Background: The fracture of ribs is a common injury presenting to trauma centers and hospitals. Along the years, a lot of methods have been introduced to stabilize the rib and sternal fractures, as most of studies reported that the treatment of these cases is warranted. In spite of the large number of methods for fixation introduced; no definitive method has been presented yet. Methods: From July 2015 to November 2016, the data of 30 patients with rib or sternal fractures or both who fulfilled the inclusion criteria were collected prospectively. Those patients were assigned into two groups; (group A) the fractures were fixed by plates and (group B) were fixed by stainless steel wires. The choice of method of fixation depended on surgeon's experience. The variables evaluated included stability of chest wall, intensive care unit stay, hospital stay and ventilator days. Results: The chest wall stability in (group A) was achieved in 100% of the patients, while in (group B) it was achieved in 60% of patients. Intensive care unit stay for group A was 9 ± 4.37 days and for group B 13.8 ± 7.61 (p ¼ 0.031). Hospital stay for group A was 11.6 ± 5.27 days and for group B 17.1 ± 6.77 (p ¼ 0.021). Ventilator days for (group A) were 6.38 ± 3.83 days, while in (group B) 10.3 ± 8.82days, however this difference was statistically insignificant (p ¼ 0.129). Conclusions: Plating of rib and sternal fractures had better outcome than wiring, regarding better chest wall stability and restoration of chest contour; also it had shorter intensive care unit, hospital and ventilator days.

Abstract Background T1‐weighted dynamic contrast‐enhanced (DCE) perfusion magnetic resonance imaging (MRI) has been broadly utilized in the evaluation of brain tumors. We aimed at assessing the diagnostic accuracy of DCE‐MRI in discriminating between low‐grade gliomas (LGGs) and high‐grade gliomas (HGGs), between tumor recurrence and treatment‐related changes, and between primary central nervous system lymphomas (PCNSLs) and HGGs. Methods We performed this study based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis of Diagnostic Test Accuracy Studies criteria. We systematically surveyed studies evaluating the diagnostic accuracy of DCE‐MRI for the aforementioned entities. Meta‐analysis was conducted with the use of a random effects model. Results Twenty‐seven studies were included after screening of 2945 possible entries. We categorized the eligible studies into three groups: those utilizing DCE‐MRI to differentiate between HGGs and LGGs (14 studies, 546 patients), between recurrence and treatment‐related changes (9 studies, 298 patients) and between PCNSLs and HGGs (5 studies, 224 patients). The pooled sensitivity, specificity, and area under the curve for differentiating HGGs from LGGs were 0.93, 0.90, and 0.96, for differentiating tumor relapse from treatment‐related changes were 0.88, 0.86, and 0.89, and for differentiating PCNSLs from HGGs were 0.78, 0.81, and 0.86, respectively. Conclusions Dynamic contrast‐enhanced‐Magnetic resonance imaging is a promising noninvasive imaging method that has moderate or high accuracy in stratifying gliomas. DCE‐MRI shows high diagnostic accuracy in discriminating between HGGs and their low‐grade counterparts, and moderate diagnostic accuracy in discriminating recurrent lesions and treatment‐related changes as well as PCNSLs and HGGs.

Intralesional (IL) vitamin D3 is an emerging treatment for cutaneous warts. However, its effectiveness and exact mechanism is not fully evaluated. We aimed to compare the efficacy and safety of IL purified protein derivative (PPD) and IL vitamin D3 in multiple warts and to investigate their systemic effect clinically and immunologically. Forty-five patients with multiple extragenital warts were treated with IL-PPD (22 patients) or IL vitamin D3 injection (23 patients) for a maximum of three sessions at 3 week intervals. Decrease in size and number of warts and adverse effects were evaluated. Serum interleukin-12 (IL-12) and interferon-gamma (IFN-γ) levels were measured before and 3 weeks after the last session. Higher clearance rates for all warts were observed with IL-PPD compared to IL vitamin D (59.1% vs. 21.7% complete clearance, p  .001). Significant increase was found in both serum IL-12 and IFN-γ after PPD treatment (p = .034 and p = .04, respectively), but only IFN-γ after vitamin D3 treatment (p = 0.02). Both IL vitamin D3 and PPD showed positive results in treatment of multiple warts. However, PPD showed higher clinical efficacy and more increase in both IL-12 and IFN-γ levels.

