Publications by authors named "Ahmad Sukari Halim"

71 Publications

Cultural Beliefs on the Causes of Cleft Lip and/or Palate in Malaysia: A Multicenter Study.

Cleft Palate Craniofac J 2021 Apr 5:10556656211003797. Epub 2021 Apr 5.

Department of Plastic and Recontsructive Surgery, Hospital Kuala Lumpur, Malaysia.

Objective: To identify the cultural beliefs about the causes of cleft among parents of patients with nonsyndromic cleft lip and/or palate in a multiethnic society in Malaysia and the difficulties encountered in receiving cleft treatment.

Design: A descriptive cross-sectional multicenter study based on a study questionnaire was conducted of parents of patients with cleft lip and/or palate.

Setting: Three centers providing cleft care from different regions in Malaysia: the national capital of Kuala Lumpur, east coast of peninsular Malaysia, and East Malaysia on the island of Borneo.

Participants: Parents/primary caregivers of patients with cleft lip and/or palate.

Results: There were 295 respondents from different ethnic groups: Malays (58.3%), indigenous Sabah (30.5%), Chinese (7.1%), Indian (2.4%), and indigenous Peninsular Malaysia and Sarawak (1.7%). Malay participants reported that attributing causes of cleft to God's will, superstitious beliefs that the child's father went fishing when the mother was pregnant or inheritance. Sabahans parents reported that clefts are caused by maternal antenatal trauma, fruit picking, or carpentry. The Chinese attribute clefts to cleaning house drains, sewing, or using scissors. Cultural background was reported by 98.3% of participants to pose no barrier in cleft treatment. Those from lower socioeconomic and educational backgrounds were more likely to encounter difficulties while receiving treatment, which included financial constraints and transportation barriers.

Conclusion: There is a wide range of cultural beliefs in the multiethnic society of Malaysia. These beliefs do not prevent treatment for children with cleft. However, they face challenges while receiving cleft treatment, particularly financial constraints and transportation barriers. Such barriers are more likely experienced by parents from lower income and lower education backgrounds.
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http://dx.doi.org/10.1177/10556656211003797DOI Listing
April 2021

Prevention of firecracker injuries via the digital platform: A Malaysian experience.

Burns 2021 Feb 23. Epub 2021 Feb 23.

Reconstructive Sciences Unit, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia; Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia.

Introduction: Health campaigns include physical campaigns in schools, community halls, or community malls. They can also be broadcast via television, newspaper, and radio. We launched a health campaign on social media platforms that have a powerful impact in this digital era.

Methods: A three-dimensional short animation was developed for the Burn and Blast Injury Awareness campaign. It was launched during the fasting month and Eid 2020 when firecracker-related injuries are highly incident in Malaysia. The video was launched primarily on Universiti Sains Malaysia (USM) and Wau Animation Sdn Bhd social media platforms. Each party shared the video on the top 3 social media platforms, which are Facebook, Instagram, and YouTube. The numbers of viewers, reaches, and shares, and demographic data were captured at 1 month after the release.

Results: We recorded 29,585 views, 60,920 reach, and 874 shares from the USM and Wau Animation platforms alone. The USM Facebook platform showed predominant female viewership (60%), whereas the Wau Facebook platform showed predominant male viewership (66%). In both platforms, the viewers were aged 18-34 years.

Conclusion: Health awareness campaigns on digital platforms are powerful because the message spreads faster, and it is also safe during the pandemic.
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http://dx.doi.org/10.1016/j.burns.2021.02.007DOI Listing
February 2021

A Review on Micro- to Nanocellulose Biopolymer Scaffold Forming for Tissue Engineering Applications.

Polymers (Basel) 2020 Sep 8;12(9). Epub 2020 Sep 8.

Nanotechnology Research Centre, Faculty of Science and Mathematics, UPSI, Tanjung Malim 35900, Perak, Malaysia.

Biopolymers have been used as a replacement material for synthetic polymers in scaffold forming due to its biocompatibility and nontoxic properties. Production of scaffold for tissue repair is a major part of tissue engineering. Tissue engineering techniques for scaffold forming with cellulose-based material is at the forefront of present-day research. Micro- and nanocellulose-based materials are at the forefront of scientific development in the areas of biomedical engineering. Cellulose in scaffold forming has attracted a lot of attention because of its availability and toxicity properties. The discovery of nanocellulose has further improved the usability of cellulose as a reinforcement in biopolymers intended for scaffold fabrication. Its unique physical, chemical, mechanical, and biological properties offer some important advantages over synthetic polymer materials. This review presents a critical overview of micro- and nanoscale cellulose-based materials used for scaffold preparation. It also analyses the relationship between the method of fabrication and properties of the fabricated scaffold. The review concludes with future potential research on cellulose micro- and nano-based scaffolds. The review provides an up-to-date summary of the status and future prospective applications of micro- and nanocellulose-based scaffolds for tissue engineering.
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http://dx.doi.org/10.3390/polym12092043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565330PMC
September 2020

The Practice of First Aid for Burn Injuries Among the Population of East Coast of Peninsular Malaysia for 2012-2016.

J Burn Care Res 2020 Jul;41(4):905-907

Reconstructive Sciences Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia.

