Allele-specific expression reveals genetic drivers of tissue regeneration in mice

In adult mammals, skin wounds typically heal by scarring rather than through regeneration. In contrast, "super-healer" Murphy Roths Large (MRL) mice have the unusual ability to regenerate ear punch wounds; however, the molecular basis for this regeneration remains elusive. Here, in hybrid crosses between MRL and non-regenerating mice, we used allele-specific gene expression to identify cis-regulatory variation associated with ear regeneration. Analyzing three major cell populations (immune, fibroblast, and endothelial), we found that genes with cis-regulatory differences specifically in fibroblasts were associated with wound-healing pathways and also co-localized with quantitative trait loci for ear wound-healing. Ectopic treatment with one of these proteins, complement factor H (CFH), accelerated wound repair and induced regeneration in typically fibrotic wounds. Through single-cell RNA sequencing (RNA-seq), we observed that CFH treatment dramatically reduced immune cell recruitment to wounds, suggesting a potential mechanism for CFH's effect. Overall, our results provide insights into the molecular drivers of regeneration with potential clinical implications.

To drain or not to drain following posttraumatic ear reconstruction with Dieffenbach's postauricular flap in patients with antithrombotic therapy

PURPOSE

To measure the association between drainage use and postoperative complications (POCs) after posttraumatic ear reconstruction (PTER) with Dieffenbach's postauricular flap (DPF) in patients with antithrombotic therapy (ATT).

METHODS

This was a retrospective double-cohort study of patients undergoing posttraumatic DRF with vs. without drainage in 4 maxillofacial units during a 7-year interval. The primary predictor variable was drainage use, and the main outcome was POCs (i.e., auricular haematoma and infection). Descriptive, bi- and multivariate statistics were computed with P ≤ 0.05 defined as statistically significant.

RESULTS

The sample was composed of 365 unilateral PTER patients (14% POCs, 15.6% ATT, 34.5% females) aged 58.1 ± 19.7 years (range, 18-101). Among subjects with ATT, drainage use significantly reduced POCs (OR, 0.5; 95% CI, 0.3 to 0.8; P = 0.009; absolute risk reduction [ASR], 34.04%; NNT, 3), especially when delayed surgery > 5 h after trauma was evident (forward stepwise logistic modelling: OR, 20.6; 95% CI, 2 to 215.9; P = 0.012). Drainage placement under DPF in ATT patients with smoking habit, concomitant diseases (e.g. diabetes mellitus), ear cartilage loss, or wound contamination almost halved POC rates (ASR, 34.5 ± 12.1%; range, 22.1% to 49%). Patient's age, gender, American Society of Anesthesiologists (ASA) class, alcohol misuse, ATT and antibiotic type, and international normalised ratio (INR) before surgery had no meaningful effect on POCs.

CONCLUSIONS

Drainage should be placed under DPF in patients with ATT, regardless of age, gender, ATT and antibiotic type, and preoperative INR.

Circumstances of human conflicts with bears and patterns of bear maul injuries in Bhutan: Review of records 2015-2019

Bhutan is one of the biological hotspots in the world where humans and natural flora and fauna co-exist in close proximity. Bhutan is home to two species of bears: Sloth Bear and Himalayan Black Bear. Human conflicts with bears are reported from all over the country. This study describes the profile of the victims and the pattern of injury resulting from bear attacks and circumstances around human conflicts with bears in Bhutan between 2015 and 2019. This was a cross-sectional study with a review of hospital records of patients treated at the National Referral Hospital from 01 January 2015 till 31 December 2019. Data were extracted into a structured pro forma and entered into EpiData Entry 3.1 and analysed in STATA 13.1. There were thirty-four patients who were provided care for bear maul injuries, with an average annual caseload of 6.8 cases per year. The injury prevalence was 100% and the kill prevalence was 0%. Bear attacks were reported from fourteen of twenty districts of the country. The mean age of the victims was 49 (±13) years. Males (26, 76%) and farmers (26, 76%) were the common victims; the risk of bear attacks was 0.16 per 100,000 farmers per year. The commonest region of the body attacked was the face (29, 85%) and victims were provided emergency and rehabilitative care within and outside the country. Thirty-three victims (97%) were provided post-exposure prophylaxis for rabies. All victims received antibiotics despite the lack of national guidelines on the choice of antibiotics post-bear maul. Human-bear conflict is multi-faceted, puts a considerable strain on bear-conservation efforts and requires multi-disciplinary efforts in the prevention of human injury and socioeconomic losses.

Otorrhoea - a parotid connection

A 36-year-old patient presented with an 18-month history of intermittent right parotid swelling accompanied by otorrhoea. The symptoms started subsequent to a palm leaf injury to the right ear. At right parotidectomy, a fistula connecting the right external auditory canal and the right parotid was demonstrated. A small fibrotic mass probably due to a remnant of the palm leaf was found intraoperatively. The symptoms resolved completely after the mass was excised by superficial parotidectomy, and the fistula closed spontaneously.

A guide to managing disorders of the ear pinna and canal

This review will help you troubleshoot everything from infections and foreign bodies to trauma and neoplasm.

