Scar deformation, contractures and tissue defects

Among three main forms of burn consequences (scar deformation, contractures and tissue defects), most often the are formed, causing disability. These contractures should be treated surgically.

More than 80% of scar contractures can be treated with local new (trapezoid) flaps.

Existing local-flap methods are based on classic triangular local or other forms of the flaps (Z-, V-Y plasty and multiple modifications and combinations). These methods, however, are not anatomically substantiated and ineffective due to insufficient research of contractures anatomy, contracture cause, and no existent anatomical classification

Vast personal experience showed that the results of these methods yield results that are far from perfect as contractures are released incompletely, and often re-contracture appears and re-operation is needed.

Anatomical studies determined main principles and characteristics of post burn scar contractures on which the diagnoses must be constructed and the choice and development of new reconstructive techniques should be based:

Big joint surfaces are divided into extensionand flexion; the flexion surface is divided into two joint flexion lateral surfaces, and medial or joint fossa. Depending on scars location, three types of scars contractures are formed: edge, medial, and total.
Scars covering flexion lateral one or both surface, neck posterior, scars of dorsal hand cause edgecontracture; scars located on flexion medial surface (big joint fossa), anterior neck, contractures of fingers, trunk and perineum cause medial contractures; scars involving entire flexion surface cause total contractures.
Every contracture type has specific anatomic features and clinical signs regardless of location and severity and can be easily diagnosed.
Scars causing contractures grow distally and form a fold the sheets of which are a new anatomic structure that has a surplus of scars and healthy skin, allowing edge and medial contractures’ elimination with local flaps.Scars’ contraction causes scar’s surface deficit which causes the contracture. Scar surface deficit is located on joint flexion surface, lateral or medial, causing edge or medial contracture, corresponding.
Contracted scars have a specific form of scar surface deficit. After contracted scars’ dissection the appeared wound accepts, as a rule, a trapezoid form regardless of contracture location (joints, commissures, other region of body).
For adequate contracture release, the wound or scar surface deficit should be covered with a trapeze-shaped flap. Consequently, all existing local flaps of other than trapeze form are not anatomically substantiated.
Donor sites for trapezoid flaps (edge and medial contractures) are local tissues having surface surplus.
Vast personal experience showed, that the use of trapeze-flap plasty solved the problem of elimination of edge and medial contractures (more than 80% of the total number) fully and definitively.
Besides contractures’ exploration and elimination, new flaps and methods were developed:

– split ascending neck flap which is axial and its basement developed techniques for face and neck resurfacing of different form and location;

– scar-fascial neck trapezoid flap for total cervical contracture elimination;

– method of restoration of the form, location and skin of breast damaged by burns;

– method of tendons plasty for restoration function of fingers in case of boutonniere deformity after burns;

– proximally based sural adipose-cutaneous flap and method of treatment of ulcerous tissue defects in zone of Achilles tendon and posterior heel regions;

– new method or principle of severe adduction joint and commissural contractures treatment with combined (suspending flap and skin transplant) technique.

All presented flaps and surgical techniques are original, effective, and their use significantly improved the level of rehabilitation of burned patients

Posted by: Hanna Grishkevich, Vishnevsky Institute of Surgery, Russia

Hydatid cyst of the brain: Typical MRI findings

     Hydatid cyst ((HC) of the brain results from arterial embolism secondary to ingestion of multiple larvae . Intracranial hypertension and motor weakness due to increased intracranial pressure are the most common clinical manifestations. Most commonly, cerebral HC are single lesions and locate anywhere within the brain, but are especially located in the middle cerebral artery territory. The parietal lobe is the most frequently involved region. HC of the brain are usually single, spherical, unilocular, and may be large ; in rare instances, they can be multiple and embolic. Both CT and MRI demonstrate a spherical and well-defined, smooth, thin walled, homogeneous cystic lesion with fluid density similar to the cerebrospinal fluid, with or without septations or calcification. The cyst wall usually showed a rim of low signal intensity on both T1- and T2-weighted images. Compression of the midline structures and ventricles are seen in most of the cases, however surrounding oedema and rim enhancement are usually absent in untreated or uncomplicated cases. The HC is usually hypointense in diffusion weighted images and Proton MR Spectroscopy demonstrate lactate, alanine and pyruvate within the lesion. Pyruvate is very characteristic of hydatid cyst. This metabolite may be a marker of parasitic etiology and perhaps that of viability of such intracranial cysts. The serologic tests are of little practical value in confirming the diagnosis of cerebral echinococcal disease. Surgery is the standard and most effective treatment for intracranial HC.