Burns are a devastating public health problem that result in 10 million disability-adjusted life-years lost in low- and middle-income countries. Adequate first aid for burn injuries reduces morbidity and mortality. The rate of proper first aid practices in other countries is 12% to 22%.1,2 A 5-year retrospective audit was performed on the database of the Burn Unit in Hospital Universiti Sains Malaysia for 2012-2016; this involved 485 patients from the east coast of Malaysia. The mean age of the patients is 17.3 years old. The audit on first aid practices for burn injury showed poor practice. Out of 485 burned patients, 261 patients (53.8%) claimed that they practiced first aid. However, only 24 out of 485 patients (5%) practiced the correct first aid technique where they run their burn wound under cool water for more than 20 minutes. Two hundred and twenty-two patients had not received any first aid. Two patients did not respond to the question on the first aid usage after burn injury. The mean age of patients who practiced first aid was 15.6 years old. Out of the 261 patients who practiced first aid, 167 (64%) run their wound under tap water for different durations. Others practiced traditional remedies such as the application of "Minyak Gamat" (6.5%), soy sauce (5.5%), other ointments (3.6%), milk (1.8%), and eggs (0.7%), as well as honey, butter, and cooking oil (0.4% each). First aid practices for burn injuries in the population of east coast Malaysia are still inadequate. The knowledge and awareness of school children and the general Malaysian population must be enhanced.
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http://dx.doi.org/10.1093/jbcr/iraa025DOI Listing
July 2020

An unusual cause of subacute airway obstruction in a hemodialysis patient with brachio-cephalic arteriovenous fistula: A rare presentation of central venous occlusion.

Hemodial Int 2020 04 5;24(2):E33-E36. Epub 2020 Mar 5.

Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

A young lady with an arteriovenous (AV) fistula on hemodialysis was referred for surgical management following a failed endovascular approach to relieve central venous occlusion. She had an obstructed left brachiocephalic vein with a history of numerous central vein catheter placements. Alternative routes for new arteriovenous fistula creation had been exhausted due to previous contralateral upper limb fistula rupture and ligation. To the best of our knowledge, no similar cases of airway obstruction in central venous occlusion occurring in hemodialysis patients with AV fistula have been reported. The importance of identifying the possible emergency red flags in hemodialysis patients with central venous occlusion is important to prevent unwanted consequences.
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http://dx.doi.org/10.1111/hdi.12832DOI Listing
April 2020

Early outcomes of cleft and palatal width following anterior palate repair (vomerine flap) in infants with wide cleft lip and palate.

Arch Plast Surg 2019 Nov 15;46(6):518-524. Epub 2019 Nov 15.

Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.

Background: Anterior palatal repair performed during cleft lip repair using a vomerine flap may assist in recruiting additional soft tissue for subsequent completion of palatoplasty, especially in patients with a wide cleft. We present our early.

Results: in the hope of triggering a re-evaluation of this technique regarding its advantages for maxillary growth through further studies of patients with a wide cleft.

Methods: A retrospective analysis of patients with complete unilateral and bilateral cleft lip and palate was performed, including cleft and palatal measurements taken during initial surgery (lip repair together with anterior palate repair) and upon completion of palatoplasty.

Results: In total, 14 patients were included in this study, of whom nine (63.3%) had unilateral cleft lip and palate and five (37.5%) had bilateral cleft. All patients had a wide cleft palate. Lip and anterior palate repair was done at a median age of 3 months, while completion of palatoplasty was done at a median age of 10.5 months. Measurements taken upon completion of palatoplasty showed significant cleft width reduction in the mid-palate and intertubercle regions; however, the palatal arch distances at nearby landmarks showed non-significant marginal changes.

Conclusions: Anterior palate repair using a vomerine flap significantly reduced the remaining cleft width, while the palatal width remained. Further research is warranted to explore the long-term effects of this technique in wide cleft patients in terms of facial growth.
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http://dx.doi.org/10.5999/aps.2019.00227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882701PMC
November 2019

A 20-year experience of immediate mandibular reconstruction using free fibula osteocutaneous flaps following ameloblastoma resection: Radical resection, outcomes, and recurrence.

Arch Plast Surg 2019 Sep 15;46(5):426-432. Epub 2019 Sep 15.

Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.

Background: The mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma.

Methods: This is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved.

Results: Twenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years.

Conclusions: Mandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.
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http://dx.doi.org/10.5999/aps.2018.01487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759441PMC
September 2019

Successful ankle replantation in two cases with different presentations.

Arch Plast Surg 2020 Mar 30;47(2):182-186. Epub 2019 Aug 30.

Hospital Universiti Sains Malaysia, Health Campus Universiti Sains Malaysia, Kota Bharu, Malaysia.

We report our experience of treating two patients with ankle amputation with different presentations. The first case was a clean-cut sharp amputation. The second case was an avulsion injury following a motor vehicle accident in a patient who arrived 8 hours after the injury. Replantation was successful in both cases. In avulsion injuries, a secondary operation for wound coverage is required at a later stage. With good strategy and a support team, encouraging limb survival outcomes are possible post-replantation.
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http://dx.doi.org/10.5999/aps.2018.00514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093274PMC
March 2020

Translation, Cross-Cultural Adaptation, and Validation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) into the Malay Language.

Int J Environ Res Public Health 2019 06 10;16(11). Epub 2019 Jun 10.

Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia.

Background: Patient feedback is an important tool in assessing health system quality. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was developed in 2006 as a standardized instrument to assess patient perceptions in the United States of America. This study aimed to translate and validate the HCAHPS questionnaire into the Malay language in order to assess patient perceptions of health services in Malaysia.

Methods: The original HCAPHS in English was translated into Malay based on the established guideline. The content validation involved an expert panel of 10 members, including patients. The face validation pilot testing of the HCAHPS-Malay version was conducted among 10 discharged patients. The exploratory factor analysis (EFA) used principal axis factor, and varimax rotation was established based on a cross-sectional study conducted among 200 discharged patients from Hospital Universiti Sains Malaysia (Hospital USM).

Results: The overall content validity index was 0.87, and the universal face validity index was 0.82. From the EFA, the factor loading value ranged from 0.652 to 0.961 within nine domains. The internal consistency reliability with Cronbach's alpha was 0.844.

Conclusion: The HCAHPS-Malay is a reliable and valid tool to determine patients' perception of healthcare services among inpatients in Hospital USM based on the content and face validation result together with a good construct validity and excellent absolute reliability. Further testing on HCAHPS-Malay version in other settings in Malaysia needs to be done for cross-validation.
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http://dx.doi.org/10.3390/ijerph16112054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604016PMC
June 2019

Superior long term functional and scar outcome of Meek micrografting compared to conventional split thickness skin grafting in the management of burns.

