Publications by authors named "Mehran Karvar"

13 Publications

  • Page 1 of 1

Muscle Cryoinjury and Quantification of Regenerating Myofibers in Mice.

Bio Protoc 2021 Jun 5;11(11):e4036. Epub 2021 Jun 5.

Department of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.

Cryoinjury, or injury due to freezing, is a method of creating reproducible, local injuries in skeletal muscle. This method allows studying the regenerative response following muscle injuries , thus enabling the evaluation of local and systemic factors that influence the processes of myofiber regeneration. Cryoinjuries are applicable to the study of various modalities of muscle injury, particularly non-traumatic and traumatic injuries, without a loss of substantial volume of muscle mass. Cryoinjury requires only simple instruments and has the advantage over other methods that the extent of the lesion can be easily adjusted and standardized according to the duration of contact with the freezing instrument. The regenerative response can be evaluated histologically by the average maturity of regenerating myofibers as indicated by the cross-sectional areas of myofibers with centrally located nuclei. Accordingly, cryoinjury is regarded as one of the most reliable and easily accessible methods for simulating muscle injuries in studies of muscle regeneration.
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http://dx.doi.org/10.21769/BioProtoc.4036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250343PMC
June 2021

Comparison of Conventional and Platelet-Rich Plasma-Assisted Fat Grafting: A Systematic Review and Meta-analysis.

J Plast Reconstr Aesthet Surg 2021 Jun 12. Epub 2021 Jun 12.

Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA. Electronic address:

Background: Autologous fat grafting (FG) is a popular technique for soft-tissue augmentation, but the fat survival rate is unpredictable. Platelet-rich plasma (PRP) has emerged as an adjuvant to enhance fat graft survival.

Objectives: This literature review and meta-analysis aimed to investigate the effect of PRP on the survival rate of fat grafting.

Methods: A comprehensive systematic literature search was done to identify clinical studies on PRP and fat cotransplantation in PubMed, Cochrane Library, Web of Science, and EMBASE databases up to May 2020. The reference lists of selected articles were reviewed to identify any additional related articles. A meta-analysis was conducted to compare PRP + FG and conventional FG in terms of fat graft survival rate, patient satisfaction rate, and recovery time after surgery.

Results: Eleven studies consisting of 1125 patients were analyzed. Patients were followed up from 3 to 24 months post-FG. The fat survival rate varied from 20.5% to 54.8% in FG alone and from 24.1% to 89.2% in the PRP + FG groups. The survival rate was significantly higher and recovery time was significantly lower in the PRP + FG group than in the FG alone group. However, there was no significant difference in the patient satisfaction rate between the groups.

Conclusions: This study demonstrates that PRP-enhanced fat transplantation has better efficacy than conventional fat grafting. Further studies are required to provide the optimum concentration of PRP and the long-term efficacy of the technique. There is not enough evidence to compare the rate of complications with PRP and fat cotransplantation and conventional fat grafting.
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http://dx.doi.org/10.1016/j.bjps.2021.05.046DOI Listing
June 2021

Exercise-induced gene expression changes in skeletal muscle of old mice.

Genomics 2021 Jun 30;113(5):2965-2976. Epub 2021 Jun 30.

Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Harvard Stem Cell Institute, Cambridge, MA, United States. Electronic address:

