The new formulation of the 0,05% sodium hypochlorite electrolytic solution for cutaneous use: reasons and advantages

Superinfection of skin lesions is quite common, and often delays wound recovery. Infection control plays therefore a key role in the management of skin lesions, requiring the use of specific antimicrobials. Among available agents, topic antiseptic drugs are currently recommended as a first-choice option, to be preferred to antibiotics, given the growing resistance to these drugs. Compared to antibiotics, antiseptic drugs have a wider spectrum of action, including bacteria, fungi, virus, protozoa, and prions. The ideal antiseptic for the management of an infected skin lesion is expected to be both highly effective and well tolerated, in order to promote the physiologic process of tissue restoration. Among available antiseptics, the 0,05% sodium hypochlorite electrolytic solution meets these criteria: the product proved to be effective in vitro and in animal experimental models against a wide range of microorganisms, besides exerting an anti-inflammatory action in the absence of any irritating, cytotoxic or carcinogenic adverse effect, and being useful in biofilm removal. Similarly, in several clinical trials, the 0,05% sodium hypochlorite electrolytic solution was demonstrated to be very effective and safe in the management of infected skin wounds: based on these results, this product should be strongly considered among the first-choice options for the disinfection of skin wounds. The new formulation, developed according to the latest reference standards for wound healing and in agreement with current guidelines, is qualitatively improved, with an expected positive impact in every field of clinical application and a subsequent benefit for treated patients

Converged Digital TV Services: The Role of Middleware and Future Directions of Interactive Television

The migration from analog to digital of the broadcasting technologies, already well consolidated for satellite systems, is becoming a reality also for terrestrial transmission. Digital Terrestrial Television (DTT) is also evolving to offer interactive services and a degree of flexibility which can be exploited to offer tailored applications to users which include, for instance interactivity, different levels of personalization, and innovative location-based, as well as context-aware, services. A clear example of this trend is given by the rising success of the Internet Protocol Television (IPTV) which allows for a degree of flexibility on offered services unknown to the traditional broadcasting systems. In this framework, several satellite operators are starting to launch IPTV services using direct satellite links, as well as some terrestrial internet service providers are offering digital TV channels embedded in the IP streaming over XDSL. Furthermore, IPTV services are likely to be broadcast also wirelessly, exploiting advanced broadband access technologies such asWiMAX, LTE, or LTEA. Last, but not least, TV and broadcast services for mobile users have also been deployed in many countries using DVBH and will be soon available on an even broader scale thanks to its satellite counterpart, DVB-SH. In the near future, a set of different technologies able to offer personalized and customized services to different classes of users are expected in the area of wireless broadcasting and convergence of technologies is auspicious. This concept entails different levels of convergence, namely, at terminal level (one device fits all), at service level (convergence of traditional fixed, mobile, and broadcast services), and at transport and network level with a common and standardized set of protocols and at access layer thanks to the harmonic coexistence of different radio technologies. This special issue aims to capture the state-of-the-art research work concerning the integration of DTT/Satellite/IPTV systems for the broadcasting of multimedia and interactive services

La continuità assistenziale nella gestione delle lesioni da pressione: un opuscolo informativo per la collaborazione ospedale-territorio

