Significant Difference In Healing Research Articles

Effect of Platelet-Rich Plasma Dosing for Healing after Arthroscopic Cuff Repair Compared with Surgery Alone: A Systematic Review and Meta-Analysis.

Platelet-rich plasma (PRP) has been used for arthroscopic rotator cuff repairs (aRCR), but no studies have addressed the impact of platelet concentration. The primary aim was to evaluate whether the PRP cell concentration has an effect on tendon healing after aRCR compared with surgery alone. The secondary aim was to assess the functional and pain outcomes. A systematic review was performed with searches in the MEDLINE (PubMed), Scopus, Web of Science, and Cochrane (Central) databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Metanalytic procedures were performed for randomized controlled trials (RCTs), and a subgroup analysis was used for studies with target (approximately 10 6 cells·μL -1 ) or below-target PRP cellular concentrations (app. 5 × 10 5 cells·μL -1 ) regarding the primary outcome of tendon healing. This review included 10 studies (8 RCTs) with 342 patients in the aRCR + PRP group and 344 patients with isolated aRCR. The risk of bias was low to intermediate (6/4, respectively). Meta-analysis of the RCT revealed that the aRCR + high-concentration PRP group had an approximately 3.9-fold higher chance of healing than the non-PRP group (odds ratio, 3.89; 95% confidence interval, 1.78-8.44; P = 0.0007). No significant difference in healing was found between the aRCR + low-concentration PRP and non-PRP groups (odds ratio, 2.21; 95% confidence interval, 0.66-7.45; P = 0.2). The Constant-Murley score and University of California Los Angeles scores were significantly improved in the aRCR + PRP groups with more than 12 months of follow-up, and no significant differences were found consistently for the American Shoulder and Elbow Society and visual analog scale scores. This study highlights that a PRP cell concentration close to the target (10 6 cells·μL -1 ) of patients with aRCR may improve their healing and functional outcomes and that dosing may be potentially useful in therapy.

The Effect of Ascorbic Acid Supplementation on the Time of Healing of Rats Submitted to Neurosurgical Procedures

Abstract Introduction Vitamin C is an essential nutrient for both humans and rats and has been noted for its beneficial properties, among them, healing. Objective To verify the effect of oral and subcutaneous vitamin C supplementation on the healing time of surgical wounds of rats skulls. Statistical Methodology Thirty male Wistar rats were divided into 3 groups: 10 from the control group (GI), 10 from the group treated with oral vitamin C (GII), and 10 from the group treated with subcutaneous vitamin C (GIII). Vitamin C was administered to GI and GIII animals from the 3rd to the 7th postoperative day, totaling 10 days of administration at a dose of 100 mg/kg/day. On the 4th day of the study, the rats were submitted to a surgical procedure consisting of a 2-cm incision of the skin of the animals' heads and suturing with single stitches. After a determined period, the rats were killed and submitted to the collection of material for study by the picrosirius red technique for the evaluation of collagen types I and III, the degree of hematoxylin and eosin healing, and the rate of contraction of the wound on subsequent days. The results were described in averages, medians, minimum and maximum values, and standard deviations. For the comparison of the three groups, the analysis of variance with one factor (one-way ANOVA) or Kruskal-Wallis non-parametric test was used. The normality of the variables was evaluated by the Shapiro-Wilk test. Values of p < 0.05 indicated statistical significance. The data were analyzed using the IBM SPSS Statistics for Windows, v.20.0. software. (IBM Corp., Armonk, NY, USA). Results The amount of collagen type III was higher in the groups that received vitamin C, however, without significant difference (n = 0.292). In relation to the rate of contraction of the surgical wound, it was higher in the groups treated with vitamin C, with a significant difference between groups I and II (p = 0.001), and between groups I and III (p < 0.001). No significant difference was found between the groups that were treated with vitamin C (p = 0.227). Conclusion Healing was more effective in the groups treated with vitamin C than in the group that did not receive vitamin supplementation. There was no significant difference in healing between the groups receiving oral or subcutaneous vitamin C.

Effectiveness of adjunct therapy for the treatment of apical periodontitis: A systematic review and meta-analysis.

