Efficacy of autologous platelet-rich plasma on graft uptake in myringoplasty: a single-blinded randomized control trial

Background and aim Chronic otitis media is defined as a chronic inflammation of the middle ear cleft producing irreversible pathological changes. The myringoplasty aims at the reconstruction of the tympanic membrane using a graft material. Autologous platelet-rich plasma can be used along with the graft to have a successful outcome. The aim of the study was to assess the efficacy of autologous platelet-rich plasma on graft uptake in myringoplasty. Methods This was a randomized controlled trial with a sample size of 76 patients. All patients were above 18 and below 55 years of age diagnosed with chronic suppurative otitis media and were planned for myringoplasty. The participants were randomly allotted to two groups by block randomization (block of 4). Intra-operatively, group I (n=38) received platelet-rich plasma–soaked gel foam and group II (n=38) was taken as the control group who received saline-soaked gel foam and examined by a blinded examiner at the end of 1st and 3rd months. Results The mean air-bone gap reduction post-operatively in the platelet-rich plasma group was 8.68 ± 4.8 (P value 0.034) and 6.05 ± 4.05 in the control group. The improvement in pure-tone average in the platelet-rich plasma group (P = 0.009) is more than that in the control group. The graft uptake was higher among the platelet-rich plasma group than the control group both at 1st and 3rd months (P value 0.049) which were statistically significant. Conclusion The present study concludes that the usage of platelet-rich plasma in the conventional myringoplasty technique has improved the success rate of graft uptake and reduced the graft migration. Trial registration Clinical Trials Registry-India (ICMR-NIMS) CTRI/2020/04/024416. Date of registration: 01/04/2020. Date of enrolment of the first participant to the trial: 06/04/2020. URL of the trial registry: http://www.ctri.nic.in. Highlights Usage of autologous platelet-rich plasma (PRP) in conventional myringoplasty in underlay technique. Assessment of graft uptake, percentage of perforation closure, and the audiological outcome. Significant mean reduction of ABG in the PRP group. Significant improvement in PTA average in the PRP group. Graft uptake and percentage of perforation closure were higher in the PRP group and the control group. PRP is also beneficial in revision cases.

Significance of inflammatory biomarkers and urethral histology in patients with urethral stricture disease in relation to treatment outcome—a single centre prospective study in the north-eastern part of India

Background Inflammation plays a very important role in defining the urethral stricture. Inflammatory biomarkers may play an important role in predicting the underlying pathophysiology as well as outcome of surgery. Histology of urethral strictures along with histology of urethra proximal and distal to stricture segment may have a role in predicting the outcome of the surgery. The literature discussing this aspect is rare; thus, this novel study aimed to find out the role of inflammatory biomarkers and urethral histology in predicting the outcome of surgery in urethral stricture disease. Methods This prospective study had 105 patients with age more than 15 years with urethral stricture. Baseline characteristics, routine blood tests including inflammatory blood markers (CRP, ESR, HbA1C, fasting insulin, serum ferritin, etc.) were recorded. They underwent various types of surgery, and first biopsy was taken from stricture segment and second biopsy from proximal to stricture segment and third biopsy from distal to stricture segment and evaluated for the presence of features of lichen sclerosus and inflammation. Primary endpoint was to diagnose the role of inflammatory biomarkers and histology of stricture in stricture recurrence. Results Their mean age was 43.3 ± 13.46 years. Mean CRP of 11.54 ± 3.64 in patients with failure and 9.59 ± 2.77 in patients with successful outcome (p 0.025). Other inflammatory biomarkers like HbA1C, fasting insulin, ESR, serum ferritin, NLR had no significant correlation with the outcome. The presence of features of lichen sclerosus like hyperkeratosis and severe inflammation in stricture segment predicted higher likelihood of failure. Histology of proximal and distal segment of urethral stricture had no significant relationship in predicting outcome. Staged urethroplasty with buccal mucosal graft outperformed single-stage urethroplasty in biopsy-proven LS strictures. Conclusions The present study found a negative impact of increased CRP and the presence of features of lichen sclerosus in urethral histology with the outcome of urethral stricture disease. Thus, our study confirms that inflammatory biomarkers (CRP) and histology of stricture segment play a significant role predicting the outcome of surgery.

Development of New Antimicrobial Oleanonic Acid Polyamine Conjugates

A series of oleanolic acid derivatives holding oxo- or 3-N-polyamino-3-deoxy-substituents at C3 as well as carboxamide function at C17 with different long chain polyamines have been synthesized and evaluated for antimicrobial activities. Almost all series presented good to moderate activity against Gram-positive S. aureus, S. faecalis and B. cereus bacteria with minimum inhibitory concentration (MIC) values from 3.125 to 200 µg/mL. Moreover, compounds possess important antimicrobial activities against Gram-negative E. coli, P. aeruginosa, S. enterica, and EA289 bacteria with MICs ranging from 6.25 to 200 µg/mL. The testing of ability to restore antibiotic activity of doxycycline and erythromycin at a 2 µg/mL concentration in a synergistic assay showed that oleanonic acid conjugate with spermine spacered through propargylamide led to a moderate improvement in terms of antimicrobial activities of the different selected combinations against both P. aeruginosa and E. coli. The study of mechanism of action of the lead conjugate 2i presenting a N-methyl norspermidine moiety showed the effect of disruption of the outer bacterial membrane of P. aeruginosa PA01 cells. Computational ADMET profiling renders this compound as a suitable starting point for pharmacokinetic optimization. These results give confidence to the successful outcome of bioconjugation of polyamines and oleanane-type triterpenoids in the development of antimicrobial agents.