Burns 2019 09 1;45(6):1386-1400. Epub 2019 May 1.

Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia; Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. Electronic address: http://ashalim.usm.my.

Introduction: Autologous skin grafting is the mainstay of treatment in burn patients. Extensive full thickness burns remains a challenge to the burns surgeon due to the lack of autologous skin donor sites. The conventional split thickness skin grafting (SSG) and the Meek micrografting (Meek) technique are part of the armamentarium of the burns surgeon to curtail the challenge of paucity of donor sites. With advances in burn care, mortality rates of burn patients have reduced. As a result, with more patients surviving acute burn, there is a paradigm shift of research towards assessment of functional outcomes and quality of life of the burn survivors. As there is lack of research regarding the functional outcome of the Meek technique, this study was designed to examine the long term functional outcome of the Meek technique and SSG in burns.

Method: A cross-sectional study was conducted in Hospital Universiti Sains Malaysia to assess patients with burns between 10 to 40% total body surface area (TBSA) and with at least one year after injury. The Burn Specific Health Score-brief (BSHS-B) was utilized to compare the functional outcome whilst the Vancouver Scar Scale (VSS) was used for comparison on the scar outcome of the two skin grafting techniques.

Results: Forty three patients (Meek,15; SSG,28) were included. The mean current age (years old) of Meek and SSG was 24.7 (range, 7-75) and 25.9 (range, 7-65) respectively. The mean TBSA (%) of the Meek group was 26.7 (range, 13-40) while that of the SSG group was 16.1 (range, 10-32). A simplified domain structure was used for the BSHS-B questionnaire. The work and sexuality subscale were analyzed separately due to missing data. There mean scores of affect and relations was higher in Meek compared to SSG (Meek, 3.86; SSG, 3.75; p > 0.05). Function domain was also better in Meek compared to SSG (Meek, 3.88; SSG, 3.73; p > 0.05). The Meek group displayed superior scar outcome compared to SSG as evidenced by the statistically significant difference in score for the pigmentation, pliability, height and total VSS score.

Conclusion: The Meek group showed more favorable BSHS-B scores compared to the SSG group. The scar outcome of the Meek technique is significantly superior to SSG. Therefore, the Meek technique is superior in the management of burns because the long term scar and functional outcome of this technique is better compared to conventional SSG.
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http://dx.doi.org/10.1016/j.burns.2019.04.011DOI Listing
September 2019

Two novel genes TOX3 and COL21A1 in large extended Malay families with nonsyndromic cleft lip and/or palate.

Mol Genet Genomic Med 2019 05 28;7(5):e635. Epub 2019 Mar 28.

Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Background: Nonsyndromic cleft lip and/or palate is one of the most common human birth defects worldwide that affects the lip and/or palate. The incidence of clefts varies among populations through ethnic, race, or geographical differences. The focus on Malay nonsyndromic cleft lip and/or palate (NSCL/P) is because of a scarce report on genetic study in relation to this deformity in Malaysia. We are interested to discuss about the genes that are susceptible to cause orofacial cleft formation in the family.

Methods: Genome-wide linkage analysis was carried out on eight large extended families of NSCL/P with the total of 91 individuals among Malay population using microarray platform. Based on linkage analyses findings, copy number variation (CNV) of LPHN2, SATB2, PVRL3, COL21A1, and TOX3 were identified in four large extended families that showed linkage evidence using quantitative polymerase chain reaction (qPCR) as for a validation purpose. Copy number calculated (CNC) for each genes were determined with Applied Biosystems CopyCallerTM Software v2.0. Normal CNC of the target sequence expected was set at two.

Results: Genome-wide linkage analysis had discovered several genes including TOX3 and COL21A1 in four different loci 4p15.2-p16.1, 6p11.2-p12.3, 14q13-q21, and 16q12.1. There was significant decreased, p < 0.05 of SATB2, COL21A1, and TOX3 copy number in extended families compared to the normal controls.

Conclusion: Novel linkage evidence and significant low copy number of COL21A1 and TOX3 in NSCLP family was confirmed. These genes increased the risks toward NSCLP formation in that family traits.
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http://dx.doi.org/10.1002/mgg3.635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503016PMC
May 2019

A prospective study evaluating wound healing with sea cucumber gel compared with hydrogel in treatment of skin graft donor sites.

Complement Ther Med 2018 Dec 4;41:261-266. Epub 2018 Oct 4.

Reconstructive Sciences Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia.

Background: Gamat (sea-cucumber) is a natural occurring fauna which is popularly used as traditional medication in Southeast Asian countries. There have been many animal studies done on its' biochemical properties and its' effects in vivo. The effect of gamat on human cutaneous wounds was studied using a split-skin graft donor site wound.

Methods: This was a comparative case-control study done on patients in Hospital Universiti Sains Malaysia (Hospital USM), requiring split-thickness skin grafting, whereby, the skin graft donor site was divided to almost equal halves, and applied with both gamat-based gel on one side, with Duoderm hydrogel on the other side. The epithelialization of the wounds was observed and compared on days 10, 14 and 21. Pain score, and pruritus score were also observed. Repeated measure analysis of variance (ANOVA) test and Paired t-test was used to test statistical significance accordingly.

Results: No significant differences were seen in rates of epithelialization of wounds on days 10, 14 and 21 (p > 0.01). No significant difference was also seen in the pain score and pruritus score (p > 0.01).

Conclusions: A gamat-based gel is comparable to conventional hydrogels in treatment of split-skin graft donor site. No adverse effects were observed in either group.
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http://dx.doi.org/10.1016/j.ctim.2018.10.006DOI Listing
December 2018

Outcome of the Modified Meek Technique in the Management of Major Pediatric Burns.