Adjunct therapy refers to any intracanal procedure going beyond chemomechanical preparation with instruments and traditionally delivered irrigants (excluding interim dressings). It is not clear whether and which of these adjunct therapies have a significant impact on the outcome of root canal treatment [healing of apical periodontitis (AP) and other patient-related outcomes]. This systematic review aimed to analyse available evidence on the effectiveness of adjunct therapy for the treatment of AP in permanent teeth, according to a population, intervention, comparison, outcome, time and study design framework formulated a priori by the European Society of Endodontology. Five electronic databases (PubMed, Embase, Scopus, Cochrane and Web of Science) were searched up to October 2021 to identify clinical studies comparing adjunct therapy to no adjunct therapy in adult patients with AP. Animal studies, reviews, studies with less than 10 patients per arm and studies with a follow-up time of less than 1year, or less than 7 days for postoperative pain, were excluded. The quality of the included studies was appraised by the appropriate tools [Risk of Bias 2 (RoB2) for randomized clinical trials (RCTs) and Newcastle-Ottawa Scale for observational studies]. Meta-analysis was performed using a random-effects model. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Fourteen studies (13 RCTs and one retrospective cohort) fulfilled the inclusion criteria for this review. They evaluated different types of adjunct therapy: antimicrobial photodynamic therapy (aPDT; three studies), diode laser canal irradiation (3), Nd:YAG laser canal irradiation (2), Er;Cr:YSGG laser canal irradiation (1), ozone therapy (2) and ultrasonically activated irrigation (UAI) (4). Radiographical healing was reported in seven studies, but meta-analysis was only possible for UAI (two studies), showing no statistically significant difference in healing after 12 months. Pain after 7 days was reported in seven studies. Meta-analysis on three studies that used aPDT and on two studies using diode laser irradiation showed no significant difference in the prevalence of pain after 7 days between the control and adjunct therapy. According to RoB2 tool, six studies had a high risk of bias, five studies had some concerns, and two studies low risk of bias. The GRADE assessment revealed a very low strength of evidence for diode laser, and low strength of evidence for PDT, ozone and UAI studies. The included studies displayed significant heterogeneity in terms of type of adjunct therapy, technical details per adjunct therapy, outcome reporting and several combinations of these, limiting the potential for meta-analysis. There is insufficient evidence to recommend any adjunctive therapy for the treatment of apical periodontitis. Prospero CRD42021261869.

Comparison of post-operative outcomes after open or closed surgical techniques to stabilize metacarpal and metatarsal fractures in dogs and cats

BackfroundTreatment options for metacarpal/metatarsal fractures include conservative and surgical management. The aim of this study is to determine whether there is any significant difference in healing and complication rates, between open and closed treatment. Medical records of dogs and cats with metacarpal/metatarsal fractures with complete follow-up were retrospectively reviewed. Patients were allocated in two groups: open or closed stabilization. Minor and major complications were recorded and compared. Fracture healing was classified as good, delayed and non-union, and it was statistically compared.ResultsSixty-three patients (35 dogs and 28 cats) were included. Thirty-one were treated with an open approach and 32 by a closed stabilization. Regarding fracture healing a significantly higher proportion of delayed healing/non-union was found in the closed group (12/32 vs 2/31). Regarding postoperative complications, a significantly higher number of animals in the open group did not develop any complications (12/31 vs 3/32). A significantly higher proportion of minor complications were reported in the closed group (27/32 vs 12/31). However, a higher number of major complications was reported in the open group (7/31 vs 2/32) although this was not statistically significant. Fracture malalignment was significantly more prevalent in patients undergoing closed stabilization (11/32 vs 2/31).ConclusionAccording to the results, better healing, fracture alignment and a lower complication rate are found when fractures are stabilised with an open technique. However, other factors such as configuration of the fracture, soft tissue involvement, patient´s character and client´s situation would also need to be taken into account in the decision of stabilization technique.

