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Yazdanian M, Alam M, Abbasi K, Rahbar M, Farjood A, Tahmasebi E, Tebyaniyan H, Ranjbar R, Hesam Arefi A. Synthetic materials in craniofacial regenerative medicine: A comprehensive overview. Front Bioeng Biotechnol 2022; 10:987195. [PMID: 36440445 PMCID: PMC9681815 DOI: 10.3389/fbioe.2022.987195] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/26/2022] [Indexed: 07/25/2023] Open
Abstract
The state-of-the-art approach to regenerating different tissues and organs is tissue engineering which includes the three parts of stem cells (SCs), scaffolds, and growth factors. Cellular behaviors such as propagation, differentiation, and assembling the extracellular matrix (ECM) are influenced by the cell's microenvironment. Imitating the cell's natural environment, such as scaffolds, is vital to create appropriate tissue. Craniofacial tissue engineering refers to regenerating tissues found in the brain and the face parts such as bone, muscle, and artery. More biocompatible and biodegradable scaffolds are more commensurate with tissue remodeling and more appropriate for cell culture, signaling, and adhesion. Synthetic materials play significant roles and have become more prevalent in medical applications. They have also been used in different forms for producing a microenvironment as ECM for cells. Synthetic scaffolds may be comprised of polymers, bioceramics, or hybrids of natural/synthetic materials. Synthetic scaffolds have produced ECM-like materials that can properly mimic and regulate the tissue microenvironment's physical, mechanical, chemical, and biological properties, manage adherence of biomolecules and adjust the material's degradability. The present review article is focused on synthetic materials used in craniofacial tissue engineering in recent decades.
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Affiliation(s)
- Mohsen Yazdanian
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mostafa Alam
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Abbasi
- Department of Prosthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Rahbar
- Department of Restorative Dentistry, School of Dentistry, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Amin Farjood
- Orthodontic Department, Dental School, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Elahe Tahmasebi
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamid Tebyaniyan
- Department of Science and Research, Islimic Azade University, Tehran, Iran
| | - Reza Ranjbar
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Arian Hesam Arefi
- Dental Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Peng X, Li Y, Cheng C, Ning W, Yu X. Research on the inhibition for aseptic loosening of artificial joints by Sr-doped calcium polyphosphate (SCPP) in vivo. Biomed Mater 2021; 16:065017. [PMID: 34493695 DOI: 10.1088/1748-605x/ac2492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/27/2021] [Indexed: 02/08/2023]
Abstract
Aseptic loosening of artificial joints is the most common complication after artificial joint replacement. Finding the solution to tackle aseptic loosening of artificial joints is a focus in bone and joint surgery research field.In vitrostudies of Sr-doped calcium polyphosphate (SCPP) have found by our team that it could promote osteoblast proliferation and inhibit osteoclast activity, and it has a potential inhibitory effect on aseptic loosening by suppressing the expression of receptor activator of nuclear factor-κ B ligand and improving the expression of OPG. The present study aims to confirm the conclusionin vitroby the mean of animal experiment. The Ti rod prosthesis coated with SCPP, calcium polyphosphate (CPP), and Ultra-high molecular weight polyethylene (UHMWPE were implanted in the femur (the internal surface of bone tunnel was also coated with SCPP, CPP and UHMWPE respectively). Radiography (x-rays, micro-CT), histochemistry (Hematoxylin-eosin staining (HE), methylene blue-acid fuchsin, Von Kossa histological staining), molecular biology (alkaline phosphatase and TRAP5b factors, Mir21-5p and Mir 26a-5p) were performed to analyzed the effects of SCPP within 20 weeks. The Radiography results showed that osteolysis with various severity occurred in all groups, and SCPP group had the mildest osteolysis. Histochemistry results showed that arthritis was milder in SCPP and CPP groups, while the bone formation in SCPP group was most significant. Its bone reconstruction effect was the best as well. The Molecular biology results showed that the bone reconstruction was out-sync in each group. Compared with other groups, the bone resorption occurred at the latest and the bone resorption time was the shortest in experimental animals of SCPP group. All results indicated that SCPP could promote osteoblast activity and bone reconstruction, improve the integration of bone interface between prosthesis and base bone, reduce osteoclast activity and shorten the osteoclast action time at the implantation sitein vivo. Thus, it could postpone or alleviate the occurrence and development of aseptic looseningin vivo. Therefore, SCPP could be a promising material for the construction of artificial joints with the ability to resist aseptic loosening.