Exercise is believed to be beneficial for skeletal muscle functions across all ages. Regimented exercise is often prescribed as an effective treatment/prophylaxis for age-related loss of muscle mass and function, known as sarcopenia, and plays an important role in the maintenance of mobility and functional independence in the elderly. However, response to exercise declines with aging, resulting in limited gain of muscle strength and endurance. These changes likely reflect age-dependent alterations in transcriptional response underlying the muscular adaptation to exercise. The exact changes in gene expression accompanying exercise, however, are largely unknown, and elucidating them is of a great clinical interest for understanding and optimizing the exercise-based therapies for sarcopenia. In order to characterize the exercise-induced transcriptomic changes in aged muscle, a paired-end RNA sequencing was performed on rRNA-depleted total RNA extracted from the gastrocnemius muscles of 24 months-old mice after 8 weeks of regimented exercise (exercise group) or no formal exercise program (sedentary group). Differential gene expression analysis of aged skeletal muscle revealed upregulations in the group of genes involved in neurotransmission and neuroexcitation, as well as equally notable absence of anabolic gene upregulations in the exercise group. In particular, genes encoding the transporters and receptor components of glutaminergic transmission were significantly upregulated in exercised muscles, as exemplified by Gria 1, Gria 2 and Grin2c encoding glutamate receptor 1, 2 and 2C respectively, Grin1 and Grin2b encoding N-methyl-d-aspartate receptors (NMDARs), Nptx1 responsible for glutaminergic receptor clustering, and Slc1a2 and Slc17a7 regulating synaptic uptake of glutamate. These changes were accompanied by an increase in the post-synaptic density of NMDARs and acetylcholine receptors (AChRs), as well as their innervation at neuromuscular junctions (NMJs). These results suggest that neural responses predominate the adaptive response of aged skeletal muscle to exercise, and indicate a possibility that glutaminergic transmission at NMJs may be present and responsible for synaptic protection and neural remodeling accompanying the exercise-induced functional enhancement in aged skeletal muscle. In addition, the absence of upregulations in the anabolic pathways highlights them as the area of potential pharmacological targeting for optimizing exercise-led sarcopenia therapy.
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http://dx.doi.org/10.1016/j.ygeno.2021.06.035DOI Listing
June 2021

Adherence to Personal Protective Equipment Guidelines During the COVID-19 Pandemic Among Health-Care Personnel: A Louisiana Case Study.

Disaster Med Public Health Prep 2021 Jun 8:1-4. Epub 2021 Jun 8.

Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Objective: The aim of this study was to determine the extent that appropriate personal protective equipment (PPE), per Centers for Disease Control and Prevention (CDC) guidance, was used during the coronavirus diseases 2019 (COVID-19) pandemic by health-care personnel (HCP) in Louisiana in 5 clinical settings.

Methods: An online questionnaire was distributed to the LA Nursery registry. Appropriate use of PPE in each of the 5 clinical scenarios was defined by the authors based on CDC guidelines. The scenarios ranged from communal hospital space to carrying out aerosol generating procedures (AGPs). A total of 1760 HCP participated between June and July 2020.

Results: The average adherence in LA was lowest for the scenario of carrying out AGPs at 39.5% compliance and highest for the scenario of patient contact when COVID-19 not suspected at 82.8% compliance. Adherence among parishes varied widely. Commentary to suggest a shortage of PPE supply and the practice of re-using PPE was strong.

Conclusions: Use of appropriate PPE varied by setting. It was higher in scenarios where only face masks (or respirators) were the standard (ie, community hospital or when COVID-19 not suspected) and lower in scenarios where additional PPE (eg, gloves, eye protection, and isolation gown) was required.
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http://dx.doi.org/10.1017/dmp.2021.176DOI Listing
June 2021

Epidemiology and cost-analysis of emergency department patients treated following traffic accidents in Iran: A retrospective cross-sectional study.

Int J Crit Illn Inj Sci 2020 Oct-Dec;10(4):182-188. Epub 2020 Dec 29.

Department of Health Management, Policy and Economics, School of Management and Medical Information Sciences, Kerman University of Medical Science, Kerman, Iran.

Introduction: Epidemiological analysis of traffic accidents can provide information for future plans to lower the cost and burden of road traffic accidents (RTAs). This study was aimed to determine the epidemiological characteristics of patients with RTAs.

Methods: We conducted a retrospective cross-sectional study of RTA patients presenting in 2016 to the Emergency Department at Shahid Bahonar Medical Education Center in Kerman, Iran. A checklist including variables such as age, sex, month, in which the patient referred, final outcome, overall cost and the site of injury used to collect data. The diagnostic criteria were in accordance to ICD 10.