Lipid emulsions prevent postoperative abdominal adhesions

IntroductionAdhesions are the most common cause of long-term morbidity after abdominal surgery and most often cause various forms of intestinal passage disorders ranging from partial obstruction to complete, life-threatening intestinal obstruction. The aim of the present study was to evaluate the protective effect of intraperitoneally administered lipid emulsions on the formation of adhesions in larger animal model, as the lubricating effect of phospholipids and the mechanical barrier of the lipid component are combined with the anti-inflammatory effect of fish oil. MethodsThirty-one female domestic pigs were randomly divided into three groups. At the end of the surgical procedure, a lipid emulsion or saline solution was applied intraperitoneally. After 14 days, an independent macroscopic, histological and immunohistochemical evaluation of the adhesions were performed. ResultsIntraperitoneal administration of lipid emulsions significantly reduced the incidence of intra-abdominal adhesions. Microscopic examination demonstrated a significant reduction in the number of inflammatory elements and the amount of collagen in the adhesions, especially after administration of the fish oil-based emulsion. A simultaneous decrease in neovascularization was observed in the adhesions. Evaluation of the intestinal anastomosis did not reveal significant differences in healing between the groups. ConclusionIntraperitoneal administration of lipid emulsions can reduce the development of postoperative intra-abdominal adhesions by the combined action of phospholipids as important lubricants and lipids as a mechanical barrier. Their effect is caused by a reduction in proinflammatory and profibrotic mediators. At the same time, intraperitoneal administration of lipid emulsions does not impair healing of the anastomosis in larger animal model.

Triamcinolone-impregnated bioabsorbable middle meatus packing following endoscopic sinus surgery: A prospective randomized controlled trial.

Topical steroids are a mainstay in the treatment of chronic rhinosinusitis (CRS). Multiple delivery methods of topical steroids following sinus surgery have been investigated. The purpose of this trial is to evaluate the effect of triamcinolone-impregnated absorbable nasal packing on healing following endoscopic sinus surgery (ESS). This is a prospective, randomized, double-blind, placebo-controlled trial. A total of 22 subjects (14 without polyps and eight with polyps) were enrolled and were randomized to receive triamcinolone-impregnated packing in one sinus cavity and normal saline-soaked packing in the contralateral sinus cavity. Endoscopic evaluation was completed at the first two postoperative visits, and Lund-Kennedy (LK) endoscopic scores and perioperative sinus endoscopy (POSE) scores were calculated at each visit. The results of this study found no significant difference in the appearance of the sinuses at either postoperative visit. Mean LK scores for the triamcinolone and saline groups at the first and second postoperative visits were 2.09±1.23 versus 2.18±1.01 (p=0.79) and 1.79±1.08 versus 1.68±1.16 (p=0.77), respectively. POSE scores were 2.59±1.71 versus 2.68±1.62 (p=0.86) and 1.74±1.15 versus 1.95±1.22 (p=0.59). The results of this study demonstrated no significant difference in healing, crusting, polyps, edema, or secretions between the triamcinolone-treated and non-triamcinolone-treated sinuses. There were no adverse effects from the use of triamcinolone-impregnated absorbable packing. Further studies will be necessary to determine the impact of triamcinolone-impregnated absorbable packing following ESS.

Evaluation of amniotic membrane in the healing of apicomarginal defects using 2D and 3D imaging modalities: a randomized controlled trial.

The study aimed to evaluate healing in apicomarginal defects with amniotic membrane (AM) using 2D periapical radiography and 3D cone beam computed tomography imaging. Thirty-four patients with symptomatic apical periodontitis and apicomarginal communication were allocated to either the AM or control group. Clinical and radiographic assessment was performed at baseline and at 12 months using Molven criteria, modified Penn 3D criteria, and RAC and B indices at resected plane, apical area, cortical plate, and combined apicocortical area, respectively. There was no significant difference in the healing outcome in 2D imaging (93.3% control and 86.7% AM) and 3D imaging (80.0% control and 53.3% AM) between the groups. With RAC scoring, a greater percentage of unhealed cases was observed in cortical plate. Radiographic buccal bone formation in the 3D imaging was evident only in six cases. However, both the groups depicted significantly greater percentage reduction in the size of the lesion in 2D than the 3D analysis (AM group 91.69 ± 15.99 2D, 76.06 ± 47.62 3D, P = .020) and (control group 92.06 ± 14.36 2D, 85.12 ± 18.55 3D, P = .005). No significant difference in healing was observed between the AM and the control groups with the use of both periapical radiography and CBCT imaging. Despite good clinical healing and radiographic apical bone fill, buccal bone formation was not evident in 3D imaging in most of the cases.