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Affiliation(s)
- Xu Peng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, People's Republic of China
- Experimental and Research Animal Institute, Sichuan University, Chengdu 610065, People's Republic of China
| | - Yanjiang Li
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, People's Republic of China
| | - Can Cheng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, People's Republic of China
| | - Wang Ning
- Regenerative Medicine Research Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Xixun Yu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, People's Republic of China
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Zhong NY, Wang LP. [Research progress in the osteogenetic mechanism of strontium]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:697-703. [PMID: 33377350 PMCID: PMC7738917 DOI: 10.7518/hxkq.2020.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/10/2020] [Indexed: 11/21/2022]
Abstract
Strontium (Sr) is an essential trace element and widely exists in nature. It plays an important role in the in vivo regulation of bone metabolism. Sr locates below Fe in the periodic table, and its chemical structure and polarity are similar to those of Ca. It can induce bone mesenchymal stem cells to differentiate into osteoblasts by inhibiting the activity of osteoclasts and reducing bone resorption. It promotes bone formation through a series of related pathways. The mechanism of Sr regulation of bone metabolism has been extensively researched in recent years. The current study aims to investigate the mechanism of Sr and provide a theoretical basis for its clinical application.
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Affiliation(s)
- Ning-Ying Zhong
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatological Hospital of Guangzhou Medical University, Guangzhou 510140, China;Stomatology Center, Shunde Hospital, Southern Medical University The First People's Hospital of Shunde, Foshan 528308, China
| | - Li-Ping Wang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatological Hospital of Guangzhou Medical University, Guangzhou 510140, China
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Xiong B, Shirai K, Matsumoto K, Abiko Y, Furuichi Y. The potential of a surface pre-reacted glass root canal dressing for treating apical periodontitis in rats. Int Endod J 2020; 54:255-267. [PMID: 32961600 DOI: 10.1111/iej.13414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 09/14/2020] [Indexed: 12/27/2022]
Abstract
AIM To evaluate the efficacy of a prototype root canal dressing containing surface pre-reacted glass-ionomer (S-PRG) fillers on repairing induced periapical lesions in a rat model. Calcium hydroxide [Ca(OH)2 ] was applied as a comparison in the healing process. METHODOLOGY The pulp chambers of the maxillary first molars in 64 male Wistar rats aged 16 weeks were opened to induce periapical lesions. After 28 days, the mesial canal of each tooth was prepared, irrigated with 2.5% sodium hypochlorite only (control group: irrigation) or followed by the respective dressing [Ca(OH)2 group, irrigation + Ca(OH)2 ; S-PRG group, irrigation + S-PRG] and restored with composite resin for 3 or 7 days (10/group). Four rats with healthy molars were used as blank controls. Descriptive analysis of the periapical radiographs, haematoxylin and eosin staining and immunohistochemical observation was performed 3 and 7 days after treatment. The periapical grey value, CD68 macrophages and osteoclasts (cathepsin-K) were quantified and statistically analysed with Tukey's honest significant difference test. A significant difference was achieved when P values were <0.05. RESULTS S-PRG and Ca(OH)2 dressings were associated with increased periapical grey values and inhibited osteoclast activity at 3 and 7 days; a significant difference in radiographic results and the number of osteoclasts was obtained at 3 and 7 days compared with the control group (P < 0.05). Reparative tissue was observed histologically in the space of the periapical resorbed necrotic area after S-PRG and Ca(OH)2 treatment for 3 and 7 days. The number of macrophages was significantly decreased at 3 and 7 days in the S-PRG and Ca(OH)2 specimens when compared with the controls (P < 0.05). CONCLUSIONS In a rat experimental model, the S-PRG root canal dressing was comparable to Ca(OH)2 in promoting the healing of experimentally induced periapical lesions. S-PRG paste has the potential to be used as an alternative intracanal dressing in teeth with apical periodontitis.
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Affiliation(s)
- B Xiong
- Division of Periodontology and Endodontology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - K Shirai
- Division of Periodontology and Endodontology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - K Matsumoto
- Division of Periodontology and Endodontology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Y Abiko
- Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Y Furuichi
- Division of Periodontology and Endodontology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
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Liu X, Cheng C, Peng X, Xiao H, Guo C, Wang X, Li L, Yu X. A promising material for bone repair: PMMA bone cement modified by dopamine-coated strontium-doped calcium polyphosphate particles. ROYAL SOCIETY OPEN SCIENCE 2019; 6:191028. [PMID: 31824710 PMCID: PMC6837193 DOI: 10.1098/rsos.191028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/02/2019] [Indexed: 02/05/2023]
Abstract
Polymethyl methacrylate (PMMA) bone cement has been widely used in clinics as bone repair materials for its excellent mechanical properties and good injection properties. However, it also has defects such as poor biological performance, high temperature, and the monomer has certain toxicity. Our study tried to modify the PMMA bone cement by doping with various particle weight fractions (5, 10 and 15%) of SCPP particles and polydopamine-coated SCPP particles (D/SCPP) to overcome its clinical application disadvantages. Our study showed that all results of physical properties of samples are in accordance with ISO 5833. The 15% D/SCPP/PMMA composite bone cement had much better biocompatibility compared with pure PMMA bone cement and SCPP/PMMA composite bone cement due to the best cell growth-promoting mineralization deposition on the surface of 15% D/SCPP/PMMA composite bone cements and Sr2+ released from SCPP particles. Our research also revealed that the reaction temperature was found to be reduced with an increase in doped particles after incorporating the particles into composite bone cements. The novel PMMA bone cements modified by D/SCPP particles are promising materials for bone repair.