Supramolecular Polymer Hydrogels for Drug-Induced Tissue Regeneration

Supramolecular polymers self-assemble into nanofibers, micelles, and other nanostructures through weak noncovalent interactions between subunits. Such systems possess attractive properties for use in a variety of practical settings such as energy, sustainability, and healthcare. In regenerative medicine, a common approach involves implanting a supramolecular material containing cell and growth factor binding motifs directly into a diseased or traumatized tissue defect, whereupon it interacts with and/or recruits components of the biological system to induce tissue healing. Here we introduce a supramolecular therapeutic in which tissue regeneration is orchestrated by a supramolecular polymer prodrug implanted subcutaneously in a remote tissue. Our approach exploits a hydrophobic small-molecule inhibitor of prolyl hydroxylase enzyme as both a regeneration-inducing therapeutic and a structure-directing agent in a supramolecular polymer that forms shear-thinning nanofiber hydrogels. Subcutaneous injection of the supramolecular hydrogel in the back of mice wounded with a critical-sized defect in the ear led to transient upregulation of hypoxia inducible factor-1α and regeneration of ear tissue in a manner reminiscent of epimorphic regeneration. This drug-induced regeneration strategy utilizes a simple and translatable supramolecular design, eliminates the need for delivery of biologics ( e. g., growth factors, cells), and avoids implantation of a foreign material directly in a tissue defect.

Skin lesion monitoring at slaughter on heavy pigs (170 kg): Welfare indicators and ham defects

In order to evaluate at the slaughterhouse external carcass lesions on heavy pigs (170 kg) as potential welfare indicators, and the prevalence of ham defects determining ham exclusion from Protected Designation of Origin (PDO) markets, 732 pig batches from northern Italy were monitored during a 12-month period, and then processed analysing the effect of slaughter season, overnight lairage, and production type. On the slaughter line, skin scratches were separately scored in the posterior region (defined as the area including the hind legs and the tail) and the anterior one (as the remaining area), while the whole carcass was examined for external hematomas. Chronic ear and tail lesions referable to the rearing phase, and bursitis were recorded as retrospective welfare indicators. The annual median prevalence of carcasses per batch with severe anterior scratches was 64% while 46.4% had severe posterior scratches. The highest autumn score for both skin scratches (P < 0.001) and traumatic ham defects (P = 0.005) is reflected in the positive correlation between severe posterior scratches and ham hematomas (r² = 0.27; P < 0.001). Overnight lairage batches resulted in higher prevalence for scratches, while among ham defects only veining increased. Among binary records, only ear lesions were frequently recorded (annual median = 10%). A comparison analysis between pigs in and out of PDO circuit was performed to evaluate the variation related to the different genetics, showing differences for ear and tail lesions and for almost all the considered ham defects. The present study confirms that skin lesions represent a problem also for heavy pigs and that overnight lairage and season can affect their prevalence, with the associated possibility to give ham defects. Ear lesions are suitable to be used as retrospective welfare indicator, while tail lesions usage is nowadays limited by the extensive use of tail docking.

Effects of bomb blast injury on the ears: The Aga Khan University Hospital experience

OBJECTIVE

To evaluate the frequency and effects of blast-related otologic injuries.

METHODS

his retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised charts of patients who were victims of bomb explosions between January 2011 and July 2013. Frequency and percentages were reported using cross tabulation with size of bomb, distance of person from blast and the presence of victim in open or closed space. Association of associated variables were also analysed.

RESULTS

Of the 100 patients, 81(81%) were men and 19(19%) were women. Besides, 68(68%) patients were aged <30 years. Also, 78(78%) subjects were exposed to < 80kg of explosives and 68(68%) were at a distance of>10m. Furthermore, 61(61%) patients were exposed to explosion in openspace. The prevalence of ear injuries was 21(21%). The odds of experiencing various symptoms of ears was high in those who were exposed to >80 kg of explosives (odds ratio: 3.38; 95% confidence interval, 1.16, 9.91). The odds of hearing loss in those who were within 10m was 8.62 (95% confidence interval: 2.72, 27.28) times than those who were >10 m from the site of explosion.

CONCLUSIONS

Otologic injuries were frequently associated with large blasts.

Pediatric Cotton-Tip Applicator-Related Ear Injury Treated in United States Emergency Departments, 1990-2010

OBJECTIVE

To evaluate the characteristics of children with cotton-tip applicator (CTA)-related ear injuries.

STUDY DESIGN

Data on CTA-related ear injuries among children presenting to US emergency departments (EDs) from 1990 through 2010 were obtained from the National Electronic Injury Surveillance System.

RESULTS

Between 1990 and 2010, an estimated 263 338 children aged <18 years were treated for CTA-related ear injuries in US hospital EDs. There was a nonsignificant increase in the annual number of injuries from 1990 through 2001 (78.2%) and a significant decrease from 2001 through 2010 (26.0%). Younger children sustained the highest rate of injury (32.2 per 100 000 for age 0-3 years). Ear cleaning was the most frequently documented circumstance at the time of injury (73.2%), and patients themselves were most commonly handling the CTA (76.9%). Foreign body sensation (39.2%) and bleeding (34.8%) were commonly documented reasons for visiting the ED. The presence of a foreign body (29.7%) and tympanic membrane perforation (25.3%) were common diagnoses.