Ann Plast Surg 2018 09;81(3):295-301

Introduction: The modified Meek micrografting technique has been used in the treatment of severely burned patients and a number of articles have examined the use of the modified Meek technique in adults and in mixed-age groups. However, there is a paucity of research pertaining to the outcome in the pediatric age group. The aim of this study is to present our favorable outcome in pediatric major burns using the modified Meek technique.

Methods: A retrospective review of burn cases in Hospital Universiti Sains Malaysia from 2010 to 2015 was conducted. Cases of major burns among pediatric patients grafted using the Meek technique were examined.

Results: Twelve patients were grafted using the Meek technique. Ten (91.7%) patients were male, whereas 2 (8.3%) were female. The average age of patients was 6 years (range, 2-11 years). The average total body surface area was 35.4% (range, 15%-75%). Most burn mechanisms were due to flame injury (66.7%) as compared with scalds injury (16.7%) and chemical injury (16.7%). There was no mortality. All patients were completely grafted with a good donor site scar. The average graft take rate was 82.3%, although 8 cases had positive tissue cultures from the Meek-grafted areas. The average follow-up duration was 3.6 years (range, 1.1-6.7 years). Only 1 case developed contracture over minor joint.

Conclusions: The Meek technique is useful when there is a paucity of donor site in the pediatric group. The graft take is good, contracture formation is low, and this technique is cost-effective.
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http://dx.doi.org/10.1097/SAP.0000000000001565DOI Listing
September 2018

Breast Reconstruction After Mastectomy: A Survey of Surgeons' and Patients' Perceptions.

Clin Breast Cancer 2018 10 28;18(5):e1011-e1021. Epub 2018 Apr 28.

Reconstructive Sciences Unit, School of Medical Sciences and Hospital Universiti Sains Malaysia, Health Campus Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Electronic address:

Background: Breast reconstruction after mastectomy is important in breast cancer care.

Materials And Methods: A cross-sectional study was designed to assess surgeons' and patients' perceptions toward breast reconstruction. Questionnaires were distributed to general and breast surgeons in East Coast Malaysian hospitals and Hospital Kuala Lumpur and to postmastectomy patients with and without breast reconstruction at the Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II. The response rates were 82.5% for the surgeons (n = 33), 95.4% for the patients with reconstruction (n = 63), and 95.5% for the patients without reconstruction (n = 278).

Results: The median surgeon age and experience was 42 and 6 years, respectively. Each surgeon saw an average of 20 new breast cancer cases annually. Most surgeons (86.7%) discussed reconstruction options with their patients but had only referred an average of 4 patients for reconstruction during a 3-year period. Surgeons' concerns regarding the qualitative outcome increased the likelihood of a breast reconstruction discussion (β = 4.833; P = .044). The women who underwent breast reconstruction were younger (mean age, 42 vs. 50 years), were more often working (69.4% vs. 42.2%), and more often had previous awareness of the option (90.3% vs. 44.3%). The most common reasons for undergoing breast reconstruction were "to feel more balanced" (92.1%) and "surgeon's strong recommendation" (92.1%). Previous knowledge of breast reconstruction increased the likelihood of reconstruction (odds ratio, 5.805; P = .026). Although 70% of surgeons thought that patients would not be interested in reconstruction, only 37.9% of patients with previous awareness reported having no interest.

Conclusion: The low reconstruction rate (20.6%) can be attributed to the low referral rate. Patients' likelihood to undergo reconstruction with their surgeon's recommendation and with previous awareness were reflective of the surgeons' strong influence on their patients. Thus, clarification of surgeons' hypothetical criticisms could conceivably increase the reconstructive surgery rate.
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http://dx.doi.org/10.1016/j.clbc.2018.04.012DOI Listing
October 2018

Mechanism Action of Platelets and Crucial Blood Coagulation Pathways in Hemostasis.

Int J Hematol Oncol Stem Cell Res 2017 Oct;11(4):319-327

Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Blood is considered to be precious because it is the basic necessity for health; our body needs a steady provision of oxygen, supplied via blood, to reach billions of tissues and cells. Hematopoiesis is the process that generates blood cells of all lineages. However, platelets are the smallest blood component produced from the very large bone marrow cells called megakaryocytes and they play a fundamental role in thrombosis and hemostasis. Platelets contribute their hemostatic capacity via adhesion, activation and aggregation, which are triggered upon tissue injury, and these actions stimulate the coagulation factors and other mediators to achieve hemostasis. In addition, these coordinated series of events are the vital biological processes for wound healing phases. The aim of this review is to summarize and highlight the important pathways involved in achieving hemostasis that are ruled by platelets. In addition, this review also describes the mechanism action of platelets, including adhesion, activation, aggregation, and coagulation, as well as the factors that aid in hemostasis and wound healing.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767294PMC
October 2017

The Effects of Passive Cigarette Smoke Exposure on the Survival of the Reverse Sural Fasciocutaneous Flap.

J Hand Microsurg 2017 Dec 4;9(3):120-125. Epub 2017 Aug 4.

Wound and Stoma Care Unit, Department of Surgery, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia.