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Affiliation(s)
- Xing Liu
- College of Polymer Science and Engineering, Sichuan University, No. 24 South Section 1, Yihuan Road, Chengdu 610065, People's Republic of China
| | - Can Cheng
- College of Polymer Science and Engineering, Sichuan University, No. 24 South Section 1, Yihuan Road, Chengdu 610065, People's Republic of China
| | - Xu Peng
- College of Polymer Science and Engineering, Sichuan University, No. 24 South Section 1, Yihuan Road, Chengdu 610065, People's Republic of China.,Laboratory Animal Center, Sichuan University, Chuanda Road, Chengdu 610065, People's Republic of China
| | - Hong Xiao
- Department of Pain Management, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu 610041, People's Republic of China
| | - Chengrui Guo
- College of Polymer Science and Engineering, Sichuan University, No. 24 South Section 1, Yihuan Road, Chengdu 610065, People's Republic of China
| | - Xu Wang
- College of Polymer Science and Engineering, Sichuan University, No. 24 South Section 1, Yihuan Road, Chengdu 610065, People's Republic of China
| | - Li Li
- Department of Oncology, The 452 Hospital of Chinese PLA, No. 317, Shunjiang Road, Chengdu, Sichuan Province 610021, People's Republic of China
| | - Xixun Yu
- College of Polymer Science and Engineering, Sichuan University, No. 24 South Section 1, Yihuan Road, Chengdu 610065, People's Republic of China
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Diao S, Yang H, Cao Y, Yang D, Fan Z. IGF2 enhanced the osteo-/dentinogenic and neurogenic differentiation potentials of stem cells from apical papilla. J Oral Rehabil 2019; 47 Suppl 1:55-65. [PMID: 31291686 DOI: 10.1111/joor.12859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In dental tissue engineering, niche is important for maintaining stem cell function and regenerating the dental tissues. However, there is limited knowledge for the growth factors in niche to maintain the function of stem cells. In this study, we investigated the effect of IGF2, a growth factor in stem cells from apical papilla (SCAPs) niche, on differentiation and proliferation potentials of SCAPs. MATERIALS AND METHODS Recombinant human IGF2 protein (rhIGF2) was used. Cell counting kit-8 assay, Carboxyfluorescein succinimidyl ester assay, alkaline phosphatase (ALP) activity, Alizarin Red staining, quantitative calcium analysis, immunofluorescence staining and real-time RT-PCR were performed to investigate the cell proliferation and differentiation potentials of SCAPs. And proteomic analysis was used to identify the differential secreted proteins. RESULTS By ALP activity assay, we found that 5 ng/mL rhIGF2 might be the optimal concentration for treatment. Then, Alizarin Red staining, quantitative calcium analysis and osteogenesis-related gene expression results showed that 5 ng/mL rhIGF2 could enhance the osteo-/dentinogenic differentiation potentials in SCAPs. Immunofluorescence staining and real-time RT-PCR results showed that neurogenic markers were significantly induced by 5 ng/mL rhIGF2 in SCAPs. Then, CCK-8 assay and CFSE assay results showed that 5 ng/mL rhIGF2 could enhance the cell proliferation in SCAPs. Furthermore, proteomic analysis showed that IGF2 could induce some secreted proteins which function related to the osteogenesis, neurogenesis and cell proliferation. CONCLUSIONS Our results identified that IGF2 might be the potential mediator in niche to promote SCAP function and dental tissue regeneration.
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Affiliation(s)
- Shu Diao
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China.,Department of Pediatric dentistry, Capital Medical University School of Stomatology, Beijing, China
| | - Haoqing Yang
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
| | - Yangyang Cao
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
| | - Dongmei Yang
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China.,Department of Pediatric dentistry, Capital Medical University School of Stomatology, Beijing, China
| | - Zhipeng Fan
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
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Progress and Applications of Polyphosphate in Bone and Cartilage Regeneration. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5141204. [PMID: 31346519 PMCID: PMC6620837 DOI: 10.1155/2019/5141204] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/29/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023]
Abstract
Patients with bone and cartilage defects due to infection, tumors, and trauma are quite common. Repairing bone and cartilage defects is thus a major problem for clinicians. Autologous and artificial bone transplantations are associated with many challenges, such as limited materials and immune rejection. Bone and cartilage regeneration has become a popular research topic. Inorganic polyphosphate (polyP) is a widely occurring biopolymer with high-energy phosphoanhydride bonds that exists in organisms from bacteria to mammals. Much data indicate that polyP acts as a regulator of gene expression in bone and cartilage tissues and exerts morphogenetic effects on cells involved in bone and cartilage formation. Exposure of these cells to polyP leads to the increase of cytokines that promote the differentiation of mesenchymal stem cells into osteoblasts, accelerates the osteoblast mineralization process, and inhibits the differentiation of osteoclast precursors to functionally active osteoclasts. PolyP-based materials have been widely reported in in vivo and in vitro studies. This paper reviews the current cellular mechanisms and material applications of polyP in bone and cartilage regeneration.