Efficacy of Low Level Laser Therapy in Reducing Pain, Swelling and Trismus Following Impacted Third Molar Extraction Surgery: A Split-mouth Randomised Controlled Trial

Introduction: The use of local or systemic corticosteroids and non steroidal anti-inflammatory drugs are often recommended after surgical extraction of impacted lower third molars to abolish postoperative pain, but some of them may manifest adverse effects such as gastrointestinal irritation, systemic bleeding tendency, and allergic reactions. Aim: To evaluate the efficacy of low level laser therapy in reducing pain, swelling, and trismus following impacted third molar extraction surgery. Materials and Methods: The present split-mouth randomized controlled clinical trial was carried out in the Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Mangalore, Karnataka, India. The study sample consisted of nine clinically and radiologically confirmed cases of bilateral symmetrical impacted mandibular third molars indicated for extraction. After extraction surgery, low level laser therapy was administered intraorally and extraorally (Low Level Laser Group). On the contralateral side (Non laser Group), extraction was carried out 15 days prior in the same manner except that patient was not subjected to laser therapy. Trismus, pain, swelling and healing were evaluated on 2nd, 3rd, 4th and 7th day; and were subjected to statistical analysis using Independent-t-Test and Mann-Whitney Test. Results: The study consisted of nine patients, among which six were males and three were females with mean age of 25.89±6.79 years. Pain intensity was lower in the laser group than in the non laser group at all-time points assessed and was non significant (p-value >0.05). Swelling when assessed was less for laser group than non laser group at all-time points and were statistically significant (p-value <0.05) except on the 7th day. The extent of mouth opening was greater in the laser group than in the non laser group at all-time points which was statistically significant only on 2nd day (p-value=0.048). Both laser and non laser group had no statistically significant difference in healing (p-value >0.05). Conclusion: The use of therapeutic laser in the postoperative management of patients undergoing surgical removal of impacted third molars decreases postoperative pain, swelling, and trismus.

Evaluating the Effect of Omega-3–rich Fish Skin in the Treatment of Chronic, Nonresponsive Diabetic Foot Ulcers: Penultimate Analysis of a Multicenter, Prospective, Randomized Controlled Trial

This is the second of 3 planned articles reporting on a prospective, multicenter, randomized controlled trial assessing the efficacy of fish skin graft in the management of diabetic foot ulcers in comparison with the standard of care (collagen alginate dressing). The primary end point of this prospective randomized trial is the number of closed wounds at 12 weeks. As of the time of this writing, 94 patients had completed the protocol. At 12-week follow-up, healing was achieved in 63.0% of index ulcers (29 of 46 patients) in the acellular fish skin graft group compared with 31.3% in the control group (15 of 48 patients) (P =.0036). In both groups, the mean time to healing was 7 weeks. The median number of applications of the fish skin graft to achieve healing was 6. A clinically and statistically significant difference in healing was observed between patients treated with acellular fish skin graft and those treated with a collagen alginate dressing. The data support the completion of this prospective randomized trial.

Evaluation of LL-37 in healing of hard-to-heal venous leg ulcers: A multicentric prospective randomized placebo-controlled clinical trial.

Many patients with venous leg ulcers do not reach complete healing with compression treatment alone, which is current standard care. This clinical trial HEAL LL‐37 was a phase IIb double‐blind, randomized, placebo‐controlled study, with the aim to evaluate the efficacy and safety of a new drug LL‐37 for topical administration, in combination with compression therapy, in 148 patients suffering from hard‐to‐heal venous leg ulcers. The study had three arms, consisting of two groups treated with LL‐37 at concentrations of 0.5 or 1.6 mg/mL, and a placebo cohort. Patients had a mean age of 67.6 years, a median ulcer duration of 20.3 months, and a mean wound size at the time of randomization of 11.6 cm2. Efficacy analysis performed on the full study population did not identify any significant improvement in healing in patients treated with LL‐37 as compared with the placebo. In contrast, a post hoc analysis revealed statistically significant improvement with LL‐37 treatment in several interrelated healing parameters in the subgroup of patients with large target wounds (a wound area of at least 10 cm2 at randomization), which is a known negative prognostic factor for healing. The study drug was well tolerated and safe in both dose strengths. In summary, this clinical trial did not detect any significant differences in healing of venous lower leg ulcers in the entire study cohort comparing patients treated with LL‐37 versus placebo. A subgroup analysis provided an interesting observation that LL‐37 could offer a treatment benefit in patients with large ulcers, exigently warranting a further study adequately powered to statistically assess the treatment outcome in this patient group.

A systematic review and meta-analysis of the efficacy of topical sphincterotomy treatments for anal fissure.

