Impact of the impulse electrophoresis of the blood plasma on the wounds healing and formation of cicatricial tissue in experiment

Objective. To study in experiment the impact of the impulse electrophoresis of the blood plasma method on the wounds healing process in postoperative wounds. Materials and methods. The investigations were conducted on 15 white rats, to which in aseptic environment under intraabdominal narcosis the hip surgical access through the skin and muscles was conducted with subsequent layered closure of the wound, using separate knots. Ten laboratory animals were included into the main group, in whom transdermal introduction of the blood plasma, using the impulse electrophoresis method, was conducted on the 4th, 7th, 10th and 14th postoperative days. Into a control group 5 white rats were included, in which transdermal introduction of the blood plasma was not applied postoperatively. In all the laboratory animals the wounds have healed primarily. On the19th day postoperatively the laboratory animals were extracted from the experiment, and the near suture skin was investigated, using histological methods. Results. The surgical access healing in the hip skin and muscles with formation of normotrophic cicatrices was observed in the main group of the laboratory animals. Hypertrophic cicatrix in the operative intervention zone have been formatted in the laboratory animals of a control group on the 19th postoperative day. Conclusion. More qualitative healing of the wounds with formation of normotrophic cicatrix while application of transdermal introduction of the blood plasma, using the impulse electrophoresis method, was confirmed in experimental investigation in laboratory animals of the main group. Excessive creation of collagen was omitted in the laboratory animals of the main group, what have promoted formation of more thin and tender cicatrix, which have become slightly visible up to the end of experiment

Formation and evaluation of bilio-digestive and interintestinal anastomoses by the method of high-frequency electric welding of tissues in experiment

Objective. To develop a new method of the anastomoses formation, that would allow to form bilio-digestive and entero-entero anastomoses both on unchanged and inflamed tissues. Маterials and methods. In experimental on 50 laboratory rabbits the single-layer everting cholecysto-entero and entero-entero anastomoses on the Roux-defunctionalized loop of small intestine was created by the method of a high-frequency electric welding. The welding anastomoses were formed both on non-inflamed tissues and in the setting of biliary peritonitis. Patency, hermeticity, strength, macroscopic and microscopic pictures of the obtained joints were evaluated at different postoperative periods. Results. All anastomoses, formed by the method of a high-frequency electric welding, were not only patent and hermetic, but also sufficiently strong (40 – 100 mm Hg). The tissues were joined using thermo-adhesion; a coagulation scar was rather narrow, its complete epithelization was accomplished in 3 mo, and a scar maturation completed – in 6 mo. Conclusion. The method of a high-frequency electric welding permits to form both, bilio-digestive and inter-intestinal, anastomoses of equal reliability in the settings of non-inflamed and inflamed tissues

ВІДТВОРЕННЯ СТРЕСОВОЇ МОДЕЛІ НЕТРИМАННЯ СЕЧІ У ЛАБОРАТОРНИХ ТВАРИН

Стресове нетримання сечі (СНС), особливо у жінок, є найпоширенішим ускладненням урогінекологічних захворювань. Створено адекватну і стабільно відтворювану модель СНС у лабораторних білих щурів шляхом двобічного перев’язування соромітних нервів. Це забезпечувало стійкі прояви СНС, що прогресували у міру збільшення тривалості експерименту. За даними уродинамічних досліджень, реєстрували зниження тиску витікання першої краплини сечі в оперованих тварин; результати гістологічних та морфометричних досліджень свідчили про збільшення просвіту сечівника, зниження тонусу м’язів. За даними дослідження, денервація сечівника та його сфінктера була стійкою, використання моделі дозволяло отримати стабільно відтворювані результати

Breast cancer patients' clinical outcome measures are associated with Src kinase family member expression

<p>BACKGROUND: This study determined mRNA expression levels for Src kinase family (SFK) members in breast tissue specimens and assessed protein expression levels of prominent SFK members in invasive breast cancer to establish associations with clinical outcome. Ki67 was investigated to determine association between SFK members and proliferation.</p> <p>METHODS: The mRNA expression levels were assessed for eight SFK members by quantitative real-time PCR. Immunohistochemistry was performed for c-Src, Lyn, Lck and Ki67.</p> <p>RESULTS: mRNA expression was quantified in all tissue samples. SRC and LYN were the most highly expressed in malignant tissue. LCK was more highly expressed in oestrogen receptor (ER)-negative, compared with ER-positive tumours. High cytoplasmic Src kinase protein expression was significantly associated with decreased disease-specific survival. Lyn was not associated with survival at any cellular location. High membrane Lck expression was significantly associated with improved survival. Ki67 expression correlated with tumour grade and nuclear c-Src, but was not associated with survival.</p> <p>CONCLUSIONS: All eight SFK members were expressed in different breast tissues. Src kinase was highest expressed in breast cancer and had a negative impact on disease-specific survival. Membrane expression of Lck was associated with improved clinical outcome. High expression of Src kinase correlated with high proliferation.</p&gt

Primary versus early secondary referral to a specialized neurotrauma center in patients with moderate/severe traumatic brain injury: a CENTER TBI study.