 The possibility of a person who had undergone surgery to be exposed to the ill effects of cigarette smoke is high, more so if the person lives with a smoker. With increasing popularity of reverse sural fasciocutaneous flaps, a surgeon may have to manage a person who lives with a smoker or is exposed to cigarette smoke. A clear understanding of the effects of exposure to cigarette smoke on reverse sural fasciocutaneous flaps is necessary. This study was performed to establish a clearer understanding of the effects of smoking on reverse sural fasciocutaneous flaps and evidence for preoperative patient counseling about smoking and smoke exposure.  The study investigated effects of exposure to cigarette smoke on the survival of the reverse sural fasciocutaneous flap.  This was an experimental observational study conducted at the Laboratory for Animal Research Unit in the Health Campus of Universiti Sains Malaysia. Twelve adult White New Zealand rabbits ( ) were divided into two groups of six. All 12 rabbits had a 2.5- × 2.5-cm reverse sural fasciocutaneous flap raised on both its hind limbs. The group exposed to cigarette smoke underwent 4 weeks of smoke exposure for 2 hours daily prior to surgery. This was then continued until analysis of the results. The control group had no intervention. All flaps were analyzed on the seventh postoperative day, after tracing on transparent plastic sheets with the necrotic area marked followed by 2D planimetry done on a grid paper. The flaps were assessed on the total flap area and survival area percentage. It was recorded as mean ± SD. The presence or absence of infection and hematoma was also noted.  Twelve flaps were analyzed in each group. Total mean flap area and survival area percentage of the control group were 120.33 ± 31.03 mm and 80.12 ± 15.75%, respectively, whereas in the cigarette smoke-exposed group, it was 121.83 ± 17.93 mm and 62.04 ± 34.01%, respectively. The control group had two infections and one hematoma, and the smoking-exposed group had six infections and nine hematomas. The comparison between the groups was made in terms of total flap area, survival percentage, presence of infection, and hematoma for which the values were 0.886, 0.115, 0.083, and 0.003, respectively. The differences between right and left hind limbs were also analyzed (  = 0.414).  There was no statistical difference in the results from the right and left hind limbs. There was no statistical difference in the survival of reverse sural fasciocutaneous flap between the control and smoking-exposed groups.
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http://dx.doi.org/10.1055/s-0037-1605354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741404PMC
December 2017

Compatibility of Porous Chitosan Scaffold with the Attachment and Proliferation of human Adipose-Derived Stem Cells .

J Stem Cells Regen Med 2016 29;12(2):79-86. Epub 2016 Nov 29.

Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.

Adipose-derived stem cells (ASCs) have potential applications in the repair and regeneration of various tissues and organs. The use of various scaffold materials as an excellent template for mimicking the extracellular matrix to induce the attachment and proliferation of different cell types has always been of interest in the field of tissue engineering because ideal biomaterials are in great demand. Chitosan, a marine polysaccharide, have wide clinical applications and it acts as a promising scaffold for cell migration and proliferation. ASCs, with their multi-differentiation potential, and chitosan, with its great biocompatibility with ASCs, were investigated in the present study. ASCs were isolated and were characterized by two different methods: immunocytochemistry and flow cytometry, using the mesenchymal stem cell markers CD90, CD105, CD73 and CD29. The ASCs were then induced to differentiate into adipogenic, osteogenic and chondrogenic lineages. These ASCs were incorporated into a porous chitosan scaffold (PCS), and their structural morphology was studied using a scanning electron microscope and hematoxylin and eosin staining. The proliferation rate of the ASCs on the PCS was assessed using a PrestoBlue viability assay. The results indicated that the PCS provides an excellent template for the adhesion and proliferation of ASCs. Thus, this study revealed that PCS is a promising biomaterial for inducing the proliferation of ASCs, which could lead to successful tissue reconstruction in the field of tissue engineering.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5227107PMC
November 2016

Report on von Willebrand Disease in Malaysia.

Open Access Maced J Med Sci 2016 Mar 29;4(1):112-7. Epub 2016 Feb 29.

Hemophilia Clinic, National Blood Centre (Pusat Darah Negara), Jalan Tun Razak, 50400, Wilayah Persekutuan, Kuala Lumpur, Malaysia.

Background: Von Willebrand disease (vWD) is an inherited hemostatic disorder that affects the hemostasis pathway. The worldwide prevalence of vWD is estimated to be 1% of the general population but only 0.002% in Malaysia.

Aim: Our present paper has been written to disclose the statistical counts on the number of vWD cases reported from 2011 to 2013.

Material And Methods: This article is based on sociodemographic data, diagnoses and laboratory findings of vWD in Malaysia. A total of 92 patients were reported to have vWD in Malaysia from 2011 to 2013.

Results: Sociodemographic-analysis revealed that 60% were females, 63% were of the Malay ethnicity, 41.3% were in the 19-44 year old age group and 15.2% were from Sabah, with the East region having the highest registered number of vWD cases. In Malaysia, most patients are predominately affected by vWD type 1 (77.2%). Factor 8, von Willebrand factor: Antigen and vWF: Collagen-Binding was the strongest determinants in the laboratory profiles of vWD.

Conclusion: This report has been done with great interest to provide an immense contribution from Malaysia, by revealing the statistical counts on vWD from 2011-2013.
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http://dx.doi.org/10.3889/oamjms.2016.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884229PMC
March 2016

Chitosan: A Promising Marine Polysaccharide for Biomedical Research.

Pharmacogn Rev 2016 Jan-Jun;10(19):39-42

Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Biomaterials created 50 years ago are still receiving considerable attention for their potential to support development in the biomedical field. Diverse naturally obtained polysaccharides supply a broad range of resources applicable in the biomedical field. Lately, chitosan, a marine polysaccharide derived from chitins-which are extracted from the shells of arthropods such as crab, shrimp, and lobster-is becoming the most wanted biopolymer for use toward therapeutic interventions. This is a general short review of chitosan, highlighting the history, properties, chemical structure, processing method, and factors influencing the usage of chitosan derivatives in the biomedical field.
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http://dx.doi.org/10.4103/0973-7847.176545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791986PMC
April 2016

Discovery of candidate genes for nonsyndromic cleft lip palate through genome-wide linkage analysis of large extended families in the Malay population.

BMC Genet 2016 Feb 11;17:39. Epub 2016 Feb 11.

School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia.

Background: Nonsyndromic orofacial clefts are one of the most common birth defects worldwide. It occurs as a result of genetic or environmental factors. This study investigates the genetic contribution to nonsyndromic cleft lip and/or palate through the analysis of family pedigrees. Candidate genes associated with the condition were identified from large extended families from the Malay population.