Anal fissure is a common condition that can be treated medically or surgically. Chemical sphincterotomy is often used before surgical intervention. This study aims to evaluate the effectiveness of topical agents for chemical sphincterotomy on healing of anal fissures and side-effects. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant systematic review was performed using MEDLINE, EMBASE, Scopus, and CENTRAL databases. Eligible studies included randomized controlled trials which compared topical sphincterotomy agents with topical placebo agents or each other. Studies that included surgical treatments were excluded. Overall evidence was synthesized according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Thirty-seven studies met the study selection criteria. Seventeen studies show that glyceryl trinitrate (GTN) was significantly more likely to heal anal fissure than placebo (relative risk (RR) = 1.96, 95% confidence interval (95%CI) = 1.35-2.84, I2 = 80%). Eleven studies showed a marginally significant difference between healing rates for diltiazem vs GTN, RR = 1.16, (1.01-1.33) I2 = 48%. There was no significant difference in healing between diltiazem and placebo, RR = 1.65, (0.64-4.23), I2 = 92%. GTN significantly reduced pain on the visual analog scale compared to the placebo group, MD-0.97 (-1.64 to -0.29) I2 = 92%. There was high certainty of evidence that GTN was significantly more likely to cause headache than placebo (RR = 2.73 (1.82-4.10) I2 = 58%) and diltiazem RR = 6.88 (2.19-21.63) I2 = 17%. There is low certainty evidence topical nitrates are an effective treatment for anal fissure healing and pain reduction compared to placebo. Despite widespread use of topical diltiazem, more evidence is required to establish the effectiveness of calcium channel blockers compared to placebo.

Effects of Buprenorphine, Chlorhexidine, and Low-level Laser Therapy on Wound Healing in Mice.

Systemic buprenorphine and topical antiseptics such as chlorhexidine are frequently used in research animals to aid in pain control and to reduce infection, respectively. These therapeutics are controversial, especially when used in wound healing studies, due to conflicting data suggesting that they delay wound healing. Low-level laser therapy (LLLT) has been used to aid in wound healing without exerting the systemic effects of therapies such as buprenorphine. We conducted 2 studies to investigate the effects of these common treatment modalities on the rate of wound healing in mice. The first study used models of punch biopsy and dermal abrasion to assess whether buprenorphine HCl or 0.12% chlorhexidine delayed wound healing. The second study investigated the effects of sustained-released buprenorphine, 0.05% chlorhexidine, and LLLT on excisional wound healing. The rate of wound healing was assessed by obtaining photographs on days 0, 2, 4, 7, and 9 for the punch biopsy model in study 1, days 0, 1, 2, 4, 6, 8, 11, and 13 for the dermal abrasion model in study 1, and days 0, 3, 6, and 10 for the mice in study 2. Image J software was used to analyze the photographed wounds to determine the wound area. When comparing the wound area on the above days to the original wound area, no significant differences in healing were observed for any of the treatment groups at any time period for either study. Given the results of these studies, we believe that systemic buprenorphine, topical chlorhexidine, and LLLT can be used without impairing or delaying wound healing in mice.

Comparative Study Between the effect of Skeletonized and Pedicled Internal Thoracic Artery on sternum healing in Patient Undergoing CABG

Background: Myocardial revascularization is performed preferentially with internal thoracic artery grafts. This study aimed to investigate sternal healing over time and the incidence of poor sternal healing and wound infection in patients undergoing coronary artery bypass graft (CABG) surgery using skeletonized internal thoracic artery. Objectives: (1) comparison of two surgical take-down techniques (skeletonizing vs. standard pedicle harvestation); (2) assessment of sternal healing and wound infection. Method: This study enrolled 50 patients (divided in two groups) who underwent isolated CABG using skeletonized internal thoracic artery (25 patients) and pedicled internal thoracic artery (25 patients) from December 2017 to August 2019. Postoperative assessment was performed on all patients for three months after surgery. In all patients, chest X-ray study was performed after surgery to assess sternal healing. Medical records were also retrospectively reviewed to identify perioperative variables associated with poor early sternal healing. Results: (1) After coronary grafting, assessment of sternum showed significant differences in healing between the two groups. (2) Diabetes mellitus as an independent predictor for superficial wound infection. (3) Pedicled procedure is an important factor associated with superficial wound infection in post-operative period. (4) Skeletonized procedure prolong the operation. (5) Pedicled procedure prolong the ICU and hospital stay.Conclusion: (1) Skeletonization of internal thoracic artery conduits lowers the risk of superficial and deep sternal wound infection in patients undergoing CABG with internal thoracic artery grafting. (2) Skeletonization of internal thoracic artery conduits prolong the operation time and require more surgical skills. (3) Skeletonization of ITA has better outcome.