Results: Of the total of 3277 patients who were studied, 2713 (82.78%) were men and 564 (16.66%) were women. Most of the accidents occurred at the age group of 16-30 years and the average cost of treatment in the hospital was 2152.45 USD. The most affected area was the lower limb. The majority of accidents occurred in spring and summer. The mortality rate was (2.74%).

Discussion: Injuries and deaths due to RTAs are a major public health problem, especially in young age groups. Therefore, more preventive programs targeting young adults should be considered to reduce the burden of RTAs.
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http://dx.doi.org/10.4103/IJCIIS.IJCIIS_93_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033206PMC
December 2020

Trends in the management of hidradenitis suppurativa in the Middle East region: a systematic review.

Int J Dermatol 2020 Dec 8. Epub 2020 Dec 8.

Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA.

Background: Hidradenitis suppurativa (HS) is a chronic, painful, and severely debilitating inflammatory disease that affects apocrine gland-bearing skin. There is no universal consensus on the management of hidradenitis suppurativa (HS). Current available guidelines are from western countries, which may be of limited use in other parts of the world. In this study, we aim to identify trends in the management of HS in the Middle East (ME) and its differences with the West.

Methods: A systematic literature review was performed to identify all studies in HS management performed by experts in the ME from database inception to June 2020 using PubMed, EMBASE, and Cochrane Library databases. Only original articles published in English language were included. Guidelines from western countries were used for comparison.

Results: Fifty-four eligible studies comprising 7649 HS patients from the ME region and nine guidelines from the West were included. No established guidelines were found for the management of HS in the ME. Sex ratio of HS patients in the ME is different in that men reported to be affected at a higher rate than in the West. Different antibiotic regimens were recommended in the ME, and the experts in the ME tend to be more procedure intensive than experts in the West.

Conclusions: Establishing a guideline for HS management in the ME is recommended to address unique considerations in the countries in this region.
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http://dx.doi.org/10.1111/ijd.15293DOI Listing
December 2020

Adherence to Personal Protective Equipment Guidelines During the COVID-19 Pandemic Among Health Care Personnel in the United States.

Disaster Med Public Health Prep 2021 Jan 8:1-3. Epub 2021 Jan 8.

Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.

Objectives: Protecting frontline health care workers with personal protective equipment (PPE) is critical during the coronavirus disease (COVID-19) pandemic. Through an online survey, we demonstrated variable adherence to the Centers for Disease Control and Prevention (CDC) PPE guidelines among health care personnel (HCP).

Methods: CDC guidelines for optimal and acceptable PPE usage in common situations faced by frontline health care workers were referenced to create a short online survey. The survey was distributed to national, statewide, and local professional organizations across the United States and to HCP, using a snowball sampling technique. Responses were collected between June 15 and July 17, 2020.

Results: Responses totaling 2245 were received from doctors, nurses, midwives, paramedics, and medical technicians in 44 states. Eight states with n > 20 (Arizona, California, Colorado, Louisiana, Oregon, South Carolina, Texas, and Washington) and a total of 436 responses are included in the quantitative analysis. Adherence to CDC guidelines was observed to be highest in the scenario of patient contact when COVID-19 was not suspected (86.47%) and lowest when carrying out aerosol generating procedures (AGPs) (42.47%).

Conclusions: Further research is urgently needed to identify the reasons underlying variability between professions and regions to pinpoint strategies for maximizing adherence and improving the safety of HCPs.
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http://dx.doi.org/10.1017/dmp.2021.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010287PMC
January 2021

Novel application of autologous micrografts in a collagen-glycosaminoglycan scaffold for diabetic wound healing.

Biomed Mater 2020 Oct 22. Epub 2020 Oct 22.

Brigham and Women's Hospital, Boston, UNITED STATES.

Background: Therapeutic strategies that successfully combine two techniques-autologous micrografting and biodegradable scaffolds-offer great potential for improved wound repair and decreased scarring. In this study we evaluate the efficacy of a novel modification of a collagen-glycosaminoglycan scaffold with autologous micrografts using a murine dorsal wound model.