 

Written by: Dr. Hasni Bouraoui I, Imaging Department, Sahloul Hospital, Tunisia

 

Interaction of Nitrogen Fixation and Alginate Synthesis of Azotobacter vinelandii isolated from Myanmar Mangrove

     The mangrove flora consists of three separate regions in Myanmar: the Rakhine mangroves, Irrawaddy mangroves, and Taninthayi mangroves. Mangrove communities are recognized as highly productive ecosystems that provide large quantities of organic matter to adjacent costal water. Mangroves provide a unique ecological niche for different microbes, which play various roles in nutrient recycling as well as in various environmental activities. The highly productive and diverse microbial community living associated with mangrove ecosystems continuously transforms nutrients from dead mangrove material into sources of nitrogen, phosphorous and other nutrients. Those can be used by the plants and in turn plant-root exudates serve as a food source for the microbes. The major aim of this research work is to create the deactivated gene by antibiotic mutation for studying the interaction of nitrogen-fixation and alginate producing activity of Azotobacter vineladii isolate from mangrove rhizospheric soil.

     A nitrogen fixation bacterium Azotobacter vinelandii was isolated from the mangrove rhizosphere soil of Irrawaddy Region, Myanmar. Screening and quantitative determination of the nitrogen fixation activity and alginate producing activity of the isolated strain was studied. The algD and algU gene fragments of Azotobacter vinelandii were isolated by using designated primers. A deletion was engineered in the cloned algD and algU genes by digestion with suitable restriction endonucleases and Kanamycin resistance gene cartridge was inserted. The mutation was subsequently transferred to the host bacteria, Azotobacter vinelandii by biparental mating using pEX18 vector and E.coli ST18 under pressure of kanamycin selection. Two mutant strains were developed and confirmed by PCR. It was observed that the resultant two mutant strains lost of their nitrogen fixation activity due to lost of their alginate producing activity.

 

Written by: Dr. San San Yu, Microbiology Laboratory, Biotechnology Research  Department, Kyaukse, Myanmar

 

Genetic Diversity and Genetic Uniqueness of Indigenous Myanmar Mango (Sein Ta Lone) Cultivar in Kyaukse District

Myanmar Sein Ta Lone cultivar is one of the choicest cultivars of mango among the horticultural fruits not only in national level but also in global market due to its superior characteristics such as sweet taste, fibreless pulp, good aroma and flavor. Kyaukse District stands out as a major producer and supplier of Sein Ta Lone cultivar because of its appropriate weather and geographical conditions. Genetic diversity of 60 Myanmar Sein Ta Lone mango accessions from 21 orchards within three locations in Kyaukse District was studied in this research. 9 Simple Sequence Repeat (SSR) markers were used to study the genetic diversity and phylogenetic relationships among the collected mango accessions. Total of 48 scorable bands were observed on amplification with the sizes ranging between 110bp and 369bp. Polymorphic information content (PIC) of 9 SSR markers were 0.265 to 0.74 with an average of 0.421 per marker. The optimal annealing temperature of the primers was 42 to 58°C in range.

By using UPGMA cluster analysis, it grouped all the accessions from three locations with a genetic similar coefficient between 0.68-0.96. The cluster analysis by UPGMA of 60 mango accessions were shown in Figure. This study also discriminated the homogeneity and heterogeneity within the orchards. There was no clone in each orchard and the least dissimilarity was ~ 4% in SM orchard in location 1, SH orchard and SPu orchard in location 2 and STM orchard in location 3. In the present study, the analysis of genetic study by means of microsatellite markers showed high genetic diversity of Sein Ta Lone mango accessions and a mix pattern of geographic origin within three locations.

 

Written by: Dr. San San Yu, Biotechnology Research Department, Kyaukse, Ministry of Education, Myanmar

Do we need research for good patient care?