Surgical Management of Impacted Lower Second Molars: A Comprehensive Review

Impacted lower second molars (ILM2) are rarely reported in the literature, but various studies have been done for its treatment. Apart from solely orthodontic approaches, different surgical management techniques were reported to have successful outcomes. Surgical intervention of ILM2 can help expose the tooth for further orthodontic purposes, simplifying complex treatment methods, and reducing treatment time. This review illustrates the comprehensive evaluation and updated methods of surgical uprighting, repositioning, and transplantation of ILM2 with future directions for better understanding and treatment planning in the clinical setting. The successful outcome of surgical intervention depends on case selection, root development of ILM2, careful surgical manipulation, and adherence to sound biological principles.

High Frequency Pressure Monitoring of the Re-Fracturing or Continuous Pumping Operations: Case Studies

The opportunity to refracture low-producing horizontal wells, which have been fractured few months before is getting more and more popular in the last few years. It provides the opportunity of restoring production without drilling new wells, which might be economically feasible especially in the oil and gas low price environment. However, the success rate of refracturing operations is usually low, mainly driven by the inability to properly stimulate the entire horizontal section. Consequently, many operators do not widely deploy this efficient technology. In contrast, completing a newly drilled well with plug and perf technology allows to individually treat from forty to sixty or even more individual compartments in the lateral section while refracturing attempts to retreat the entire lateral in the absence of any isolating device while trying to cover the entire lateral. There are at least two key factors affecting this operation. First is diversion technology: without efficient chemical diverters, which allow to temporarily block recently treated intervals and divert the stimulation fluid to different open sections of the well is extremely challenging. These diverters should normally be able to hold pressure differentials up to thousand psi or more. Attempting a treatment without this technology, aka a "blind frac" is not an option in many cases. The second factor is monitoring technology: The ability to recognize whether a zone has been successfully stimulated, to decide on the deployment of diverting technology or the further addition of stimulation fluid, to sponsor lateral coverage with minimal risk of premature screen out becomes of utmost importance for the successful outcome of hydraulic refracturing operations. In the absence of either of the aforementioned factors hydraulic refracturing may become inefficient and yield uneconomic success. This paper presents how the application of novel diverters, combined with proper hydraulic fracturing fluid selection, sound engineering design and more importantly hydraulic fracturing monitoring provide a new opportunity for the deployment of hydraulic refracturing to provide significant production increase and enhance recovery factor.

Optimist, Pessimist or Engineer - Conductivity Based on Need Not Fashion

An optimist says the glass is half-full, a pessimist half-empty, whereas a good engineer says that the glass is twice as big as it needs to be. There has been much debate over the years about the relative functionality, application and even necessity of proppant in delivering effective hydraulic fractures. Often these debates have been directly linked to major changes in core frac applications, more recently in the dominant North American onshore unconventional market. However, the debates have all too often used broad or unclear brush strokes to describe shifting fracture requirements. Meanwhile, the developing oilfield in the rest of the world resides in more permeable areas of the resource triangle, great care must be taken to ensure that conventional lessons hard learned are not lost, but also that unconventional understanding develops. Over recent years there have been many debates and publications on the relative value of the use of proppant (and associated conductivity), although the true question was about appropriate fracture design in different rock/matrix qualities and environments. Certainly, the vast majority of fracturing engineers appreciate the difference between continuous proppant-pack conductivity and other techniques, such as infinite conductivity, pillar fracturing or duning designs. However, there is increasing evidence that conventional fracturing is suffering from populist attitudes, leading to ineffective fracturing. Additionally, and just as impactful, that unconventional fracturing continues to rely on the lessons learned and physics derived directly from our conventional experience but applying this in an entirely different environment. Primarily, the main concern is with the transfer of recent lessons learned and techniques utilised in one rock quality and environment, to an entirely different scenario, resulting in the misapplication, reduced IP30, poorer NPV or reduced long term EUR and IRR. Examples will be referenced where appropriate proppant selection and frac design can be the difference between success and failure. Fundamentally, we have not sufficiently developed our understanding of the role of proppant and conductivity, for application in unconventionals and thereby rely far too much on our previous conventional thinking. While at the same time we are exporting often inappropriate unconventional populist practice into very conventional environments, thereby potentially achieving the abhorrence of the worst of both worlds. This paper will describe and address scenarios where appropriate engineering selection, rather than popularity-based decision making, has resulted in a successful outcome. It will also attempt to ensure that we show the importance of studying your rock, in anticipation of engineering design, and that this should be a key consideration. The paper will also suggest that as an industry we urgently need to address our approach to consideration of conductivity, placement and importance and ensure that unconventional knowledge and learning progresses with a beneficial outcome for all.