CONCLUSION

Most CTA-related injuries occurred with children themselves handling CTAs while cleaning their ears. Foreign body and tympanic membrane perforation were the most common associated diagnoses. Despite warnings against the use of CTAs in the ear canal and use of CTAs by children, these injuries continued to occur. Additional injury prevention strategies through further parent/caregiver and child education are warranted.

Macrophages are necessary for epimorphic regeneration in African spiny mice

How the immune system affects tissue regeneration is not well understood. In this study, we used an emerging mammalian model of epimorphic regeneration, the African spiny mouse, to examine cell-based inflammation and tested the hypothesis that macrophages are necessary for regeneration. By directly comparing inflammatory cell activation in a 4 mm ear injury during regeneration (Acomys cahirinus) and scarring (Mus musculus), we found that both species exhibited an acute inflammatory response, with scarring characterized by stronger myeloperoxidase activity. In contrast, ROS production was stronger and more persistent during regeneration. By depleting macrophages during injury, we demonstrate a functional requirement for these cells to stimulate regeneration. Importantly, the spatial distribution of activated macrophage subtypes was unique during regeneration with pro-inflammatory macrophages failing to infiltrate the regeneration blastema. Together, our results demonstrate an essential role for inflammatory cells to regulate a regenerative response.

Otologic Hazards Related to Scuba Diving

Context:

As of 2015, more than 23 million scuba diver certifications have been issued across the globe. Given the popularity of scuba diving, it is incumbent on every physician to know and understand the specific medical hazards and conditions associated with scuba diving.

Evidence Acquisition:

Sources were obtained from PubMed, MEDLINE, and EBSCO databases from 1956 onward and ranged from diverse fields including otologic reviews and wilderness medicine book chapters.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

Otologic hazards can be categorized into barotrauma-related injuries or decompression sickness.

Conclusion:

When combined with a high index of suspicion, the physician can recognize these disorders and promptly initiate proper treatment of the potentially hazardous and irreversible conditions related to scuba diving.

Impulse noise injury prediction based on the cochlear energy

The current impulse noise criteria for the protection against impulse noise injury do not incorporate an objective measure of hearing protection. A new biomechanically-based model has been developed based on improvement of the Auditory Hazard Assessment Algorithm for the Human (AHAAH) using the integrated cochlear energy (ICE) as the damage risk correlate (DRC). The model parameters have been corrected using the latest literature data. The anomalous dose-response inversion behavior of the AHAAH model was eliminated. The modeling results show that the annular ligament (AL) parameters are the dominant cause of the non-monotonic dose-response behavior of AHAAH. Based on parametric optimization analysis, a 40% reduction of the AL compliance from the AHAAH default value removed the dose-response inversion problem, and this value was found to be within the physiological range when compared with experimental data. The transfer functions from the new model are in good agreement with those of the human ear. A dose-response curve based on ICE was developed using the human walk-up temporary threshold shift (TTS) data. Furthermore, the ICE values calculated for the German rifle noise tests show excellent comparison with the injury outcomes, hence providing a significant independent validation of the improved model. The ICE was found to be the best DRC to both large weapons and small arms noise injury data, covering both protected and unprotected exposures, respectively. The new AHAAH model with ICE as the dose metric is adequate for use as a medical standard against impulse noise injury.

[Treatment of traumatic facial injuries]

Correct treatment of traumatic facial lacerations is essential to achieve the best cosmetic and functional outcome. This article discusses wound management, anatomy and techniques to repair lacerations of scalp, eyelid, nose, lip and ear. Scalp lacerations should be sutured in layers. Injury to the eyelid mandates a careful examination of the eye. Accurate adaptation of the lid margin is required. Nasal septum haematoma must be drained and the nares and alar margins aligned. The key to proper repair of lip laceration is alignment of the vermillion border. Injury to the ear can often be closed in one layer.

Ear trauma

Understanding basic ear anatomy and function allows an examiner to quickly and accurately identify at-risk structures in patients with head and ear trauma. External ear trauma (ie, hematoma or laceration) should be promptly treated with appropriate injury-specific techniques. Tympanic membrane injuries have multiple mechanisms and can often be conservatively treated. Temporal bone fractures are a common cause of ear trauma and can be life threatening. Facial nerve injuries and hearing loss can occur in ear trauma.

Wound contraction decreases with intravenously injected substance P in rabbits

Substance P is an injury-inducible endogenous factor for the mobilization of CD29+ stromal-like cells into circulation and that are major effectors of accelerated healing. In this study, we evaluated the effect of intravenously injected substance P on full-thickness skin wound healing as a secondary intention wound model. We made circular full-thickness skin wounds on the ears of 28 New Zealand white rabbits. They were treated with phosphate-buffered saline, or intravenous 5, 50, or 250 n mole/kg substance P at days 0 and 1. All substance P-treated groups showed a 2.6-5.4-fold higher CD29 expression and resulted in greatly decreased wound contraction and early maturation of the stroma. However, a significant decrease in wound contraction was measured only in the 5 n mole/kg treatment group. We conclude that intravenously injected substance P at 5 n mole/kg decreases wound contraction and promotes wound maturation in full-thickness skin wounds in a rabbit ear model.