Methods: db/db mice underwent dorsal wound excision and were treated with a collagen-glycosaminoglycan scaffold (CGS), a modified collagen-glycosaminoglycan scaffold (CGS+MG) or simple occlusive dressing (Blank). The modified scaffold was created by harvesting full thickness micrografts and transplanting these into the collagen-glycosaminoglycan membrane. Parameters of wound healing, including cellular proliferation, collagen deposition, keratinocyte migration, and angiogenesis were assessed.

Results: The group treated with the micrograft-modified scaffold healed at a faster rate, showed greater cellular proliferation, collagen deposition, and keratinocyte migration with higher density and greater maturity of microvessels. The grafts remained viable within the scaffold with no evidence of rejection. Keratinocytes were shown to migrate from the wound border and from the micrograft edges towards the center of the wound, while cellular proliferation was present both at the wound border and wound bed.

Conclusion: We report successful treatment of diabetic wounds with a novel collagen-glycosaminoglycan scaffold modified with full-thickness automicrografts. Differences in cellular migration and proliferation offer maiden evidence on the mechanisms of wound healing. Clinically, the successful scaffold engraftment, micrograft viability and improved wound healing offer promising results for the development of a new therapeutic modality for wound repair.
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http://dx.doi.org/10.1088/1748-605X/abc3dcDOI Listing
October 2020

Low mortality oxidative stress murine chronic wound model.

BMJ Open Diabetes Res Care 2020 09;8(1)

Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

Introduction: Investigators have struggled to produce a reliable chronic wound model. Recent progress with antioxidant enzyme inhibitors shows promise, but mortality rates are high. We modified the dosage and administration of an antioxidant enzyme inhibitor regimen to reduce mortality while inducing a chronic wound environment.

Research Design And Methods: To chemically induce a chronic wound environment, we applied modified doses of catalase (3-amino-1,2,4-triazole; intraperitoneal 0.5 g/kg) and glutathione peroxidase (mercaptosuccinic acid; topical 300 mg/kg) inhibitors to the dorsal wounds of 11-week-old db/db mice. A cohort of these mice was treated with a collagen-glycosaminoglycan scaffold. Both groups were compared with Diabetic control mice.

Results: This study successfully induced a chronic wound in 11-week-old db/db mice, with no animal deaths. The antioxidant enzyme treated groups showed delayed wound contraction and significantly higher levels of inflammatory tissue, collagen deposition, cellular proliferation and leukocyte infiltration than the Diabetic control group. Angiogenesis was significantly higher in the antioxidant enzyme treated groups, but the vessels were immature and friable. Scaffold engraftment was poor but appeared to promote blood vessel maturation.

Conclusions: Overall, the two in vivo groups treated with the antioxidant enzyme inhibitors appeared to be arrested in the inflammatory stage of wound healing, while the Diabetic control group progressed to the maturation phase and ultimately remodeling. This model may be instrumental for the development of new wound therapeutics.
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http://dx.doi.org/10.1136/bmjdrc-2020-001221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478002PMC
September 2020

Results of a Campaign for Motorcycle Helmets Advocacy in a City in Southwest of Iran; A Population-Based Intervention Study.

Bull Emerg Trauma 2019 Oct;7(4):404-410

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: We conducted a triple phase project for motorcycle helmets advocacy in Darab, a city in southwest Iran. The aim of this study was to evaluate the effect of the project on decreasing the hazards of motorcycle accidents.

Methods: Using a questionnaire, data for ICU admission rates, hospital costs for patients who required ICU admission, rate of helmet usage, mortality and the duration of ICU care for patients admitted to Darab hospital due to motorcycle accidents in Winter 2015 (before conducting the project) and Winter 2016 (after conducting the project) were gathered and compared. This feature was also separately done for patients younger than 17 years.

Results: The rate of wearing helmets increased significantly in winter 2016 (from 3.4 % to 33%). Also ICU admission rate due to head trauma was significantly decreased after the project was done (from 14.5 % to 4%). However, hospital costs for patients required ICU admission were increased in winter 2016. This increase, though not significant, seems to be due to an increase in health service expenses in the year 2016 as compared with the year 2015. The mortality rate was not significantly changed between the two mentioned years results. For patients younger than 17 years, no ICU admissions were needed in winter 2016.