     Relevance of research in clinical practice is often debated. Many clinicians specially those in busy private practice consider that the time spent on research could be put to better use. When I began my training  in Neurosurgery, I was intrigued by the problems in management of one of the patients who had congenital vascular malformation. This triggered my interest to look further into the problem of Arterio-venous  malformations in the brain. This pursuit finally resulted in a PhD and multiple papers. I have to this day I have continued to study various facets of this problem. This has brought me in contact with Pathologists, Engineers and specialists in the field of Aeronautical Engineering. The result of this long association has produced a book on the subject.

      In my opinion research is an integral part of good clinical practice. It provides an opportunity for the clinician to assess the outcomes of his practice and modify the methods if the study suggests such a need. Pure laboratory research may not seem to be relevant to medical practice. The technique of 3D printing which started as a project in metallurgy has now become an integral part of medicine similar to robotics. In the present day context funding for pure research is discouraged due to financial problems. This is unfortunate. A proper balance between pure and applied research is necessary if we are committed to safe patient care.

Written by: Dr. Vidyasagar Casikar, Department of Vascular Research, University of Sydney, Australia

DNA Barcoding: A Promising Tool for Diverse Ichthyoplankton Conservation in Mangrove Ecosystem

Among different ecosystems, mangroves are very exclusive that they are marginal ecosystems and distinctively well-defined by marked boundaries with high and low tide levels. Mangrove ecosystem act as breeding and nursery grounds for several wildlife species comprising fishes(finfishes & shellfishes), crustaceans and mollusk population. Currently, the mangroves are facing severe threats due to anthropogenic activities and climate change. Thus the habitat loss of this unique ecosystem has direct impacts in the fishery of the particular region.To conserve these valuable ecosystems and to formulate sustainable management and conservation measures, knowledge of biotic components of the mangrove ecosystem is required. A better understanding of the interaction between ichthyoplankton and its nursery ground is crucial for protecting the threatened fish stocks and this information could provide insights on the effect of coastal degradation on aquatic fauna (fish) nursery ground.

Despite the significance of mangroves as breeding nursery ground for aquatic fauna, researches on the documentation of early stages of aquatic fauna in the mangrove ecosystem have not been studied so far. With this experience the DNA barcoding approach can be used to document and compare the Ichthyoplankton diversity from mangrove areas. Under DNA barcoding process, a mitochondrial gene, cytochrome c oxidase subunit 1 (COI), has been standardized to distinguish all the animal species. The ichthyoplankton diversity in mangroves can be a useful sign of the state and health of an aquatic ecosystem. Ichthyoplankton diversity in an ecosystem can reveal their spawning output and make available an index of relative population size for the fish. Variation in the size of fish stocks can be detected more quickly and sensitively by monitoring the ichthyoplankton related with them. The present article conclude that DNA barcoding can play a very important role in assessment and conservation of biodiversity in the massive and diverse mangrove ecosystem.

Written by: Dr. Raju Ram,  ICAR-Central Institute of Fisheries Education, India

Do you think that blood/sweat can be used to power batteries?- Many of the researches say yes

 

 

       

       We cannot think of a world without batteries. We use batteries for our daily use in many ways.  But still we cannot endure the fact that batteries die with time. A clear solution to all this is the introduction of batteries that can be charged and recharged with the help of our blood and sweat.

       Scientists have created a sweat-powered bio battery. Batteries formulate energy by passing current, in the form of electrons, from an anode to cathode. The device works by identifying and retorting to lactate, which is naturally present in sweat. In this case, the anode contained the enzyme that removes electrons from lactate, and the cathode contained a molecule that accepts the electrons. Interestingly, people who were less fit (exercising fewer than once a week) produced more power than those who were moderately fit (exercising one –three times a week).

       As the electrolyte is available as long as humans are alive, this type of battery is also ideal for medical applications. This will be useful to much more advanced artificial heart. Due to its small size, the battery can easily be setup under the human skin without distress. As the ionic liquid used for these batteries work at higher and lower temperatures this technology is also applicable to mechanical innovations. The researchers are trying to the best possible way of production and also trying to increase its efficiency. Hope, this new innovation will be a success and become a asset for the forthcoming technology

 

Posted by Lina Mark