BackgroundPrehospital care for patients with traumatic brain injury (TBI) varies with some emergency medical systems recommending direct transport of patients with moderate to severe TBI to hospitals with specialist neurotrauma care (SNCs). The aim of this study is to assess variation in levels of early secondary referral within European SNCs and to compare the outcomes of directly admitted and secondarily transferred patients.MethodsPatients with moderate and severe TBI (Glasgow Coma Scale ResultsA total of 1347 moderate/severe TBI patients from 53 SNCs in 18 European countries were included. Of these 1347 patients, 195 (14.5%) were admitted after early secondary referral. Secondarily referred moderate/severe TBI patients presented more often with a CT abnormality: mass lesion (52% vs. 34%), midline shift (54% vs. 36%) and acute subdural hematoma (77% vs. 65%). After adjusting for case-mix, there was a large European variation in early secondary referral, with a median OR of 1.69 between countries. Early secondary referral was not associated with functional outcome (adjusted OR 1.07, 95% CI 0.78-1.69), nor with survival at discharge (1.05, 0.58-1.90).ConclusionsAcross Europe, substantial practice variation exists in the proportion of secondarily referred TBI patients at SNCs that is not explained by case mix. Within SNCs early secondary referral does not seem to impact functional outcome and survival after stabilisation in a non-specialised hospital. Future research should identify which patients with TBI truly benefit from direct transportation

Simulation of the stress model of the urine incontinence in laboratory animals

Стресове нетримання сечі (СНС), особливо у жінок, є найпоширенішим ускладненням урогінекологічних захворювань. Створено адекватну і стабільно відтворювану модель СНС у лабораторних білих щурів шляхом двобічного перев'язування соромітних нервів. Це забезпечувало стійкі прояви СНС, що прогресували у міру збільшення тривалості експерименту. За даними уродинамічних досліджень, реєстрували зниження тиску витікання першої краплини сечі в оперованих тварин; результати гістологічних та морфометричних досліджень свідчили про збільшення просвіту сечівника, зниження тонусу м'язів. За даними дослідження, денервація сечівника та його сфінктера була стійкою, використання моделі дозволяло отримати стабільно відтворювані результати.The stress urinary incontinence (SUI), especially in women, constitutes most frequent complication of urogynecological diseases. Adequate and a stably reproducible model of SUI in white laboratory rats was created, using bilateral ligature of pudendal nerves. This guarantees a stable signs of SUI, which had progressed while the experiment duration enhanced. In accordance to the urodynamical investigations data, the leak pressure of the urine first drop in operated laboratory animals was registered; results of histological and morphometric investigations had witnessed about the ureter's diameter enhancement and the muscles tone lowering. In accordance to the investigation data, the ureter's and its sphincter denervation was stable, and the model application had permitted to obtain stably reproducible results

How do 66 European institutional review boards approve one protocol for an international prospective observational study on traumatic brain injury? Experiences from the CENTER-TBI study

Background The European Union (EU) aims to optimize patient protection and efficiency of health-care research by harmonizing procedures across Member States. Nonetheless, further improvements are required to increase multicenter research efficiency. We investigated IRB procedures in a large prospective European multicenter study on traumatic brain injury (TBI), aiming to inform and stimulate initiatives to improve efficiency. Methods We reviewed relevant documents regarding IRB submission and IRB approval from European neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Documents included detailed information on IRB procedures and the duration from IRB submission until approval(s). They were translated and analyzed to determine the level of harmonization of IRB procedures within Europe. Results From 18 countries, 66 centers provided the requested documents. The primary IRB review was conducted centrally (N = 11, 61%) or locally (N = 7, 39%) and primary IRB approval was obtained after one (N = 8, 44%), two (N = 6, 33%) or three (N = 4, 23%) review rounds with a median duration of respectively 50 and 98 days until primary IRB approval. Additional IRB approval was required in 55% of countries and could increase duration to 535 days. Total duration from submission until required IRB approval was obtained was 114 days (IQR 75-224) and appeared to be shorter after submission to local IRBs compared to central IRBs (50 vs. 138 days, p = 0.0074). Conclusion We found variation in IRB procedures between and within European countries. There were differences in submission and approval requirements, number of review rounds and total duration. Research collaborations could benefit from the implementation of more uniform legislation and regulation while acknowledging local cultural habits and moral values between countries.Peer reviewe

Tracheal intubation in traumatic brain injury: a multicentre prospective observational study

Background We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. Methods Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. Results In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79–1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65–1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. Conclusion The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting. Clinical trial registration NCT02210221

Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): A Prospective Longitudinal Observational Study

BACKGROUND: Current classification of traumatic brain injury (TBI) is suboptimal, and management is based on weak evidence, with little attempt to personalize treatment. A need exists for new precision medicine and stratified management approaches that incorporate emerging technologies. OBJECTIVE: To improve characterization and classification of TBI and to identify best clinical care, using comparative effectiveness research approaches. METHODS: This multicenter, longitudinal, prospective, observational study in 22 countries across Europe and Israel will collect detailed data from 5400 consenting patients, presenting within 24 hours of injury, with a clinical diagnosis of TBI and an indication for computed tomography. Broader registry-level data collection in approximately 20 000 patients will assess generalizability. Cross sectional comprehensive outcome assessments, including quality of life and neuropsychological testing, will be performed at 6 months. Longitudinal assessments will continue up to 24 months post TBI in patient subsets. Advanced neuroimaging and genomic and biomarker data will be used to improve characterization, and analyses will include neuroinformatics approaches to address variations in process and clinical care. Results will be integrated with living systematic reviews in a process of knowledge transfer. The study initiation was from October to December 2014, and the recruitment period was for 18 to 24 months. EXPECTED OUTCOMES: Collaborative European NeuroTrauma Effectiveness Research in TBI should provide novel multidimensional approaches to TBI characterization and classification, evidence to support treatment recommendations, and benchmarks for quality of care. Data and sample repositories will ensure opportunities for legacy research. DISCUSSION: Comparative effectiveness research provides an alternative to reductionistic clinical trials in restricted patient populations by exploiting differences in biology, care, and outcome to support optimal personalized patient management

Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury : A European Prospective and Multicenter Study

Background Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care. Objective Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI. Methods Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge. Results In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24). Conclusions Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.Peer reviewe