A retrospective comparison on surgical management of varicose veins with and without venous stripping

Varicose veins, one of the oldest known diseases of mankind were treated by various modalities starting from simple phlebotomy to minimally invasive approaches. Aim and Objectives: In this study the outcome of two surgical treatment modalities of varicose surgery with and without venous stripping was compared based upon a follow up period of two months. Materials and Methods: Among the 92 patients operated for varicose veins between September 2018 to November 2019 in all surgical units of Trichy SRM Medical College Hospital, S50 patients of age group 16 – 70 yrs were taken up for the study after matching. Results: In this study males contribute the maximum bulk of about 82%. As for as the age is considered, patients aged between 40 – 70 yrs was more, which was about 58%. The hematoma formation after venous stripping was 28% whereas it was only 4% in the other group. There was no significant difference in healing of leg wounds in both the studies The first postoperative comfortable ambulation with minimal pain was possible in more patients who did not undergo venous stripping (92%) than who underwent stripping (68%).Long postoperative stay of more than 6 days was found in 8% of those who underwent stripping and 4% of the other group. The long stay was mostly due to pain and delayed wound healing. Pain relief was seen in 96% of those who had venous stripping and 88 % of those who did not undergo venous stripping at the end of second month.Conclusion: This study on observation concludes there was no significant difference in healing of leg wounds, hospital stay and pain relief in both the studies, but the Trendelenburg procedure with incompetent perforators ligation without venous stripping appears to be better than Trendelenburg procedure with incompetent perforators ligation with venous stripping.

The effect of an intraorifice barrier and base under coronal restorations on the healing of apical periodontitis: a randomized controlled trial.

To evaluate the effect of intraorifice barriers and bases on the healing of apical periodontitis following root canal treatment in mandibular molars. A total of 120 permanent mandibular molars with necrotic pulps and periapical radiolucencies (PAI score≥3) were recruited. Root canal treatment was performed in all teeth using a standard protocol, following which they were randomly allocated to one of the three treatment groups: intraorifice barrier group: coronal 3-mm gutta-percha was removed and replaced with glass-ionomer cement (GIC) barrier. The floor of the pulp chamber was then sealed with 2-mm-thick GIC base followed by final composite resin restoration; base group: received 2-mm-thick GIC base before placement of composite resin restoration; and control group: had pulp chamber entirely filled with composite resin only. Follow-up was done at 3, 6, 9 and 12months. Combination of clinical and radiographic parameters were used to assess treatment outcome. The data were analysed using Kruskal-Wallis, chi-square and Wilcoxon signed-rank tests and logistic regression analysis. At the end of 12months, the base group had the most favourable healing (97.1%), whilst the control group had the least favourable healing (83.8%). The intraorifice barrier group had healing of 92.1%. However, there was no significant difference in healing between groups at the end of the follow-up period (P>0.05). Additional subgroup analysis revealed a nonsignificant effect of periodontal status and root filling level on periapical healing. The use of an additional barrier under permanent restorations did not significantly improve the outcome of primary root canal treatment in posterior teeth after 12months. However, its influence in the long term requires further evaluation.

Does postoperative alignment affect union in distal femoral fractures?

Background: Distal femoral shaft fractures can be hard to treat. Recently, a meta-analysis concluded that healing rates of distal femoral fractures are suboptimal, and further research is needed. The purpose of our study was to evaluate if postoperative alignment affected union rates of distal femoral fractures. Methods: Eighty-nine distal femoral fractures from the University of Louisville met inclusion and exclusion criteria. We used the Fracture and Dislocation Classification Compendium-2018 to classify fractures. Radiographs were evaluated for fracture location, alignment, and for healing. All statistical tests had a level of significance of 0.05. Statistical tests included a chi squared analysis, a t-test for two independent samples for proportions, and Fisher’s exact tests. Results: Chi squared analysis showed a statistically significant difference in healing of fractures with anatomic alignment versus those with nonanatomic alignment (χ2=18.241, P<0.001). The t-test of two independent samples for proportions showed that the 51% increase in healing of fractures with anatomic alignment was statistically significant (P<0.002, 95% CI 0.22, 0.80). Fisher’s exact test for specific fracture types also showed statistical significance (P<0.01). Conclusions: Proper anatomical alignment during surgical fixation of infraisthmal and supracondylar fractures is strongly associated with increased rates of fracture healing. Likewise, there is a strong association between nonanatomic alignment and nonunion. A prospective study examining the effect of alignment on union, regardless of fixation method, is reasonable and recommended.

