A New Method for Treating Burn Wounds Using Targeted Delivery of Medicinal Substances by Magnetic Nanocarrier (Experimental Part)

Проведено экспериментальное исследование на лабораторных животных по изучению эффективности адресной доставки мази левомеколь с помощью магнитных наночастиц и внешнего магнитного поля при термических ожогах. В исследовании принимало участие 20 крыс с двумя очагами ожога. Крысы были разделены на 4 группы: без лечения, терапия с использованием мази левомеколь, лечение с использованием наночастиц, мази левомеколь и внешнего магнитного поля и только магнитотерапии. При гистологическом исследовании на 14-е сутки во всех группах в зоне термического повреждения кожи были отмечены признаки глубокого ожога III и IV степени с распространением некроза на всю глубину дермы и на мышцы. В группе с наночастицами, мазью левомеколь и магнитным полем на фоне уменьшения воспаления отмечалось очаговое появление грануляционной ткани. Таким образом, гистологические исследования ожогового раневого процесса лабораторных животных показали, что использование инновационного биологически активного ранозаживляющего средства на основе наночастиц в сочетании с мазью левомеколь улучшает регенерацию тканей и приводит к ускорению эпителизации, что в целом повышает результаты лечения ожоговой раны. Использование внешнего магнитного поля способствует адресной доставке лечебного нанокомплекса и поддержанию оптимальной концентрации препарата в ранеExperimental studies have been carried out on laboratory animals to investigate the effectiveness of targeted delivery of levomekol ointment using magnetic nanoparticles and an external magnetic field for treatment of thermal burns. The study involved 20 rats, with two burns on each. The rats were divided into 4 groups: untreated; treated with levomekol ointment; treated with levomekol ointment associated with nanoparticles and an external magnetic field; and treated with magnetic field alone. Histological examination was conducted on Day 14, and in all groups, in the thermal burn zone of the skin there were signs of deep three- and four-degree burns with necrosis spread through the dermis, reaching the muscle. In the group with levomekol ointment associated with nanoparticles and magnetic field, inflammation was decreased, and focal granulation tissue formation was observed. Thus, histological studies of the burn wound process in laboratory animals showed that the use of an innovative biologically active wound healing agent based on nanoparticles in combination with the levomecol ointment improved tissue regeneration and accelerated epithelialization, which enhanced the effectiveness of burn wound treatment. The use of an external magnetic field facilitated targeted delivery of the therapeutic nanosystem and maintenance of the optimal concentration of the drug in the woun

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)