Incidental cutaneous microcystic/reticular schwannoma in pilonidal sinus

Schwannoma, a non-malign peripheral nerve sheath tumor, develops slowly and is usually clinically inapparent. It usually arises after the fourth decade of life in the subcutaneous tissue of the extremities and in the head and neck region of patients, with no gender bias. Microcystic/reticular schwannoma (MRS) is a rare histological form of schwannoma, first described in 2008 by Liegl et al. (1) MRS is a recent addition to this group of tumors, which shows predilection for visceral organs, without Antoni A and Antoni B areas or Verocay bodies (2,3). Cutaneous presentation of MRS is very unusual neoplasm which seven cases reported in the sources until to date (4). Here we report a case of incidental cutaneous MRS in a pilonidal sinus material

Endovascular treatment of femoro-popliteal artery stenosis/obstruction using a repositionable self-expanding nitinol stent: a preliminary study

Introduction. The aim of this study was to report our preliminary results regarding the use of the repositionable self-expanding nitinol stent in a cohort of patients with femoro-popliteal artery occlusion/stenosis. Material and methods. The study groups consisted a total of 8 patients (10 extremities) between 47 and 70 years of age who presented with typical symptoms of intermittent claudication and/or critical limb ischaemia (Fontaine stage II–IV) and underwent primary elective superficial femoral artery percutaneous transluminal angioplasty and/or stenting using a Jaguar repositionable self-expanding nitinol stent in the dates of 2013–2015. Information for patency at 6th month after the stenting procedure was obtained. Results. The mean operation time was 38.56 ± 26.40 minutes. No patients had procedure-related stent fracture, distal thromboembolism, haematoma, femoral pseudoaneurysm or stent occlusion. At 6-month follow-up, at least one categorical improvement was observed in 7 patients (87.5% of intent-to-treat population). Conclusions. The Jaguar self-expanding nitinol stent has several technical advantages, and its use was associated with a low risk of complications. Further study is warranted to establish its superiority in providing good long-term patency

An expert system based material selection approach to manufacturing

Selection of proper materials for a diverse mechanism is one of the hardest tasks in the design and product improvements in various industrial applications. Materials play a vital and important function during the entire design and manufacturing process. The wrong selection of materials often leads to huge prices and ultimately results in product breakdown. Hence, the designers need to identify and select suitable materials with specific functionalities in order to attain the preferred output with the minimum cost concern and specific applicability. This paper tries to solve the materials selection problem by means of an expert system approach to manufacturing. According to this method either four or five different properties are inspected for each automotive part such as impact resistance, lightness, formability, corrosion resistance and low prices for bumpers; strength, formability, vibration absorption and low cost for flywheels; and strength, formability, corrosion resistance, biocompatibility and a small price for implants. Then, these were made more efficient using the expert system approach. Due to performing most of the above mentioned properties, polymeric materials {such as PP (polypropylene), HDPE (high density polyethylene) and PMMA (polymethyl methacrylate)} are selected for the bumpers; GFRPs (glass fiber reinforced plastics) and CFRPs (carbon fiber reinforced plastics) composites for high speed running, and cast iron and steel for low speeds for the flywheels; and finally stainless steel and polymeric materials {such as PVC (polyvinyl chloride) and PE (polyethylene)} were found to be the best materials for automotive parts. The selected materials were almost identical to those obtained by previous authors. (C) 2012 Elsevier Ltd. All rights reserved

Effect of methylprednisolone loaded poly lactic-co-glycolic acid (PLGA) bioabsorbable nanofibers on tendon healing and adhesion formation