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Cao J, Lu Y, Chen H, Zhang L, Xiong C. Bioactive poly(etheretherketone) composite containing calcium polyphosphate and multi-walled carbon nanotubes for bone repair: Mechanical property and in vitro biocompatibility. J BIOACT COMPAT POL 2018. [DOI: 10.1177/0883911518783214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Poly(etheretherketone) exhibits good biocompatibility, excellent mechanical properties, and bone-like stiffness. However, the natural bio-inertness of pure poly(etheretherketone) hinders its applications in biomedical field, especially when direct bone-implant osteo-integration is desired. For developing an alternative biomaterial for load-bearing orthopedic application, combination of bioactive fillers with poly(etheretherketone) matrix is a feasible approach. In this study, a bioactive multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite was prepared through a compounding and injection-molding process for the first time. Bioactive calcium polyphosphate was added to polymer matrix to enhance the bioactivity of the composite, and incorporation of multi-walled carbon nanotubes to composite was aimed to improve both the mechanical property and biocompatibility. Furthermore, the microstructures, surface hydrophilicity, and mechanical property of multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite, as well as the cellular responses of MC3T3-E1 osteoblast cells to this material were investigated. The mechanical testing revealed that mechanical performance of the resulting ternary composite was significantly enhanced by adding the multi-walled carbon nanotubes and the mechanical values obtained were close to or higher than those of human cortical bone. More importantly, cell culture tests showed that initial cell adhesion, cell viability, and osteogenic differentiation of MC3T3-E1 cells were significantly promoted on the multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite. Accordingly, the multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite may be used as a promising bone repair material in dental and orthopedic applications.
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Affiliation(s)
- Jianfei Cao
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yue Lu
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Hechun Chen
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, China
- Changzhou Institute of Chemistry, Changzhou, China
| | - Lifang Zhang
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, China
| | - Chengdong Xiong
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, China
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Berksoy Hayta S, Durmuş K, Altuntaş EE, Yildiz E, Hisarciklıo M, Akyol M. The reduction in inflammation and impairment in wound healing by using strontium chloride hexahydrate. Cutan Ocul Toxicol 2017; 37:24-28. [PMID: 28468507 DOI: 10.1080/15569527.2017.1326497] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Numerous growth factors, cytokine, mitogen and chemotactic factors are involved in wound healing. Even though inflammation is important for the stimulation of proliferative phase, excessive inflammation also causes impairment in wound healing. Strontium salts suppress keratinocyte-induced TNF-alpha and interleukin-1 and interleukin-6 in in vitro cultures. This study was conducted to determine the effects of administration of topical strontium chloride hexahydrate on wound healing through TNF-alpha and TGF-beta in surgical wound healing model of in-vivo rat skin. MATERIAL AND METHODS Twenty-four rats were used in the study. After approximately 2 cm cutaneous-subcutaneous incision was horizontally carried out on the mid-neckline of the rats, the incision was again closed using 2.0 vicryl. The rats were assigned into three groups including eight rats in each group. Placebo emollient ointment and also the ointments, which were containing 5% and 10% strontium chloride hexahydrate and were prepared at the same base with placebo ointment, were administered to the groups by a blind executor twice a day for a week. At the end of seventh day, the rats were sacrificed and cutaneous and subcutaneous tissue of their wound site was resected for histopathological examination. Scoring of histopathological wound healing and scoring of tissue TNF-alpha and TGF-beta level with immunohistochemical staining were performed. RESULTS The groups, to which both 5% and 10% strontium chloride hexahydrate was administered, had lower immunohistochemical TNF-alpha levels and histopathological wound scores compared to controls, which was statistically significant (p < 0.05). CONCLUSION Strontium chloride hexahydrate can lead to impairment in wound healing by suppressing inflammation through TNF-alpha.
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Affiliation(s)
| | - Kasim Durmuş
- b Department of Otolaryngology, Faculty of Medicine , and
| | | | - Esin Yildiz
- c Department of Pathology, Faculty of Medicine , Cumhuriyet University , >Sivas > , Turkey
| | | | - Melih Akyol
- a Deparment of Dermatology, Faculty of Medicine
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