Successful outcome of pre-engraftment COVID-19 in an HCT patient: impact of targeted therapies and cellular immunity

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has emerged as a global pandemic that upended existing protocols and practices, including those for allogeneic hematopoietic stem cell transplantation (HCT). Here we describe the successful clinical course and multiple key interventions administered to an acute lymphoblastic leukemia patient, who tested SARS-CoV-2 positive by RT-PCR on day -1 of matched unrelated donor (SARS-CoV-2 IgG negative) T-cell-replete HCT. This experience allowed for implementing a virologic and immunomonitoring panel to characterize the impact of SARS-CoV-2 on the recipient's nascent humoral and cellular immune response. The finding of robust, functional, and persistent levels of SARS-CoV-2 specific T-cells, starting early after transplant was unexpected, and in combination with the clinical strategy may have contributed to the favorable outcome. Additionally, it is plausible that pre-existing cross-reactive endemic coronavirus immunity in the allogeneic graft reduced recipient susceptibility to COVID-19 disease. This case supports the critical role that T-cell responses may play in mitigating SARS-CoV-2 infection, even in the context of transplant immunosuppression, in which reconstitution of humoral response is commonly delayed. Interventional approaches to transfer SARS-CoV-2-specific cellular immunity such as HCT donor vaccination and adaptive cellular therapy could be of benefit.

Acute HBV Related ALF- Successful Outcome with Oral Antiviral Treatment

Case report: We present a young female of fourteen years who was admitted to the hospital with short duration of Icterus, malaise, vomiting and diagnosed to be having acute hepatitis B. She went into acute liver failure as evidenced by development of hepatic encephalopathy and coagulopathy. She was managed on lines of hepatic encephalopathy along with oral antiviral treatment. She recovered successfully and was discharged after two weeks in heamodynamically stable condition. After a gap of six months, she became Hepatitis B surface (HbsAg) & hepatitis B e-antigen (HbeAg) negative and Hepatitis B Virus DNA (HBV DNA) was undetectable with normal liver function tests. She is on regular follow up for last one year and is absolutely normal. Conclusion: Acute hepatitis B can go into acute liver failure in 1% of cases, treatment for which includes liver transplantation and oral antiviral treatment which is especially helpful in cases who cannot afford liver transplantation, as was in our case.

Modified Target Angle as a Predictor of Success in Strabismus Management after Orbital Fracture

Surgery for strabismus secondary to orbital fracture reconstruction surgery has had low success rates and high reoperation rates due to its incomitant nature and complex underlying mechanisms. There has been no consensus as to which of the various methods for improving the surgical results are best. We proposed a modified target angle criteria that combined the regular target angle and a favorable Hess area ratio percentage (HAR%) threshold to evaluate surgical results within the first postoperative week and conducted a retrospective chart review. According to the criteria of the modified target angle at the first postoperative week, a total of 63 patients were divided into two groups: Group 1, patients who fulfilled the criteria (49 patients); and Group 2, those who did not (14 patients). Sex, type of fracture, and the use of porous polyethylene sheets and titanium mesh during reconstruction surgery were significantly different between the groups. Group 1 showed a significantly higher percentage of patients who met the criteria of HAR% > 65% at the first week and >85% (i.e., a successful outcome) at the 6-month visit (p < 0.01). Additionally, Group 1 had a higher HAR% at the first postoperative week (p < 0.01). In conclusion, the patients meeting the criteria of the modified target angle at the first postoperative week had a favorable outcome at the 6-month visit in both ocular alignment and ocular movement.

Application of decellularized bone matrix as a bioscaffold in bone tissue engineering

Autologous bone grafts are commonly used as the gold standard to repair and regenerate diseased bones. However, they are strongly associated with postoperative complications, especially at the donor site, and increased surgical costs. In an effort to overcome these limitations, tissue engineering (TE) has been proposed as an alternative to promote bone repair. The successful outcome of tissue engineering depends on the microstructure and composition of the materials used as scaffold. Decellularized bone matrix-based biomaterials have been applied as bioscaffolds in bone tissue engineering. These biomaterials play an important role in providing the mechanical and physical microenvironment needed by cells to proliferate and survive. Decellularized extracellular matrix (dECM) can be used as a powder, hydrogel and electrospun scaffolds. These bioscaffolds mimic the native microenvironment due to their structure similar to the original tissue. The aim of this review is to highlight the bone decellularization techniques. Herein we discuss: (1) bone structure; (2) properties of an ideal scaffold; (3) the potential of decellularized bone as bioscaffolds; (4) terminal sterilization of decellularized bone; (5) cell removing confirmation in decellularized tissues; and (6) post decellularization procedures. Finally, the improvement of bone formation by dECM and the immunogenicity aspect of using the decellularized bone matrix are presented, to illustrate how novel dECM-based materials can be used as bioscaffold in tissue engineering. A comprehensive understanding of tissue engineering may allow for better incorporation of therapeutic approaches in bone defects allowing for bone repair and regeneration.