Il progetto consiste nella creazione di un opuscolo informativo, all'interno del quale sono spiegate le principali informazioni relative la gestione del paziente portatore di Lesioni da Pressione. Le nozioni espresse sono alla base del percorso terapeutico, in quando sono indirizzate a lettori non esperti nel campo delle medicazioni difficili. Viste le esigenze del pubblico di assistere a questa tipologia di pazienti, in molti casi in maniera autonoma per quanto riguarda la medicazione vera e proprio, si è ritenuto necessario fornire del materiale per aumentare le conoscenze dei caregiver informali. Lo scopo ultimo è proprio quello di fornire un metodo semplice e sicuro di apprendimento per i cittadini che si occupano della gestione del paziente e delle relative medicazioni; considerando sempre un affiancamento da parte di professionisti. Gli obiettivi che ci si pone con il progetto sono: valutare e visualizzare quelli che sono gli aspetti importanti per i soggetti aventi Lesioni da Pressione, questo comprende la definizione, prevenzione, classificazione e trattamento; l'importanza della continuità assistenziale per questa tipologia di paziente; informare il cittadino su cosa sono le lesioni da pressione (quali sono le accortezze quotidiane da dover attuare per evitare il peggioramento o lo stallo della condizione) ed infine il trattamento vero e proprio tramite l'insegnamento delle medicazioni difficili e della loro applicazione in base ai diversi casi (essendo un argomento vasto e materia di specializzazione in ambito infermieristico si tratterà in maniera semplificata in modo da dare informazioni basilari ma utili). Per la creazione dell'opuscolo è stata effettuata una revisione della letteratura che vede la consultazione di due linee guida, undici articoli e due testi

Esiste un'alternativa alla matrice dermica acellulare per la gestione delle ferite? Rivisitazione del ruolo di una medicazione bioattiva a base di collagene e acido ialuronico

La guarigione delle ferite è un processo complesso che coinvolge molte interazioni sinergiche tra diverse linee cellulari, citochine, enzimi e fattori di crescita. Negli ultimi anni sono stati introdotti diversi biomateriali e medicazioni bioattive che si ritiene svolgano un ruolo attivo nella guarigione delle ferite. Sia il collagene che l'Acido Ialuronico (AI) sono stati ampiamente adottati per la gestione delle ferite e la sua combinazione, utilizzata come medicazione bioattiva, è stata studiata. Abbiamo riportato la nostra esperienza clinica con una medicazione avanzata composta da AI più collagene eterologo di tipo I applicato su ferite acute e croniche di diversa eziologia in una coorte retrospettiva di 30 pazienti. Tutti i pazienti inclusi avevano ferite cutanee portate a guarigione completa per seconda intenzione, e tutte le ferite sono state trattate utilizzando Bionect Pad® (BP). Se necessario, alcuni casi sono stati gestiti con trattamenti combinati al fine di ottenere un'adeguata preparazione del letto della ferita prima dell'applicazione di BP. Trenta pazienti con età media di 60,2 anni sono stati trattati per ferite di diversa eziologia. La tipologia di ferite trattate includeva ulcere venose, ferite post-traumatiche, complicanze di ferite chirurgiche, lesioni da decubito, ustioni, ulcerazioni peristomali e ulcerazioni cutanee dopo radioterapia. Il tempo medio di guarigione è stato di 31 giorni (range: 21-76 giorni). Sulla base dei nostri risultati incoraggianti, riteniamo che tali medicazioni bioattive possano essere considerate un'alternativa utile e affidabile ad altri metodi di trattamento ben noti e consolidati, come le matrici dermiche acellulari o altre medicazioni avanzate, in casi selezionati

ossigenoterapia iperbarica e terapia a pressione negativa nel trattamento delle lesioni difficili hyperbaric oxygen therapy and negative pressure wound therapy in the treatment of non healing wounds