Results: A significant nonparametric linkage (NPL) score was detected in family 100. Other suggestive NPL and logarithm of the odds (LOD) scores were attained from families 50, 58, 99 and 100 under autosomal recessive mode. Heterogeneity LOD (HLOD) score ≥ 1 was determined for all families, confirming genetic heterogeneity of the population and indicating that a proportion of families might be linked to each other. Several candidate genes in linkage intervals were determined; LPHN2 at 1p31, SATB2 at 2q33.1-q35, PVRL3 at 3q13.3, COL21A1 at 6p12.1, FOXP2 at 7q22.3-q33, FOXG1 and HECTD1 at 14q12 and TOX3 at 16q12.1.

Conclusions: We have identified several novel and known candidate genes for nonsyndromic cleft lip and/or palate through genome-wide linkage analysis. Further analysis of the involvement of these genes in the condition will shed light on the disease mechanism. Comprehensive genetic testing of the candidate genes is warranted.
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http://dx.doi.org/10.1186/s12863-016-0345-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4751652PMC
February 2016

Chitosan scaffold enhances growth factor release in wound healing in von Willebrand disease.

Int J Clin Exp Med 2015 15;8(9):15611-20. Epub 2015 Sep 15.

Industrial Biotechnology Research Centre, SIRIM Berhad No. 1 Persiaran Dato' Menteri, Section 2, P. O. Box 7035, Shah Alam 40700, Selangor, Malaysia.

Chitosan-derived biomaterials have been reported to adhere when in contact with blood by encouraging platelets to adhere, activate and aggregate at the sites of vascular injury, thus enhanced wound healing capacity. This study investigated platelet morphology changes and the expression level of transforming growth factor-β1 (TGF-β1) and platelet-derived growth factor-AB (PDGF-AB) in the adherence of two different types of chitosans in von Willebrand disease (vWD): N,O-carboxymethylchitosan (NO-CMC) and oligo-chitosan (O-C). Fourteen vWD voluntary subjects were recruited, and they provided written informed consent. Scanning electron microscopy and enzyme-linked immunosorbent assay test procedures were employed to achieve the objective of the study. The results suggest that the O-C group showed dramatic changes in the platelet's behaviors. Platelets extended filopodia and generated lamellipodia, leading to the formation of grape-like shaped aggregation. The platelet aggregation occurred depending on the severity of vWD. O-C was bound to platelets on approximately 90% of the surface membrane in vWD type 1; there was 70% and 50% coverage in vWD type II and III, respectively. The O-C chitosan group showed an elevated expression level of TGF-β1 and PDGF-AB. This finding suggests that O-C stimulates these mediators from the activated platelets to the early stage of restoring the damaged cells and tissues. This study demonstrated that the greater expression level of O-C assists in mediating the cytokine complex networks of TGF-β1 and PDGF-AB and induces platelet activities towards wound healing in vWD. With a better understanding of chitosan's mechanisms of action, researchers are able to accurately develop novel therapies to prevent hemorrhage.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4658944PMC
December 2015

Long-term outcome of free fibula osteocutaneous flap and massive allograft in the reconstruction of long bone defect.

J Plast Reconstr Aesthet Surg 2015 Dec 19;68(12):1755-62. Epub 2015 Aug 19.

Orthopedics Oncology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia.

Reconstruction of massive bone defects in bone tumors with allografts has been shown to have significant complications including infection, delayed or nonunion of allograft, and allograft fracture. Resection compounded with soft tissue defects requires skin coverage. A composite osteocutaneous free fibula offers an optimal solution where the allografts can be augmented mechanically and achieve biological incorporation. Following resection, the cutaneous component of the free osteocutaneous fibula flaps covers the massive soft tissue defect. In this retrospective study, the long-term outcome of 12 patients, who underwent single-stage limb reconstruction with massive allograft and free fibula osteocutaneous flaps instead of free fibula osteal flaps only, was evaluated. This study included 12 consecutive patients who had primary bone tumors and had follow-up for a minimum of 24 months. The mean age at the time of surgery was 19.8 years. A total of eight patients had primary malignant bone tumors (five osteosarcomas, two chondrosarcomas and one synovial sarcoma), and four patients had benign bone tumors (two giant-cell tumors, one aneurysmal bone cyst, and one neurofibromatosis). The mean follow-up for the 12 patients was 63 months (range 24-124 months). Out of the 10 patients, nine underwent lower-limb reconstruction and ambulated with partial weight bearing and full weight bearing at an average of 4.2 months and 8.2 months, respectively. In conclusion, augmentation of a massive allograft with free fibula osteocutaneous flap is an excellent alternative for reducing the long-term complication of massive allograft and concurrently addresses the soft tissue coverage.
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http://dx.doi.org/10.1016/j.bjps.2015.08.013DOI Listing
December 2015

Cementoblastic lineage formation in the cross-talk between stem cells of human exfoliated deciduous teeth and epithelial rests of Malassez cells.

Clin Oral Investig 2016 Jul 22;20(6):1181-91. Epub 2015 Sep 22.

Conservative Department, School of Dental Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.

Objectives: The purpose of this study was to evaluate the synergistic effect of epithelial rests of Malassez cells (ERM) and transforming growth factor-β1 (TGF-β1) on proliferation, cementogenic and osteogenic differentiation of stem cells derived from human exfoliated deciduous teeth (SHED).

Materials And Methods: SHED were co-cultured with ERM with/without TGF-β1. Then, SHED proliferation, morphological appearance, alkaline phosphatase (ALP) activity, mineralization behaviour and gene/protein expression of cemento/osteoblastic phenotype were evaluated.

