Today, mesenchymal stem cells (MSCs) are candidates for various autoimmune disease treatments due to immunomodulatory activity in these cells. Much research has recently been done to improve the immunomodulatory activity of MSCs. Genetic variation is one of these methods. microRNAs (miRNAs) are small noncoding RNAs that control most of the cell's biological activities. Recent studies have shown that miRNAs play a significant role in the regulation of MSC immunomodulatory activity. Pomegranate is a fruit that has antioxidant, anti-inflammatory, and anticancer properties and has been used for many years for therapeutic purposes. The objective of this research is to evaluate the immunoregulatory-related miRNAs level of adiposederived MSCs (Ad-MSCs) obtained from adipose tissue in the presence or lack of pomegranate (Punica granatum) extract (PGE). Our results showed that miRNA-23 and miRNA-126 were upregulated by PGE treatment in MSCs, and in contrast, miRNA-21 and miRNA-155 were downregulated by PGE treatment in MSCs. In addition this research shows that PGE can downregulate the expression of PI3K\AKT1\NF-jB in Ad-MSCs. Our bioinformatics data have shown that the target of these four miRNAs and the signaling pathways, in which these targets are involved, can play an important role in regulating the immunomodulation function of stem cells. In conclusion, PGE can inhibit the expression of PI3K\AKT1\NF-jB genes involved in inflammatory pathways via miRNA-23 and miRNA-126 overexpression or miRNA-21 and miRNA-155 downregulation that plays a role in the pathways of immune modulation in Ad-MSCs. These results may provide insight into the mechanism underlying the regulation of the immunomodulatory activity of Ad-MSCs by PGE.
Reconstructing scalp defects can be challenging for a plastic surgeon. For this purpose, different procedures such as primary repair and coverage with skin grafts or flaps can be considered. Sometimes, the external table of the skull can be removed completely to the diploic space. At the same time or after the formation of granulation tissue, the diploic space can be covered with split-thickness skin grafting.In this article, we have reported the reconstruction of a traumatic scalp defect in a one-year-old baby. There was a large defect in the left temporoparietal area of the scalp. The wound was debrided and irrigated with normal saline frequently. After the wound infection was controlled, instead of covering it with a flap or excising the external table of the skull and skin grafting, we managed this defect by the fenestration of the external table of the skull followed by the formation of the granulation tissue and coverage of the defect with split-thickness skin grafting. The post-op course was uneventful, and the wound was covered completely with the skin graft. We believe that this method of treatment in a child allows us to provide better coverage for the defect when the patient is older and after tissue expansion. We also showed that the punctate fenestration of the skull can provide a granulated tissue bed for skin grafting, as well as the excision of the external table of the skull.
Lipomas are the most common benign tumors of connective tissue which can be found in different parts of the human body. In rare cases, their size may be so giant which could be an indication for surgery. Here, we present a case of congenital multiple asymmetrical giant lipomas of the back in a young female. She presented with a chief complaint of physical discomfort due to the giant size and weight of the lipomas. Apart from that, she was in total health. She was born with 5 small lipomas in the back and flank region which had become giant lipomas with estimated weigh around 16 kg in total by the age of 24. The patient underwent seven operations to remove or debulk the mass over a 24-year period since the recurrence of the growths was inevitable. Considering the size of the mass and differential diagnosis, such as liposarcoma, and since no risk factor or underlying etiology was detected for the patient`s condition, surgical excision was the preferred technique for this case.
Achieving adequate coverage of soft tissue defects located on the lower third of the legs and feet is challenging for reconstructive surgeons. Fasciocutaneous flaps can be used to meet this challenge. Two common fasciocutaneous flaps used in this context are the reverse sural flap and lateral supramalleolar flap (LSMF). Plastic and reconstructive surgeons are relatively unfamiliar with the second flap. In this article, we introduce a patient with an extensive soft-tissue defect on the dorsum and lateral side of her foot and ankle.
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