Clinical and experimental Study to evaluate the effect of Biphasic calcium phosphate collagen composite (cpcc) on healing of bone defects after oral surgical procedures

Background: A recent discoveries used for reconstruction in maxillofacial surgery is the composite bone graft materials. The availability of collagen I matrix make our choice to use this material in surgery .It is biomaterials that its structure could be modified by simple techniques. Studies to find a new materials use for bone reconstruction is to overcome the disadvantages of autogenous bone and the synthetic resorbable bone substitutes.
 Objectives: This study was done to evaluate the effect of biphasic calcium phosphate collagen composite (ccpc) on healing of bone defects after oral surgical procedures.
 Type of the study: A cross sectional study.
 Method: It involved 60 patients, 35 male and 25 female, age (15-40) yearsand experimental animals study involved sixty rabbits.The study was done in Department of Maxillofacial surgery in Al anbarCollege of Dentistry (2015-2016).These patients were received tooth extraction, and other minor surgical procedures .Clinical and radiographical examination and patients consents are done before surgery. The surgery was done under local anesthesia.The resulting bone cavities are filled with composite bone graft material composed from combination of lyophilized hydrolysed collagen sponge (Hemospon),Brasil and Osteon II bone graft material,Korea .The area is closed with 3/0 block silk suture .Antibiotic cover (Ampicillin 500mg ×4) for 1 week was prescribed. The patients were followed up by careful clinical examination with radiograph 15-30 days after surgery. .Sixty New Zeleandi White rabbit were used in our study for histopathologicalexamination.Intraperitoneal injection of ketamine 10 mg with XYL-M2 solution 20 mg xylazine base used to anesthetize the animals. (5mm diameter) bone defects were made using straight surgical hand piece and bur in anterior mandibular region and filled with each material. The study design involve the following groups: group 1( involve 15 rabbit; the defect was made and filled with blood clot only (control group),group 2( involve 15 rabbit, the defect was made and filled with collagen sponge only),group 3(Involve 15 rabbit, the defect was made and filled with Osteon II bone graft only),group4( involve 15 rabbit, the defect was made and filled with Osteon II bone graft +collagen (Composite bone graft).The flap were closed 3/0 black silk suture. The rabbits were killed after 30 days. 10 cmexcisional biopsy specimen was taken from the paramandibular area and placed in 10%formalin then send histopathologicalexamination.
 Results: Clinically, the treated area show good healing with absence of infection .Radiographs during follow up period show radiopacity indicating new bone formation .The results of experimental animals (Rabbits) indicategrowth new bone . In group 1 and group2, the center of the defects was depressed by surrounding tissues Eung et al, While, in group 3&group 4, the graft materials maintained the space and the center of the defect did not depress. Statistical analysis indicates that during 4 th week ,the highest healing % is (100%) in group 3 &group4 in compared to control group (50%)..A significant difference in healing % was found among the treated groups.
 Conclusion:The result indicates that biphasic calcium phosphate collagen composite can be efficiently utilized clinically.