Mechanisms of hearing loss after blast injury to the ear

Given the frequent use of improvised explosive devices (IEDs) around the world, the study of traumatic blast injuries is of increasing interest. The ear is the most common organ affected by blast injury because it is the body's most sensitive pressure transducer. We fabricated a blast chamber to re-create blast profiles similar to that of IEDs and used it to develop a reproducible mouse model to study blast-induced hearing loss. The tympanic membrane was perforated in all mice after blast exposure and found to heal spontaneously. Micro-computed tomography demonstrated no evidence for middle ear or otic capsule injuries; however, the healed tympanic membrane was thickened. Auditory brainstem response and distortion product otoacoustic emission threshold shifts were found to be correlated with blast intensity. As well, these threshold shifts were larger than those found in control mice that underwent surgical perforation of their tympanic membranes, indicating cochlear trauma. Histological studies one week and three months after the blast demonstrated no disruption or damage to the intra-cochlear membranes. However, there was loss of outer hair cells (OHCs) within the basal turn of the cochlea and decreased spiral ganglion neurons (SGNs) and afferent nerve synapses. Using our mouse model that recapitulates human IED exposure, our results identify that the mechanisms underlying blast-induced hearing loss does not include gross membranous rupture as is commonly believed. Instead, there is both OHC and SGN loss that produce auditory dysfunction.

Heritability of articular cartilage regeneration and its association with ear wound healing in mice

OBJECTIVE

Emerging evidence suggests that genetic components contribute significantly to cartilage degeneration in osteoarthritis pathophysiology, but little information is available on the genetics of cartilage regeneration. Therefore, this study was undertaken to investigate cartilage regeneration in genetic murine models using common inbred strains and a set of recombinant inbred (RI) lines generated from LG/J (healer of ear wounds) and SM/J (nonhealer) inbred mouse strains.

METHODS

An acute full-thickness cartilage injury was introduced in the trochlear groove of 8-week-old mice (n=265) through microsurgery. Mouse knee joints were sagittally sectioned and stained with toluidine blue to evaluate regeneration. For the ear wound phenotype, a bilateral 2-mm through-and-through puncture was created in 6-week-old mice (n=229), and healing outcomes were measured after 30 days. Broad-sense heritability and genetic correlations were calculated for both phenotypes.

RESULTS

Time-course analysis of the RI mouse lines showed no significant regeneration until 16 weeks after surgery; at that time, the strains could be segregated into 3 categories: good, intermediate, and poor healers. Analysis of heritability (H2) showed that both cartilage regeneration (H2=26%; P=0.006) and ear wound closure (H2=53%; P<0.00001) were significantly heritable. The genetic correlations between the two healing phenotypes for common inbred mouse strains (r=0.92) and RI mouse lines (r=0.86) were found to be extremely high.

CONCLUSION

Our findings indicate that articular cartilage regeneration in mice is heritable, the differences between the mouse lines are due to genetic differences, and a strong genetic correlation between the two phenotypes exists, indicating that they plausibly share a common genetic basis. We therefore surmise that LG/J by SM/J intercross mice can be used to dissect the genetic basis of variation in cartilage regeneration.

[The magnitude and the structure of ENT sanitary losses in modern local armed conflicts]

The objective of the present study was to estimate the magnitude and the structure of ENT losses in modern local armed conflicts. We have considered characteristics of battle injuries inflicted in modern wars based on the materials collected during the armed conflicts in the Caucasus during 1999-2002 and stored in the Military Medical Museum (MMM) of the Russian Defense Ministry. A total of 5608 case records of the surgical treatment of mechanical injuries were analysed including 4002 gunshot wounds and 1606 closed injuries (contusions). ENT and neck wounds were the main and concomitant injuries in 102 and 107 subjects respectively who accounted for 2.5% and 2.7% of all the wounded servicemen. Fifty five (3.93%) and 21 (1.3%) of the 1606 subjects had a closed ENT and neck wound as the leading and concomitant injury, respectively. According to the materials collected in MMM, ENT contusion was the main injury in 111 (25%) of the 410 servicemen who had received contused wounds in the armed conflict of 1999-2002.

Successful replantation of a completely amputated ear on a child

Amputation of an ear is a rare injury. Subsequent replantation is a challenging and very difficult task for an experienced micro-surgeon. Every well described successful replantation of an ear is a valuable lesson for a micro-surgeon mainly because securing the venous drainage of the replanted ear is very difficult. In the worldwide medical literature, only a minimal amount of cases have described a successful replantation of an ear after total amputation on a child. The authors describe the whole treatment process for a seven-year old boy whose ear was bitten off by a dog. They also describe their procedures which led to a successful outcome.