Background: Nanomaterials have been widely used in many fields such as vaccination and drug delivery. Beside its behavior as a degradable physical barrier, it can provide a controlled drug release. Tendon healing is a process full of complications, one of which is adhesion caused by excessive fibrosis. Aim: In this study, we aimed to prevent adhesion formation by using methylprednisolone (MP) loaded Poly lactic-co-glycolic acid (PLGA) mats. We used PLGA mats as both, biodegradable physical barrier to reduce the contact between surrounding tissues and healing tendon and as a drug delivery vehicle to release the antifibrotic MP with a controlled pattern. Methods: MP-loaded PLGA nanofiber mats were produced using electrospinning technique under optimized parameters. To find the optimal MP dose, the drug was loaded in 15%, 25% and 35% concentrations. In vitro analysis included FT-IR, antibacterial, water absorption, biodegradability and drug release behavior tests. 70 rats' tendons were used for this study. After scarification of the rats, tendons were analyzed in terms of macroscopic, histopathological and biomechanical evaluation. Results: The neat PLGA and 15%, 25%, and 35% MP-loaded nanofibers lost 47%, 83%, 88%, and 97% of their initial weights at the end of the 8 weeks' degradation process. Within the first 24 h, mats including higher drug concentrations showed more initial release burst effect than samples loaded with lower concentrations. Cumulative drug release at 24 h was 29.5%, 27.6%, and 24.7% for PLGA nanofiber samples containing 15%, 25%, 35% MP, respectively. Macroscopically, When the groups were compared, no statistically significant difference was found between group 1 (no surgical intervention) and group 5 (25% MP/PLGA) in terms of length, characteristics and degree of the adhesion. Comparing to other groups statistically significant atrophic effect was found in group 6 (35% MP/PLGA). Conclusion: 25% MP-loaded PLGA reduces the formation of adhesions macroscopically comparable to tendons that didn't receive any surgical intervention. Microscopically, it provides better tendon healing compared to tendons that received only surgical repair or surgery + neat PLGA. Methylprednisolone did not only add an antibacterial effect to PLGA but also increased the hydrophilic property and degradation rate of PLGA. Increased steroid concentration also leads to atrophy at the healing tendons which can be prevented by modifying the PLGA design

Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients

Abstract INTRODUCTION: Elevated hemoglobin A1c levels in patients with diabetes mellitus have been known as a risk factor for acute kidney injury after coronary artery bypass grafting. However, the relationship between hemoglobin A1c levels in non-diabetics and acute kidney injury is under debate. We aimed to investigate the association of preoperative hemoglobin A1c levels with acute kidney injury in non-diabetic patients undergoing isolated coronary artery bypass grafting. METHODS: 202 non-diabetic patients with normal renal function (serum creatinine <1.4 mg/dl) who underwent isolated coronary bypass were analyzed. Hemoglobin A1c level was measured at the baseline examination. Patients were separated into two groups according to preoperative Hemoglobin A1c level. Group 1 consisted of patients with preoperative HbA1c levels of < 5.6% and Group 2 consisted of patients with preoperative HbA1c levels of ≥ 5.6%. Acute kidney injury diagnosis was made by comparing baseline and postoperative serum creatinine to determine the presence of predefined significant change based on the Kidney Disease Improving Global Outcomes (KDIGO) definition. RESULTS: Acute kidney injury occurred in 19 (10.5%) patients after surgery. The incidence of acute kidney injury was 3.6% in Group 1 and 16.7% in Group 2. Elevated baseline hemoglobin A1c level was found to be associated with acute kidney injury (P=0.0001). None of the patients became hemodialysis dependent. The cut off value for acute kidney injury in our group of patients was 5.75%. CONCLUSION: Our findings suggest that, in non-diabetics, elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. Prospective randomized studies in larger groups are needed to confirm these results

Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients

<div><p>Abstract INTRODUCTION: Elevated hemoglobin A1c levels in patients with diabetes mellitus have been known as a risk factor for acute kidney injury after coronary artery bypass grafting. However, the relationship between hemoglobin A1c levels in non-diabetics and acute kidney injury is under debate. We aimed to investigate the association of preoperative hemoglobin A1c levels with acute kidney injury in non-diabetic patients undergoing isolated coronary artery bypass grafting. METHODS: 202 non-diabetic patients with normal renal function (serum creatinine <1.4 mg/dl) who underwent isolated coronary bypass were analyzed. Hemoglobin A1c level was measured at the baseline examination. Patients were separated into two groups according to preoperative Hemoglobin A1c level. Group 1 consisted of patients with preoperative HbA1c levels of < 5.6% and Group 2 consisted of patients with preoperative HbA1c levels of ≥ 5.6%. Acute kidney injury diagnosis was made by comparing baseline and postoperative serum creatinine to determine the presence of predefined significant change based on the Kidney Disease Improving Global Outcomes (KDIGO) definition. RESULTS: Acute kidney injury occurred in 19 (10.5%) patients after surgery. The incidence of acute kidney injury was 3.6% in Group 1 and 16.7% in Group 2. Elevated baseline hemoglobin A1c level was found to be associated with acute kidney injury (P=0.0001). None of the patients became hemodialysis dependent. The cut off value for acute kidney injury in our group of patients was 5.75%. CONCLUSION: Our findings suggest that, in non-diabetics, elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. Prospective randomized studies in larger groups are needed to confirm these results.</p></div