Bone marrow mesenchymal stem cells (MSCs) are considered a potential cell source for stem cell-based bone tissue engineering. However, noticeable limitations of insufficient supply and reduction of differentiation potential impact the feasibility of their clinical application. This study investigated the in vitro function of steroids and gender differences on the proliferation and differentiation of rat MSCs. Bone marrow MSCs of age-matched rats were exposed to proliferation and osteogenic differentiation media supplements with various concentrations of 17β-estradiol (E2) and dexamethasone. Cell proliferation was measured by MTS assay; osteogenic markers and steroid-associated growth factors and receptors were evaluated by ELISA and real-time PCR. The results revealed that supplements of E2 and dexamethasone increase MSC proliferation in a biphasic manner. The optimal dose and interaction of steroids required to improve MSC proliferation effectively varied depending on the gender of donors. Supplementation of E2 effectively improves osteogenic differentiation markers including ALP, osteocalcin and calcium levels for MSCs isolated from both male and female donors. The mRNA of TGF-β1 and BMP-7 are also up-regulated. However, effective doses to maximally improve osteogenic potentials and growth factors for MSCs are different between male and female donors. The relationship between steroid receptors, osteogenic markers and cytokines are also varied by genders. The outcomes of the present study strongly indicate that steroids potentially function as an effective modulator to improve the capacity of MSCs in bone regeneration. It provides crucial information for improving and optimizing MSCs for future clinical application of bone regeneration.
Trigger fingers can be treated by open or percutaneous division of the A1 pulley. The open approach allows for visualization of the pulley, the tendon, and the adjacent neurovascular bundles. The percutaneous trigger finger release (PTFR) lacks an incision and is thought to lead to a quicker recovery, but the safety and efficacy of this blind procedure are often questioned. Ultrasound imaging has recently been introduced as an adjunct for guiding the needle during percutaneous trigger finger release. This study was designed to evaluate the safety and efficacy of needle trigger finger release with added ultrasound imaging. Eighteen fresh cadaver A1 pulleys were divided percutaneously and then evaluated by converting to an open technique and examining the pulleys, the tendons, and the neurovascular bundles. This study's ultrasound images demonstrated repeated puncture of the tendon sheath and of the neurovascular bundle during PTFR. The subsequent dissection revealed three out of 18 tendons with visible lacerations and 15 out of 18 A1 pulleys with incomplete division. We concluded that ultrasound-guided PTFR can be complicated by flexor tendon lacerations, potential injury to neurovascular bundles, and incomplete division of the A1 pulleys. While the clinical significance of these findings is unclear to us, it does raise questions regarding the safety and efficacy of percutaneous trigger finger release, even when adding ultrasound guidance.
Neck deformities remain a cause of significant morbidity in children who sustain burns. Reconstructive efforts must be directed not only at restoring satisfactory head position, flexion/extension, and rotation but also at satisfying the cosmetic and functional needs of the individual patient. We present the management of these complex patients, from the acute management of neck burns to the various reconstructive options available.
Laptop computers are an uncommon source of burns to the thighs and perineum. Burns can result from the prolonged contact of hot surfaces at the base of the computer with the user's lap. The authors report a case of second-degree burns to the thigh of an otherwise healthy patient that resulted from prolonged use of the laptop. We measured the temperatures of the patient's computer and the temperatures of other popular laptop computers. Laptops can develop temperatures that can pose a risk for burns if the skin is exposed for prolonged periods of time. Patients with impaired lower extremity sensation, altered consciousness, or decreased mobility are at higher risk for laptop burns. To their knowledge, this is the first case report of such a burn injury in the American literature.
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