[General principles of treatment of mine-explosive wounds of ENT-organs]

The relevance of diagnosis and treatment of mine-explosive wounds ENT high. Treatment of explosives, Russian Academy of Sciences-the challenge and consists of a series of sequential steps that need to be applied, taking into account all the particularities of each injury. Concepts of specialized surgical care of the wounded are formulated. The main are: 1) one-stage surgical treatment of comprehensive primary wounds with detent of bone fragments, reconstruction of defects of soft tissue with positive wound and related fascial spatium drainage; 2) general intensive care during the postoperative period, including water-electrolytic balance correction, sympathetic block, controlled hemodilution and adequate analgesia; 3) intensive therapy of postoperative wounds, aimed at creating favorable conditions for its healing and includes targeted selective influence on hemophoresis in the wound and the local proteoclastic processes.

The perceived angle of the round window affects electrode insertion trauma in round window insertion - an anatomical study

CONCLUSION

In this study round window (RW) insertion of cochlear implant was performed with a lower degree of trauma in 86.6% of cases. Therefore RW insertion is a valid option to be considered in selected cochlear implant patients, especially when hearing preservation is a goal. In most cases drilling of the overhangs is required.

OBJECTIVES

To systematically examine the potential for minimizing electrode insertion trauma with RW insertion.

METHODS

Fifteen temporal bones were inserted with a 0.5 mm electrode analog in an anterior or antero-inferior vector from a reference point along the facial recess. Surface preparation of the inferior segment of the basal turn was performed and the point of first contact was analyzed using computerized morphometric software. The same software was used to measure the RW dimensions before and after drill down of the bony overhangs. An insertion was considered 'traumatic' if the point of first contact was the medial wall of the scala, whereas 'less traumatic' was an insertion in which the point of first contact was the inferior or posterior wall of the scala.

RESULTS

Less traumatic insertion was achieved in 13 of the 15 bones, and in these the mean RW angle, as observed from a surgical point of view, was 137°. The mean RW angle in the traumatic insertion group was 147°. The difference was statistically significant.

Epimorphic regeneration in mice is p53-independent

The process of regeneration is most readily studied in species of sponge, hydra, planarian and salamander (i.e., newt and axolotl). The closure of MRL mouse ear pinna through-and-through holes provides a mammalian model of unusual wound healing/regeneration in which a blastema-like structure closes the ear hole and cartilage and hair follicles are replaced. Recent studies, based on a broad level of DNA damage and a cell cycle pattern of G₂/M "arrest," showed that p21(Cip1/Waf1) was missing from the MRL mouse ear and that a p21-null mouse could close its ear holes. Given the p53/p21 axis of control of DNA damage, cell cycle arrest, apoptosis and senescence, we tested the role of p53 in the ear hole regenerative response. Using backcross mice, we found that loss of p53 in MRL mice did not show reduced healing. Furthermore, cross sections of MRL. p53(-/-) mouse ears at 6 weeks post-injury showed an increased level of adipocytes and chondrocytes in the region of healing whereas MRL or p21(-/-) mice showed chondrogenesis alone in this same region, though at later time points. In addition, we also investigated other cell cycle-related mutant mice to determine how p21 was being regulated. We demonstrate that p16 and Gadd45 null mice show little healing capacity. Interestingly, a partial healing phenotype in mice with a dual Tgfβ/Rag2 knockout mutation was seen. These data demonstrate an independence of p53 signaling for mouse appendage regeneration and suggest that the role of p21 in this process is possibly through the abrogation of the Tgfβ/Smad pathway.

[Damages of ENT-organs inflicted by the weapon of not-lethal (traumatic) action]

There was effectuated a research of killability of traumatic weapon in laboratory as well as during analyzing of clinical observations. There were considered the results of treatment of 8 persons, suffered from traumatic weapon. It was occurred a clinical recovery by 7 wounded persons from 8. There was 1 case of lethal outcome for first hours, caused by trauma of temporal bone and cerebrum (suicide). Thus, influence of traumatic weapon on ENT-organs can be a reason of serious penetrating wounds, facial bones fracture, hematomas and contusion, formation of foreign bodies and middle ear barotraumas.

Experience with prosthetic reconstruction of ear defects at LUTH, Lagos, Nigeria

AIM

The aim of the article is to report our experience with prosthetic reconstruction of ear defects in Nigerians.

MATERIALS AND METHODS

A review of all consecutive cases of alloplastic (prosthesis) reconstruction of auricular defects was conducted at the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital. Data collected included age and sex of patients, aetiology of defects, site of defects (left or right), lost tissue (partial or total), material used for the fabrication, and mode of retention of the prosthesis.

RESULTS

A total of 33 consecutive patients who had prosthetic reconstruction of auricular defects during the period were included. The male-to-female ratio was 3.7: 1. Six cases (18.2%) were congenital defects and 27 (81.8) cases were acquired defects. Three (50%) of the congenital cases were microtia. Majority (63%) of the acquired cases were due to road traffic crashes. Total loss of the auricle was recorded in 22 (66.7%) patients. Of the patients with partial loss of the auricle, pinna was the major structure lost in 5 patients while pinna +lobe were lost in another 5 patients. Silicone elastomers was the most frequently used material for the fabrication of auricular prostheses (29 patients). The most frequently used retention method was silastic medical grade adhesive.

