measurements of the alar-columellar complex were made before and after operation. Among the 48 patients with conventional tip suturing (38 women and 10 men), 19 true hanging columellae were detected. In the 34 patients with a modified dome approximation (26 women and 8 men), no more than 5 cases of true deformity were diagnosed.

Glottic microinvasive carcinoma: is it different from carcinoma in situ?

OBJECTIVE

To determine the impact of different treatment modalities on the outcome of microinvasive carcinoma.

DESIGN

Retrospective review of patients presenting between 1976 and 1990.

SETTING

Fifteen patients with microinvasive carcinoma (MIC) of the glottic larynx treated at McGill University teaching hospitals.

METHODS

All patients had MIC involving the glottis confirmed pathologically. Nine patients (60%) had right vocal cord involvement, four (27%) had left vocal cord involvement, and two (13%) had involvement of both cords. Five patients (33%) were treated by stripping(S), three patients (20%) by stripping and radiotherapy (S + RT), and six patients (40%) by radiotherapy (RT) alone as the primary treatment. Only one patient underwent hemilaryngectomy.

RESULTS

With a median follow-up time of 63 months (range 20-208 months), the 15-year actuarial survival rate is 100% for all patients.

CONCLUSIONS

Surgery alone, RT alone, or S + RT is equally effective in treating MIC of the glottic larynx; however, single-modality therapy is preferred. The choice of treatment modality should be individualized for each patient.

Carcinoma in situ of the glottic larynx: excision or irradiation?

BACKGROUND

The management of glottic carcinoma in situ (CIS) is controversial, with vocal cord stripping (S) generally accepted as the standard treatment, and radiotherapy (RT) as an alternative. We present our experience with 34 patients treated by either stripping or RT.

METHODS

++Between 1974 and 1990, 34 patients with CIS of the glottic larynx larynx were treated at McGill University teaching hospitals. The median age at diagnosis was 67 years, with a male:female ratio of 6:1. All patients had CIS involving the glottis and the pathology was reviewed on all patients. Twenty-one patients were treated by S and 13 patients by RT as the primary treatment.

RESULTS

With a median follow-up of 96 months (25-209 months), the 15-year actuarial survival rate is 95% for all patients, with 100% and 87% survival rates for S and RT groups, respectively (p = 0.25). One patient in the RT group developed a subglottic invasive squamous cell carcinoma. On the other hand, 11 patients in the S group developed recurrence and were treated by repeat S (6 patients) or RT (5 patients), with a salvage rate of 100%.

CONCLUSION

Although most patients with CIS of the glottis are traditionally treated with vocal cord S, RT is effective in terms of freedom from recurrence; it is an attractive option and should be considered in patients with lesions recurring after stripping as well as in those whose follow-up presents a problem.