Results: TGF-β1 enhanced SHED proliferation when either cultured alone or co-cultured with ERM. ERM induced the cementoblastic differentiation of SHED which was significantly accelerated when treated with TGF-β1. This activity was demonstrated by high ALP activity, strong mineral deposition and upregulation of cementum/bone-related gene and protein expressions (i.e. ALP, collagen type I, bone sialoprotein, osteocalcin and cementum attachment protein).

Conclusions: ERM were able to induce SHED differentiation along the cemento/osteoblastic lineage that was triggered in the presence of TGF-β1.

Clinical Relevance: The cemento/osteoblastic differentiation capability of SHED possesses a therapeutic potential in endodontic and periodontal tissue engineering.
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http://dx.doi.org/10.1007/s00784-015-1601-6DOI Listing
July 2016

Effect of the Novel Biodegradable N, O-Carboxymethylchitosan and Oligo-Chitosan on the Platelet Thrombogenicity Cascade in von Willebrand Disease.

Thromb Res 2015 Sep 30;136(3):625-33. Epub 2015 Jul 30.

Industrial Biotechnology Research Centre, SIRIM Berhad, No. 1 Persiaran Dato' Menteri, Section 2, P.O. Box 7035, 40700 Shah Alam, Selangor, Malaysia. Electronic address:

Introduction: Von Willebrand disease (vWD) is the second least common hemostatic disorder in Malaysia, and it has a low prevalence. This study examined the underlying platelet thrombogenicity cascades in the presence of different formulations of chitosan-derivatives in vWD patients. This paper aimed to determine the significant influence of chitosan biomaterial in stimulating the platelet thrombogenicity cascades that involve the von Willebrand factor, Factor 8, Thromboxane A2, P2Y12 and Glycoprotein IIb/IIIa in vWD.

Materials And Methods: Variable chitosan formulations of N,O-Carboxymethylchitosan (NO-CMC) and Oligo-Chitosan (O-C) were tested. Fourteen vWD subjects voluntarily participated in this study after signing informed consent forms. The patient's demographic profiles, family history, type of vWD, clinical symptoms and laboratory profiles were recorded and analyzed. Enzyme-linked immunosorbent assay, flow cytometry and Western blot tests were used to determine the level of the chitosan-adhered-platelet-mechanisms.

Results: The study revealed that most patients were predominantly affected by vWD type I. The O-C group of chitosan's scaffold pores is sufficient to allow for nutrients and cells. The O-C-stimulated-mediators are capable of initiating the platelet actions and were detected to expedite the blood coagulation processes. The oligo-group of chitosans was capable of amplifying and triggering more platelet activator's pathways via the studied mediators. The present findings suggest that the ability of each type of chitosan to coagulate blood varies depending on its chemical composition.

Conclusion: The oligo group of chitosans is potentially capable of triggering platelet thrombogenicity cascades by activating platelets in vWD patients to form a platelet plug for hemostasis process.
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http://dx.doi.org/10.1016/j.thromres.2015.07.027DOI Listing
September 2015

Epidermal Regeneration of Cultured Autograft, Allograft, and Xenograft Keratinocytes Transplanted on Full-Thickness Wounds in Rabbits.

Exp Clin Transplant 2015 Jun;13(3):273-8

From the Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Objectives: Skin grafting has been evolving as an important application in reconstructive surgery. Mixed reports about the survival of allogeneic and xenogeneic keratinocytes require further substantiation to determine the role of these cells in wound healing.

Materials And Methods: Rabbit and rat skins were recovered and cultured in vitro. Full-thickness wounds were created on the dorsum of rabbits (2 cm × 2 cm; n = 4). Cultured epithelial autograft, allograft, and xenograft cells were sprayed onto 3 freshly created wounds, with 1 wound acting as a control. The wounds were monitored every 2 days for 4 weeks. After 4 weeks, the rabbits were killed; skin biopsies were taken from each healed wound and stained with hematoxylin and eosin, and epidermal thickness was measured.

Results: All examined grafts showed favorable healing outcomes because the wounds appeared similar to normal skin upon healing. The only observed significant difference was the thickness of the epidermis layer, which was thinner in the xenograft (P = .002) than the autograft or allograft. Morphologic evaluation of the skin surface showed that the rat skin was thinner than the rabbit skin. The graft that achieved the best result was the autograft because the thickness was similar to and mimicked normal skin.

Conclusions: All 3 grafts (autograft, allograft, and xenograft) have the potential to reconstitute epithelial defects. This approach can overcome the limitation of autologous skin donor sites, especially in burn cases.
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June 2015

Long-term effect on foot and ankle donor site following vascularized fibular graft resection in children.

J Pediatr Orthop B 2015 Sep;24(5):450-5

Departments of aOrthopaedics bReconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan cDepartment of Orthopaedics, Kuliyyah of Medicine, International Islamic University, Kuantan, Pahang, Malaysia.

This study was carried out to evaluate the long-term effect on the donor side of the foot and ankle following vascularized fibular graft resection in children. Eight patients underwent resection of the fibula for the purpose of a vascularized fibular graft by a surgical team who practiced leaving at least 6 cm residual distal fibula. The age of these children at the time of surgery was between 3 and 12 years. They were reviewed between 3 and 12 years after surgery. Two patients who underwent resection of the middle shaft of the fibula at 3 and 5 years of age developed abnormal growth of the distal tibia, leading to ankle valgus. They were treated with growth modulation of the distal tibial physis and supramalleolar osteotomy with tibiofibular synostosis. Another patient who underwent the entire proximal fibula resection at the age of 6 years had developed hindfoot valgus because of weakness of the tibialis posterior muscle. He required talonavicular fusion and flexor hallucis to tibialis posterior muscle transfer. Patients operated at the age of older than 8 years neither had ankle nor hindfoot deformity. We concluded that resection of the middle shaft of the fibula for the purpose of a vascularized fibula graft, leaving a 6 cm distal fibular stump in children younger than 6 years old, may give rise to abnormal growth of the distal tibial physis, leading to valgus ankle. The entire proximal fibular resection for the similar purpose in a 6-year-old child may give rise to weakness of tibialis posterior and hindfoot valgus.
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http://dx.doi.org/10.1097/BPB.0000000000000197DOI Listing
September 2015

A Bilayer Engineered Skin Substitute for Wound Repair in an Irradiation-Impeded Healing Model on Rat.