Intralesional (IL) vitamin D3 is an emerging treatment for cutaneous warts. However, its effectiveness and exact mechanism is not fully evaluated. We aimed to compare the efficacy and safety of IL purified protein derivative (PPD) and IL vitamin D3 in multiple warts and to investigate their systemic effect clinically and immunologically. Forty-five patients with multiple extragenital warts were treated with IL-PPD (22 patients) or IL vitamin D3 injection (23 patients) for a maximum of three sessions at 3 week intervals. Decrease in size and number of warts and adverse effects were evaluated. Serum interleukin-12 (IL-12) and interferon-gamma (IFN-γ) levels were measured before and 3 weeks after the last session. Higher clearance rates for all warts were observed with IL-PPD compared to IL vitamin D (59.1% vs. 21.7% complete clearance, p  .001). Significant increase was found in both serum IL-12 and IFN-γ after PPD treatment (p = .034 and p = .04, respectively), but only IFN-γ after vitamin D3 treatment (p = 0.02). Both IL vitamin D3 and PPD showed positive results in treatment of multiple warts. However, PPD showed higher clinical efficacy and more increase in both IL-12 and IFN-γ levels.

Intralesional (IL) vitamin D3 is an emerging treatment for cutaneous warts. However, its effectiveness and exact mechanism is not fully evaluated. We aimed to compare the efficacy and safety of IL purified protein derivative (PPD) and IL vitamin D3 in multiple warts and to investigate their systemic effect clinically and immunologically. Forty-five patients with multiple extragenital warts were treated with IL-PPD (22 patients) or IL vitamin D3 injection (23 patients) for a maximum of three sessions at 3 week intervals. Decrease in size and number of warts and adverse effects were evaluated. Serum interleukin-12 (IL-12) and interferon-gamma (IFN-γ) levels were measured before and 3 weeks after the last session. Higher clearance rates for all warts were observed with IL-PPD compared to IL vitamin D (59.1% vs. 21.7% complete clearance, p  .001). Significant increase was found in both serum IL-12 and IFN-γ after PPD treatment (p = .034 and p = .04, respectively), but only IFN-γ after vitamin D3 treatment (p = 0.02). Both IL vitamin D3 and PPD showed positive results in treatment of multiple warts. However, PPD showed higher clinical efficacy and more increase in both IL-12 and IFN-γ levels.

Intralesional (IL) vitamin D3 is an emerging treatment for cutaneous warts. However, its effectiveness and exact mechanism is not fully evaluated. We aimed to compare the efficacy and safety of IL purified protein derivative (PPD) and IL vitamin D3 in multiple warts and to investigate their systemic effect clinically and immunologically. Forty-five patients with multiple extragenital warts were treated with IL-PPD (22 patients) or IL vitamin D3 injection (23 patients) for a maximum of three sessions at 3 week intervals. Decrease in size and number of warts and adverse effects were evaluated. Serum interleukin-12 (IL-12) and interferon-gamma (IFN-γ) levels were measured before and 3 weeks after the last session. Higher clearance rates for all warts were observed with IL-PPD compared to IL vitamin D (59.1% vs. 21.7% complete clearance, p  .001). Significant increase was found in both serum IL-12 and IFN-γ after PPD treatment (p = .034 and p = .04, respectively), but only IFN-γ after vitamin D3 treatment (p = 0.02). Both IL vitamin D3 and PPD showed positive results in treatment of multiple warts. However, PPD showed higher clinical efficacy and more increase in both IL-12 and IFN-γ levels.

Objectives: To explore the impact of using topical stem cell-conditioned medium (SC-CM) after fractional carbon dioxide laser (FCL) vs. combined FCL and platelet-rich plasma (PRP) or FCL alone in treatment of atrophic acne scars. Methods: Thirty-three patients were randomly divided into two split-face groups. Group I (n  =  17) received FCL plus topical SC-CM on one side or FCL plus saline on the other. Group II (n  =  16) received FCL plus topical PRP or SC-CM. All patients had three monthly sessions. Clinical assessment was done at each visit, with a final assessment after 3 months. Skin biopsies were obtained for histological and quantitative molecular analysis after treatment. Results: No significant difference in clinical improvement of acne scars was observed between the FCL/SC-CM and FCL only sides (p = .63), while better and faster improvement was detected on FCL/PRP side compared to FCL/SC-CM side (p = .006). There was no significant difference in downtime or adverse effects between the treated sides in either group. Dermal collagen was increased and procollagen type I gene was upregulated in both FCL/PRP and FCL/SC-CM sides compared to FCL only sides (p = .001 and p = .041, respectively). Conclusions: Topical SC-CM could potentially enhance the efficacy of FCL. However, PRP seems to be a better alternative.