Invited commentary

As the quest for stem cell-based therapies to treat nonhealing wounds continues, less effort has examined local, cutaneous treatments that may improve autogenous stem cell function. This exciting translational work by Dr Velazquez and colleagues examines local wound therapy using topical estrogen to improve stem cell function in diabetic wounds. This study is particularly important in light of recent clinical trials in which autogenous stem cells have been only modestly successful in improving healing in diabetic patients. It is likely that local therapy that improves the function of these cells will be necessary to see a significant difference in healing in the population of diabetic patients. This group attempts to tackle a challenging problem related to the impairment of stem cells in diabetic populations and to augment cell function by topical estrogen. In short, this study used a standard cutaneous wound model in a murine model of diabetes and treated mice with either topical estrogen or placebo for 5 days. The wounds were then harvested, and endothelial progenitor cells (EPCs) were examined for viability and proliferation as well as recruitment to the tissue. Mesenchymal stem cells (MSCs), which are well studied for their role in tissue regeneration, were examined at later time points for their role in repair and collagen deposition. They found that the wounds treated with estrogen had higher vessel density and increased EPC recruitment and the MSC activity was enhanced, resulting in increased scar density and collagen deposition. Perhaps most important, wound healing was significantly improved in the mice receiving estrogen. This is very exciting as this work holds a high potential for easy translation to human patients. Additional work will need to be done to ensure that there is minimal toxicity related to estrogen therapy applied locally. It is well known that repair of injury is dependent on progression through distinct overlapping phases; however, the failure of these phases to occur in timely progressive fashion will promote disease. In addition to therapies designed to target the EPCs and MSCs, it is likely that optimal therapy for diabetic wounds will include the targeting of other immune cell populations known to play a critical role in the tissue repair process. It is unknown whether topical estrogen therapy alters other immune cell populations involved in tissue repair. Furthermore, the mechanisms regarding how estrogen therapy is improving EPC and MSC function will need to be elucidated. Despite its minor limitations, this exciting translational study by the Velazquez laboratory is critical for advancing our knowledge of diabetic wound repair. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. The effect of estrogen on diabetic wound healing is mediated through increasing the function of various bone marrow-derived progenitor cellsJournal of Vascular SurgeryVol. 68Issue 6PreviewEndothelial progenitor cells (EPCs) are the key cells of postnatal neovascularization, and mesenchymal stem cells (MSCs) possess pluripotent differentiation capacity and contribute to tissue regeneration and wound healing. Both EPCs and MSCs are critical to the wound repair process, which is hindered in diabetes mellitus. Diabetes has been shown to decrease the function of these progenitor cells, whereas estrogen has beneficial wound healing effects. However, the role of estrogen in modulating EPC and MSC biology in diabetes is unknown. Full-Text PDF Open Access

Comparative evaluation of the efficacy of topical amlexanox 5% oral paste and triamcinolone acetonide 0.1% oral paste in the treatment of Recurrent Aphthous Stomatitis (RAS)

Background: A double-blind randomized control trial was conducted to compare the clinical efficacy of topical triamcinolone acetonide 0.1% and amlexanox 5% in recurrent apthous stomatitis (minor). Materials and Methods: Forty adult patients were assessed for erythema, ulcer size, pain scores, and ulcer healing on three evaluation visits within 24 h of ulcer formation, third day, and fifth day. All participants were monitored for compliance with treatment protocols of four times daily application of calibrated quantity of medication. Results and Discussion: Ninety percent of controls when compared with 65% of the participants in the amlexanox group showed complete improvement of peri-ulcer erythema. Pain reduction was marked from the first to the fifth day (F = 15.249, P = 0.000). The control participants showed 90% reduction in pain in comparison to 70% in the amlexanox group. The mean ulcer size was shown to reduce from the first to fifth day in both groups (F = 18.611, P = 0.000). Completely healed ulcers were seen in 70% of the participants in the control group compared with 75% of the participants in the amlexanox group. Conclusion: The data suggest that the clinical efficacy of topical amlexanox 5% is comparable to topical 0.1% triamcinolone acetonide and may be considered a substitute except in pain control, which was marginally less for the treatment for recurrent apthous stomatitis (minor).

Effect of MTA particle size on periapical healing.

To examine the effect of reduction in MTA particle size on dento-alveolar and osseous healing in dogs. Root canals of 24 mandibular premolars in four 2-year-old beagles were prepared and filled with gutta-percha and sealer. Two to four weeks later, during periapical surgery, the root-end cavity preparations in these teeth were filled with either grey ProRoot MTA or modified (reduced particle sizes with faster setting time) MTA. The animals were sacrificed 4months later. Degrees of inflammation, type of inflammatory cells, fibrous connective tissue adjacent to the root-end filling materials, cementum formation over the resected roots and root-end filling materials and bone healing were examined. Data were analysed using the McNemar test. No significant differences in healing of periapical tissues were found when comparing ProRoot MTA to a modified MTA containing reduced particle sizes. Reducing the particle sizes of MTA did not impact its biological properties.