CONCLUSIONS

Prosthetic option is a valuable technique for the reconstruction of ear defect. The primary indication for prosthetic reconstruction of ear defect in the present study is acquired ear deformity; mainly due to road traffic crashes.

Penetrating and blast ear trauma: 7-year review of two pediatric practices

OBJECTIVE

To review our experience with ear trauma in children.

DESIGN/METHODS

Retrospective review of two practices from 2000 to 2007.

SETTING

Pediatric tertiary care hospital.

MAIN OUTCOME MEASURES

Micro-otoscopic findings and audiologic data.

RESULTS

There were 18 cases of penetrating ear trauma (PET) and 6 cases of blast ear trauma (BET). The average age of the children with PET was 5 years. Fifteen of the 18 cases involved cotton-tipped applicators (CTAs); 8 patients had tympanic membrane perforations from CTA use. Six of the perforations healed spontaneously, and the other two patients were lost to follow-up. For 15 of the 18 PET patients, audiograms were available, and all eventually returned to normal. The average age of the six patients with BET was 11 years. BET caused five tympanic membrane perforations, all of which healed spontaneously. Three patients had audiograms, which were normal. The other three were lost to follow-up. None of the patients had vertigo, nystagmus, facial weakness, or cerebrospinal fluid otorrhea; this factored into our nonsurgical approach.

CONCLUSIONS

PET and BET in children are underreported. PET usually involves CTA and occurs in younger children than does BET. Urgent surgical intervention is not indicated unless a child presents with neuro-otologic signs or symptoms. CTA avoidance should be taught systematically to the public.

[Experimental study on BMSCs transfected by endogene inhibiting hypertrophic scar]

OBJECTIVE

To investigate the effects on forming of hypertrophic scar after BMSCs infected with adenovirus carrying TGF-beta3c2s2 were transplanted into the wound of animal scar model.

METHODS

The third passage of rabbit's BMSCs were infected with 150 mutiple infection, and were cultured 24 hours. The concentration of the BMSCs infected with recombinant adenovirus containing the TGF-beta3c2s2 gene was 1 x 10(5) cell/mL. The purified and evaporated recombinant adenovirus grains containing the TGF-beta3c2s2 gene were diluted by DMEM/F12 (without FBS) to 1 x 10(8) pfu/mL. The animal scar model of the standard Japanese big ear rabbit was established. Eighty wounds were generated on the gastroside of ear and were randomized to 4 groups in each rabbit, which were divided into 3 control groups (A: control, B: Ad-TGF-beta3c2s2, C: BMSCs) and 1 experimental group (D: BMSCs/Ad-TGF-beta3c2s2). Then the wounds were tranplanted with cells. On 45 days and 90 days after wounded, thickness and hardness of scars were measured with color ultrasound diagnostic unit and especial measurement for skin and scar hardness. On 21, 45 and 90 days, three specimens were harvested respectively for further histological study.

RESULTS

The wound of groups A, B, C gradually formed the different degree scars after epithelialization. The hyperplasty of scars reached peak on 45 days after wounded and lasted about 90 days. There was no prominent scar formed in group D during the whole observed procedure. Thickness and hardness of scar of group D and group E were approximate on 45 days and 90 days. Thickness and hardness of scar of groups A, B and C were lower than those of group D (P < 0.01), and group B showed more lower than group A and group C (P < 0.01). Disorder structure and overlapping arrangement, enlargement collagen fibers were showed in the HE histological sections of the scars of groups A, C. The structure of the scars of groups B, C were similar to Group E. The constitutions of groups A, B, C, D on 90 days resembled to each one on 45 days. In section of immunohistochemistry after wounded on 21 days and 45 days, positive expressions of BrdU in nucleus of Groups C, D were observed. Negative expressions of BrdU in Groups A, B, E were showed.

CONCLUSION

BMSCs with Ad-TGFbeta3c2s2 gene transplanted into wound could inhibit the forming of hypertrophic scar.

Post-traumatic otosclerosis: coincidence or trigger factor?

OBJECTIVE

The etiology of otosclerosis is poorly understood and environmental as well as genetic factors have been implicated. In this paper we will present 3 cases of otosclerosis with a clinical history of trauma and we will discuss with a literature review the place of trauma in otosclerosis etiology.

CLINICAL CASES

3 patients with clinically diagnosed otosclerosis, operated, and with a clinical history of previous head trauma.

DISCUSSION AND CONCLUSION

It is probable that environmental factors could be involved in the development of the disease and we think that trauma could be one of them. The mechanisms by which it could results in otosclerosis remain unknown. However these cases appear to be rare and under studied.

Lung abscess in a professional rugby player: an illustration of overtraining syndrome?

As in other endurance sports, the intensity of training sessions and the pace of competition has significantly increased since rugby union became a professional sport. The case history is presented of a professional rugby player who was diagnosed with septicaemia and a lung abscess following an infected wound to the ear. The symptoms only resolved after a large dose of antibiotics and 3 months of rest. It is hypothesised that this may be an example of overtraining syndrome, but complementary blood analyses would be necessary to confirm this. The case underlines the importance of clinically assessing the individual capacity of players to recover, in order to prevent overtraining and to maintain a high level of performance during the whole season.