Objectives: To explore the impact of using topical stem cell-conditioned medium (SC-CM) after fractional carbon dioxide laser (FCL) vs. combined FCL and platelet-rich plasma (PRP) or FCL alone in treatment of atrophic acne scars. Methods: Thirty-three patients were randomly divided into two split-face groups. Group I (n  =  17) received FCL plus topical SC-CM on one side or FCL plus saline on the other. Group II (n  =  16) received FCL plus topical PRP or SC-CM. All patients had three monthly sessions. Clinical assessment was done at each visit, with a final assessment after 3 months. Skin biopsies were obtained for histological and quantitative molecular analysis after treatment. Results: No significant difference in clinical improvement of acne scars was observed between the FCL/SC-CM and FCL only sides (p = .63), while better and faster improvement was detected on FCL/PRP side compared to FCL/SC-CM side (p = .006). There was no significant difference in downtime or adverse effects between the treated sides in either group. Dermal collagen was increased and procollagen type I gene was upregulated in both FCL/PRP and FCL/SC-CM sides compared to FCL only sides (p = .001 and p = .041, respectively). Conclusions: Topical SC-CM could potentially enhance the efficacy of FCL. However, PRP seems to be a better alternative.

Objectives: To explore the impact of using topical stem cell-conditioned medium (SC-CM) after fractional carbon dioxide laser (FCL) vs. combined FCL and platelet-rich plasma (PRP) or FCL alone in treatment of atrophic acne scars. Methods: Thirty-three patients were randomly divided into two split-face groups. Group I (n  =  17) received FCL plus topical SC-CM on one side or FCL plus saline on the other. Group II (n  =  16) received FCL plus topical PRP or SC-CM. All patients had three monthly sessions. Clinical assessment was done at each visit, with a final assessment after 3 months. Skin biopsies were obtained for histological and quantitative molecular analysis after treatment. Results: No significant difference in clinical improvement of acne scars was observed between the FCL/SC-CM and FCL only sides (p = .63), while better and faster improvement was detected on FCL/PRP side compared to FCL/SC-CM side (p = .006). There was no significant difference in downtime or adverse effects between the treated sides in either group. Dermal collagen was increased and procollagen type I gene was upregulated in both FCL/PRP and FCL/SC-CM sides compared to FCL only sides (p = .001 and p = .041, respectively). Conclusions: Topical SC-CM could potentially enhance the efficacy of FCL. However, PRP seems to be a better alternative.

Objectives: To explore the impact of using topical stem cell-conditioned medium (SC-CM) after fractional carbon dioxide laser (FCL) vs. combined FCL and platelet-rich plasma (PRP) or FCL alone in treatment of atrophic acne scars. Methods: Thirty-three patients were randomly divided into two split-face groups. Group I (n  =  17) received FCL plus topical SC-CM on one side or FCL plus saline on the other. Group II (n  =  16) received FCL plus topical PRP or SC-CM. All patients had three monthly sessions. Clinical assessment was done at each visit, with a final assessment after 3 months. Skin biopsies were obtained for histological and quantitative molecular analysis after treatment. Results: No significant difference in clinical improvement of acne scars was observed between the FCL/SC-CM and FCL only sides (p = .63), while better and faster improvement was detected on FCL/PRP side compared to FCL/SC-CM side (p = .006). There was no significant difference in downtime or adverse effects between the treated sides in either group. Dermal collagen was increased and procollagen type I gene was upregulated in both FCL/PRP and FCL/SC-CM sides compared to FCL only sides (p = .001 and p = .041, respectively). Conclusions: Topical SC-CM could potentially enhance the efficacy of FCL. However, PRP seems to be a better alternative.