Adv Wound Care (New Rochelle) 2015 May;4(5):312-320

Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia , Kubang Kerian, Malaysia .

An engineered skin substitute is produced to accelerate wound healing by increasing the mechanical strength of the skin wound via high production of collagen bundles. During the remodeling stage of wound healing, collagen deposition is the most important event. The collagen deposition process may be altered by nutritional deficiency, diabetes mellitus, microbial infection, or radiation exposure, leading to impaired healing. This study describes the fabrication of an engineered bilayer skin substitute and evaluates its effectiveness for the production of collagen bundles in an impaired healing model. Rats were exposed to 10 Gy of radiation. Two months postirradiation, the wounds were excised and treated with one of three skin replacement products: bilayer engineered skin substitutes, chitosan skin templates, or duoderm. The collagen deposition was analyzed by hematoxylin and eosin staining. On day 21 postwound, the irradiated wounds displayed increased collagen bundle deposition after treatment using bilayer engineered skin substitutes (3.4±0.25) and chitosan skin templates (3.2±0.58) compared with duoderm (2.0±0.63). We provide the first report on the fabrication of bilayer engineered skin substitutes using high density human dermal fibroblasts cocultured with HFSCs on chitosan skin templates. The high density of fibroblasts significantly increases the penetration of cells into chitosan skin templates, contributing to the fabrication of bilayer engineered skin substitute.
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http://dx.doi.org/10.1089/wound.2014.0551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432966PMC
May 2015

Prognostic factors and survival rate of osteosarcoma: A single-institution study.

Asia Pac J Clin Oncol 2017 Apr 13;13(2):e104-e110. Epub 2015 Apr 13.

Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Aim: Osteosarcoma is a highly malignant primary bone tumor. The study aim to evaluate the prognostic factors influencing the survival rate in our center.

Methods: This was a retrospective cohort study of all patients treated between January 2005 and December 2010.

Results: We included 163 patients with an age range of 6-59 years (median = 19). The median follow-up was 47 months (range 36-84). The overall survival in patients who completed chemotherapy and surgery (n = 117) was 72% at 2 years and 44% at 5 years. Histologically, 99 (85%) had osteoblastic, 6 (5%) had chondroblastic and 3 (2.5%) had telangiectatic osteosarcoma. Limb salvage surgery was performed in 80 (49%) and 41 (25%) underwent amputation. However, 46 patients (28%) underwent no surgical intervention and incomplete chemotherapy. In total, 38/79 patients had a good chemotherapy response. There was a significantly better survival rate for limb salvage versus amputation. Independent prognostic factors for survival are compliance to treatment and presence of lung metastasis.

Conclusion: The overall survival of osteosarcoma patients was influenced by the presence of pulmonary metastases and compliance to treatment. Histological subtype, different chemotherapy regimens and histological necrosis after chemotherapy did not significantly influence survival. The patients who did not complete treatment had significantly poorer survival.
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http://dx.doi.org/10.1111/ajco.12346DOI Listing
April 2017

Vital roles of stem cells and biomaterials in skin tissue engineering.

World J Stem Cells 2015 Mar;7(2):428-36

Abu Bakar Mohd Hilmi, School of Diagnostic and Biomedicine, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Nerus 21300, Terengganu, Malaysia.

Tissue engineering essentially refers to technology for growing new human tissue and is distinct from regenerative medicine. Currently, pieces of skin are already being fabricated for clinical use and many other tissue types may be fabricated in the future. Tissue engineering was first defined in 1987 by the United States National Science Foundation which critically discussed the future targets of bioengineering research and its consequences. The principles of tissue engineering are to initiate cell cultures in vitro, grow them on scaffolds in situ and transplant the composite into a recipient in vivo. From the beginning, scaffolds have been necessary in tissue engineering applications. Regardless, the latest technology has redirected established approaches by omitting scaffolds. Currently, scientists from diverse research institutes are engineering skin without scaffolds. Due to their advantageous properties, stem cells have robustly transformed the tissue engineering field as part of an engineered bilayered skin substitute that will later be discussed in detail. Additionally, utilizing biomaterials or skin replacement products in skin tissue engineering as strategy to successfully direct cell proliferation and differentiation as well as to optimize the safety of handling during grafting is beneficial. This approach has also led to the cells' application in developing the novel skin substitute that will be briefly explained in this review.
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http://dx.doi.org/10.4252/wjsc.v7.i2.428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369498PMC
March 2015

Proliferation of keratinocytes induced by adipose-derived stem cells on a chitosan scaffold and its role in wound healing, a review.

Arch Plast Surg 2014 Sep 15;41(5):452-7. Epub 2014 Sep 15.

Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

In the field of tissue engineering and reconstruction, the development of efficient biomaterial is in high demand to achieve uncomplicated wound healing. Chronic wounds and excessive scarring are the major complications of tissue repair and, as this inadequate healing continues to increase, novel therapies and treatments for dysfunctional skin repair and reconstruction are important. This paper reviews the various aspects of the complications related to wound healing and focuses on chitosan because of its unique function in accelerating wound healing. The proliferation of keratinocytes is essential for wound closure, and adipose-derived stem cells play a significant role in wound healing. Thus, chitosan in combination with keratinocytes and adipose-derived stem cells may act as a vehicle for delivering cells, which would increase the proliferation of keratinocytes and help complete recovery from injuries.
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http://dx.doi.org/10.5999/aps.2014.41.5.452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179346PMC
September 2014