Analgesic and anti-inflammatory activities of a fraction rich in gaultherin isolated from Gaultheria yunnanensis (FRANCH.) REHDER

The analgesic and anti-inflammatory activities of a salicylate derivatives fraction (SDF) isolated from Gaultheria yunnanensis (FRANCH.) REHDER and the mechanisms of actions were investigated in the present study. The major constituent of SDF, which represented around 50% of this fraction, was a methyl salicylate diglycoside named gaultherin. SDF showed a significant inhibition on the hind paw edema in rats (200, 400 mg/kg body wt., p.o.) and ear swelling in mice (200, 400, 800 mg/kg body wt., p.o.) caused by carrageenin and croton oil, respectively. In addition, SDF (400, 800 mg/kg body wt., p.o.) inhibited only the second phase (inflammatory) in the formalin test, and showed no effect in the hot-plate test in mice. The antinociceptive activity of SDF was predominantly peripheral and independent of the opioid system. These findings demonstrate that SDF from Gaultheria yunnanensis (FRANCH.) REHDER possesses analgesic and anti-inflammatory activities, which may be mediated, at least partly, through the suppression of inflammatory mediators or their release suggested by the animal experiment. The observed effects of SDF are probably due to the presence of high content of salicylate derivatives (80%), including gaultherin, MSTG-A and MSTG-B.

The human bite injury: a clinical audit and discussion regarding the management of this alcohol fuelled phenomenon

BACKGROUND

Human bite injuries are both deceptive and challenging in their presentation and management. They remain a frequent presentation to our unit, most often following late night alcohol fuelled aggression.

AIMS

To audit the management of these wounds, with particular focus on infective complications and outcomes.

METHODS

A three year retrospective chart review was undertaken on all patients referred to the plastic surgery unit from 1 January 2003 through to 31 December 2005.

RESULTS

A total of 92 patients with 96 human bite wounds were identified. The majority were male (92%). Alcohol consumption was documented in 86% of cases. The majority (70%) occurred over the weekend or on a public holiday. Facial injuries made up 70% of injuries with the remainder being to the upper limb. The ear was the most common target of all facial injuries (65%). Infection was documented in 18 cases (20%), with bite injuries to the upper limb and those presenting late (>12 h) having a higher incidence of infection.

CONCLUSIONS

Human bite wounds present a challenge to any emergency department, given the many issues involved in their management. Underestimation of the complexity and potential sequelae of these wounds will result in a suboptimal outcome for the patient.

The Inhibitory Effect of Minocycline on Hypertrophic Scarring

BACKGROUND

Matrix metalloproteinases are enzymes that serve to degrade the extracellular matrix, giving them a central role in the inflammatory and wound-healing processes; they have been implicated in the pathophysiology of hypertrophic scarring. The purpose of this study was to examine the effect of minocycline, a matrix metalloproteinase inhibitor, on hypertrophic scarring.

METHODS

Standardized wounds were created on the ears of eight New Zealand White rabbits. Half of the rabbits received daily injections of minocycline, whereas the other half received daily injections of saline (control). After 4 weeks, the resulting ear scars were harvested. Histologic slides were prepared from the thickest cross-sections of the scars, and from these slides the cross-sectional area of each scar was measured. A hypertrophic index was calculated by comparing the area of the scar to the baseline value of unwounded skin. Statistical analysis was performed using the SAS/STAT NESTED Procedure for hierarchical data.

RESULTS

Among the rabbits treated with minocycline, the mean hypertrophic index was 1.08 +/- 0.01, compared with 1.54 +/- 0.03 in the control group (p = 0.03), representing an 85 percent reduction in hypertrophic area.

CONCLUSIONS

Systemically administered minocycline significantly reduces the severity of hypertrophic scarring in a rabbit model. Although not directly examined in this study, matrix metalloproteinase inhibition is hypothesized to be responsible for this effect.

Blast Injury of the Ear: Clinical Update from the Global War on Terror

The purpose of this study was to describe the effects of blast exposure on hearing status. This study retrospectively analyzed hearing thresholds and otologic complaints for >250 patients with blast-related injuries from the global war on terror. Of patients who received full diagnostic evaluations, 32% reported a history of tympanic membrane perforation, 49% experienced tinnitus, 26% reported otalgia (ear pain), and 15% reported dizziness. Expected hearing thresholds were computed by applying age-correction factors to hearing tests performed earlier in the service members' careers and before their most recent deployment. Expected hearing thresholds were significantly better than actual postdeployment thresholds, indicating that significant changes occurred in the patients' hearing that could not be accounted for by age. Results from this study underline the need for documentation of pre-and postdeployment hearing tests and prompt otologic evaluation for the blast-exposed population.

Himalayan black bear mauling: offense or defense?

The Asiatic Black Bear (Ursus thibetanus or Selenarctos thibetanus), also known as the Tibetan black bear, the Himalayan black bear, or the moon bear is a omnivorous mammal. This animal is declared threatened animal and rarely comes in human contact. Recent decrease in forest area has, however, increased the chances of bear-human interaction, hence causing injuries to humans. There is only one published report in English literature on Himalayan black bear mauling. We present 5 cases referred to our department over a period of 1 year.