Conclusion: Even a short period of intervention can have positive effects on increasing the safety of motorcycle drivers.
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http://dx.doi.org/10.29252/beat-070410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911718PMC
October 2019

Cryotherapy of cutaneous leishmaniasis caused by in BALB/c mice: A comparative experimental study.

J Vector Borne Dis 2018 Jan-Mar;55(1):42-46

Kerman Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Background & Objectives: Leishmania parasites are sensitive to very low temperature. Cryotherapy is considered as an alternative to the existing pentavalent antimonials, for local treatment of cutaneous leishmaniasis (CL). Normally, liquid nitrogen (N) at a temperature of -196 °C, is used in cryotherapy of CL, but it's efficacy is not consistent. Recently, few studies have also reported the use of carbon dioxide (CO) slush at -78.5 °C in CL cryotherapy. This study was aimed to evaluate the effectiveness of N vs CO cryotherapy for CL treatment in mice. Methods: In total, 21 BALB/c mice were infected with Leishmania major strain [MRHO/IR/74/ER]. Samples were divided into three groups based on the intervention provided-Solid CO cryotherapy, liquid N cryotherapy and control group; with seven mice randomly assigned to each group. Control group received no intervention, and in the other two groups cryotherapy was used every two weeks for maximum of three months. Follow up examinations were scheduled at the time of cryotherapy, during which the size of each lesion was measured. For three mice in each study group, the spleen parasite DNA load was quantified using real-time PCR.

Results: After treatment, the liquid N cryotherapy showed significant reduction in size of the lesions (p = 0.029) as compared to the solid CO cryotherapy and control group. Also, Leishmania DNA load in spleen was significantly lower in the mice receiving liquid N cryotherapy (p <0.001).

Interpretation & Conclusion: Liquid N cryotherapy is superior to CO cryotherapy, and it can be an effective method for controlling L. major infection. Further investigations are essential to find optimal number of treatment sessions and time intervals.
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http://dx.doi.org/10.4103/0972-9062.234625DOI Listing
October 2018

Recurrent nonhealing wound in old burn scar may be due to Heterotopic Ossification.

Burns 2017 11 10;43(7):1599-1601. Epub 2017 Aug 10.

Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1016/j.burns.2017.05.016DOI Listing
November 2017

The topical treatment of anthroponotic cutaneous leishmaniasis with the tincture of thioxolone plus benzoxonium chloride (Thio-Ben) along with cryotherapy: a single-blind randomized clinical trial.

Dermatol Ther 2015 May-Jun;28(3):140-6. Epub 2015 Apr 6.

Kerman University of Medical Sciences, Kerman, Iran.

A simple efficacious topical treatment for cutaneous leishmaniasis (CL) is still an unresolved challenge. This study aimed to evaluate the efficacy of the topical use of thioxolone plus benzoxonium chloride (Thio-Ben) tincture in combination with cryotherapy in comparison with intralesional meglumine antimoniate (Glucantime) along with cryotherapy in treating anthroponotic CL (ACL). The study was conducted in Leishmaniasis Center in Dadbin Health Care Clinic, Kerman, Iran. Sixty-four CL lesions were randomly assigned to receive Thio-Ben plus cryotherapy (TC) (n = 32) or Glucantime plus cryotherapy (GC) (n = 32). Thio-Ben was used topically every other day and Glucantime was used intralesionally once a week for a maximum of 3 months. In both study groups, cryotherapy was administered using liquid nitrogen once every 2 weeks. Of 64 recruited lesions, 47 lesions completed the study protocol. Twenty lesions (91%) in TC group and 23 lesions (92%) in GC group showed complete cure. TC group showed faster clinical response. Pain, hypersensitivity reaction, dizziness, and nausea were only seen in GC group. This study showed that the topical use of Thio-Ben combined with cryotherapy has a good efficacy in treating ACL with the benefit that Thio-Ben has more patient compliance and less side effects than intralesional Glucantime.
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http://dx.doi.org/10.1111/dth.12229DOI Listing
March 2016