Lo scopo di questo articolo è valutare i risultati ottenibili trattando lesioni difficili attraverso la combinazione di ossigenoterapia iperbarica (OTI) e terapia a pressione negativa (TPN). Individuare le modalità con cui queste possano agire in sinergia coadiuvandosi, al fine di ottimizzare la rigenerazione dei tessuti e favorire la guarigione come qualità e tempi più brevi. Sono stati presi in analisi i dati di tre pazienti trattati presso il Centro Iperbarico di Ravenna che presentavano ferite agli arti inferiori aperte da più di sei settimane. È stato eseguito l'assessment iniziale della ferita e applicato un approccio multi terapeutico OTI e TPN per un periodo compreso tra 3-6 settimane. I pazienti presi in analisi sono giunti a guarigione completa entro 10 settimane di trattamento rispetto alla media di presa in carico per 28 settimane degli altri pazienti trattati presso la stessa struttura (dato reale) e alla media di 12 settimane previste nelle linee guida (benchmark). Le due terapie associate hanno prodotto un esito positivo che avrebbe richiesto tempi e costi maggiori se fossero state utilizzate singolarmente. The purpose of this work is the evaluation of the results obtaineble by treating hard to heal wounds with the combination of Hyperbaric Oxygen Therapy (HBOT) and Negative Wound Pressure Therapy (NWPT). Identify how HBOT and NWPT can act in synergy, in order to optimize tissue regeneration and promote a good quality healing and in shorter time. The study analyzes data of three patients affected, for more than six week, by lower limb wounds and treated at the Hyperbaric Center of Ravenna. The initial wound assessment was performed and a multi-therapeutic approach, HBOT and NWPT, was applied over a period of 3-6 weeks. The patients underwent to a complete healing after a maximum of 10 weeks of treatment compared to the 28-weeks average of other patients treated at the same facility (real data) and the 12-weeks average expected in the guidelines (benchmark).The combination of the two therapies, has led to a positive result saving time and money; the individual use of them would have required more time and costs

Non enzymatic upregulation of tissue factor expression by gamma-glutamyl transferase in human peripheral blood mononuclear cells

Background Besides maintaining intracellular glutathione stores, gamma-glutamyltransferase(GGT) generates reactive oxygen species and activates NFkB, a redox-sensitive transcription factor key in the induction of Tissue Factor (TF) gene expression, the principal initiator of the clotting cascade. Thus, GGT might be involved in TF-mediated coagulation processes, an assumption untested insofar. Methods Experiments were run with either equine, enzymatically active GGT or human recombinant (hr) GGT, a wheat germ-derived protein enzymatically inert because of missing post-translational glycosylation. TF Procoagulant Activity (PCA, one-stage clotting assay), TF antigen(ELISA) and TFmRNA(real-time PCR) were assessed in unpooled human peripheral blood mononuclear cell(PBMC) suspensions obtained from healthy donors through discontinuous Ficoll/Hystopaque density gradient. Results Equine GGT increased PCA, an effect insensitive to GGT inhibition by acivicin suggesting mechanisms independent of its enzymatic activity, a possibility confirmed by the maintained stimulation in response to hrGGT, an enzymatically inactive molecule. Endotoxin(LPS) contamination of GGT preparations was excluded by heat inactivation studies and direct determination(LAL method) of LPS concentrations <0.1 ng/mL practically devoid of procoagulant effect. Inhibition by anti-GGT antibodies corroborated that conclusion. Upregulation by hrGGT of TF antigen and mRNA and its downregulation by BAY-11-7082, a NFkB inhibitor, and N-acetyl-L-cysteine, an antioxidant, was consistent with a NFkB-driven, redox-sensitive transcriptional site of action. Conclusions GGT upregulates TF expression independent of its enzymatic activity, a cytokine-like behaviour mediated by NFκB activation, a mechanism contributing to promote acute thrombotic events, a possibility in need, however, of further evaluation

miR-19a and miR-20a and tissue factor expression in activated human peripheral blood mononuclear cells

Background and Aims. To investigate the behaviour of miR-19a and miR-20a, two microRNAs involved in posttranscriptional modulation of TF expression in peripheral blood mononuclear cells (PBMCs) exposed to high glucose (HG) and lipopolysaccharide (LPS), and to evaluate the involvement of angiotensin II in that process. Methods. TF Procoagulant Activity (PCA, one-stage clotting assay), antigen (Ag, ELISA), and miR-19a and miR-20a levels (specific TaqMan® MicroRNA Assays) were evaluated in PBMCs exposed to high glucose (HG, 50 mM), LPS (100 ng/mL), and Olmesartan (OLM, 10−6 M), an angiotensin II type 1 receptor antagonist. Results. HG increased TF expression and decreased both miRs as compared to control glucose conditions (11.1 mM). In HG-activated PBMCs, LPS stimulated TF expression and downregulated miR-20a, an effect reverted by OLM (10−6 M); miR-19a expression was unchanged by LPS in both CG and HG conditions. Conclusions. miR-19a and miR-20a are inhibited by inflammatory stimuli active on TF expression and their response differs by the stimulus under investigation; angiotensin II may participate in that mechanism