Temporal flap variations for craniofacial reconstruction

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Describe the anatomy of the temporal region. 2. Identify the types and possible indications of the temple group flaps to be selected depending on the defects, and then raise the flap safely for reconstruction. 3. Predict and manage successfully the potential complications of surgery.

BACKGROUND

Good harmony of color and texture with surrounding tissues, thinness and adequate pliability, good alignment, obliteration of the cavities, and minimal donor-site morbidity are the main features of an ideal flap to be used in the reconstruction of craniofacial defects. Despite the numerous local, regional, and free flaps that have been described, to date, there has not yet been an ideal flap. The authors discuss the reconstruction alternatives presented by the temporal site and its outcomes.

METHODS

The temporal group flaps can be raised using one or more tissues based on the superficial temporal artery and its branches, depending on the defect site and nature. They can be designed as axial skin flaps consisting of transposition or V-Y island flaps, composite flaps including more than one tissue, and chimeric flaps involving both the temple skin and temporal fascia based on the two distal branches of the superficial temporal artery.

RESULTS

The temporal region is a good donor site for closure of craniofacial defects, by means of its rich vascular network and almost all types of tissue, including skin, fascia, muscle, galea, calvarial bone, and periosteum. The charm of this region has gradually increased as clinical experiences have advanced and its anatomy has been better understood.

CONCLUSIONS

The authors discuss the history, anatomy, surgical dissection techniques, and potential complications and their management of temporal flaps.

Traumatic perforation of the tympanic membrane in University of Port Harcourt Teaching Hospital, Port Harcourt. Nigeria

OBJECTIVE

To evaluate the causes, clinical features and treatment of traumatic tympanic membrane perforation in University of Port Harcourt Teaching Hospital.

PATIENTS AND METHODS

Patients with traumatic perforation of the tympanic membrane from August 2003 to February 2005 were evaluated clinically to determine the cause and the site of perforation. They had pure tone audiometry done. Treated by non- surgical means and followed up.

RESULTS

Fifty- eight (8.6%) patients with traumatic perforation were seen among 676 patients with aural diseases. Average age was 27.56 years. Causes of traumatic perforation were, fights with spouse 27.6%, street fights 19%, instrumentation 17.2% and state security agents 15.5%. Hearing loss 94.8%, tinnitus 84.5% and otalgia 67.2% were common complaints. 63.8% had perforation in the lower half of pars tensa. 42.4% had mild conductive hearing impairment. 29.3% healed within 3 weeks.

CONCLUSION

Physical blow to the ear was the commonest cause of tympanic perforation.

Advanced laceration management

Many lacerations seen in the emergency department setting require specific management based on anatomic location. Lacerations of the fingertip, ear, nose, lip, tongue, and eyelid can be complex and require advanced management techniques. Many can be primarily treated by emergency clinicians; however, it is important for the clinician to know when consultation is appropriate for treatment by a specialist. Current literature recommendations are presented for initial management, methods of repair, technical tips to facilitate repair, appropriate consultation, and postoperative care for these complex lacerations.

Tinnitus in children and adolescents

ENT practitioners are rarely confronted with tinnitus complaints from children. The present paper describes a literature review conducted in an attempt to identify possible reasons for this. Rather than applying the vast amount of information about tinnitus among adults, it seeks to highlight those domains where differences between children and adults are of importance.

Use of an expanded temporoparietal fascial flap technique for total auricular reconstruction

BACKGROUND

The authors propose an expanded technique of the temporoparietal facial flap of sufficient size to provide complete coverage in a single-stage procedure for the projected three-dimensional autogenous cartilage framework, including the tragus or lobule.

METHODS

A temporoparietal fascial flap measuring 9 x 9 cm was prepared and wrapped around an expander. The expander was gradually infused with saline solution. Approximately 6 months after the first operation, a projected three-dimensional auricular framework was covered by the expanded temporoparietal fascial flap. Nine patients underwent total ear reconstruction using the expanded temporoparietal fascial flap technique. Of these, two cases were anotia, five were failed reconstructed microtia, and two were posttraumatic absence of ear.

RESULTS

A final aesthetic assessment of the results was analyzed subjectively. Three cases showed excellent results, four cases showed good results, one case showed a fair result, and one case showed a poor result.

CONCLUSIONS

This expansion technique is indicated in reconstruction of anotia patients who require longer and wider fascial flaps and in auricular reconstruction patients undergoing microvascular free fascial flap transfer for lessening postoperative vascular obstruction, when microvascular anastomosis is performed on the retroauricular region. The technique is also indicated in salvage auricular reconstruction for patients with an unusual vascular pattern on the temporoparietal fascial flap, or for patients showing a vascular insufficiency of the flap's distal portion after flap elevation.

Scuba diving: What you and your patients need to know

Self-contained underwater breathing apparatus (SCUBA) diving continues to gain popularity. General practitioners need to know the health requirements and contraindications so they can counsel patients appropriately. SCUBA diving injuries may not be apparent immediately and require knowledge and understanding for accurate diagnosis and treatment.