Advanced Fade Countermeasures for DVB-S2 Systems in Railway Scenarios

This paper deals with the analysis of advanced fade countermeasures for supporting DVB-S2 reception by mobile terminals mounted on high-speed trains. Recent market studies indicate this as a potential profitable market for satellite communications, provided that integration with wireless terrestrial networks can be implemented to bridge the satellite connectivity inside railway tunnels and large train stations. In turn, the satellite can typically offer the coverage of around 80% of the railway path with existing space infrastructure. This piece of work, representing the first step of a wider study, is focusing on the modifications which may be required in the DVB-S2 standard (to be employed in the forward link) in order to achieve reliable reception in a challenging environment such as the railway one. Modifications have been devised trying to minimize the impact on the existing air interface, standardized for fixed terminals

The effect of high glucose on the inhibitory action of C21, a selective AT2R agonist, of LPS-stimulated tissue factor expression in human mononuclear cells

Background: Intimate links connect tissue factor (TF), the principal initiator of the clotting cascade, to inflammation, a cross-talk amplified by locally generated Angiotensin (AT) II, the effector arm of the Renin Angiotensin System (RAS). C21, a selective AT2R agonist, downregulates the transcriptional expression of TF in LPS-activated peripheral blood mononuclear cell(PBMC)s implying the existence of ATII type 2 receptor (AT2R)s whose stimulation attenuates inflammation-mediated procoagulant responses. High glucose, by activating key signalling pathways and increasing the cellular content of RAS components, augments TF expression and potentiates the inhibitory effect of AT1R antagonists. It is unknown, however, the impact of that stimulus on AT2R-mediated TF inhibition, an information useful to understand more precisely the role of that signal transduction pathway in the inflammation-mediated coagulation process. TF antigen (ELISA), procoagulant activity (PCA, 1-stage clotting assay) and TF-mRNA (real-time polymerase chain reaction) were assessed in PBMCs activated by LPS, a pro-inflammatory and procoagulant stimulus, exposed to either normal (N) or HG concentrations (5.5 and 50 mM respectively). Results: HG upregulated TF expression, an effect abolished by BAY 11-7082, a NFκB inhibitor. C21 inhibited LPS-stimulated PCA, TFAg and mRNA to an extent independent of glucose concentration but the response to Olmesartan, an AT1R antagonist, was quite evidently potentiated by HG. Conclusions: HG stimulates LPS-induced TF expression through mechanisms completely dependent upon NFkB activation. Both AT2R-stimulation and AT1R-blockade downregulate inflammation-mediated procoagulant response in PBMCs but HG impacts differently on the two different signal transduction pathway

The Combination of a Hypertonic Saline Dressing and Negative Pressure Wound Therapy (NPWT) for Quick and Bloodless Debridement of Difficult Lesions in Complicated Patients

NPWT, also known as topical negative-pressure wound therapy, is widely used in managing and accelerating wound healing. However in wounds were slough is highly represented NPWT efficiency is low. In the patients included in this study clinical health conditions were precarious. We needed a rapid wound healing to not further compromise their health condition. So we added curity dressing to resolve the slough issue. In all the patients we observed slough reduction. This treatment provided beneficial for the patient, the surgeons and the National Health Service. Accelerating wound healing reduced hospitalization and thereby the patients achieved a reduction of risks of nosocomial infections and physical and psychological diseases