Response to 'Re. Improvement of Venous Pumping Function by Double Progressive Compression Stockings: Higher Pressure Over the Calf is More Important Than a Graduated Pressure Profile'

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Inelastic Compression is Effective Over Time in Spite of Significant Pressure Drop

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Compression Therapy in Mixed Ulcers: Search for a Safe Pressure Range not Affecting Arterial Inflow

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High Compression Pressure over the Calf is More Effective than Graduated Compression in Enhancing Venous Pump Function

AbstractBackgroundGraduated compression is routinely employed as standard therapy for chronic venous insufficiency.AimThe study aims to compare the haemodynamic efficiency of a multi-component graduated compression bandage (GCB) versus a negative graduated compression bandage (NGCB) applied with higher pressure over the calf.MethodsIn 20 patients, all affected by greater saphenous vein (GSV) incompetence and candidates for surgery (Clinical, etiologic, anatomic and pathophysiologic data, CEAP C2-C5), the ejection fraction of the venous calf pump was measured using a plethysmographic method during a standardised walking test without compression, with GCB and NGCB, all composed of the same short-stretch material. Sub-bandage pressures were measured simultaneously over the distal leg and over the calf.ResultsNGCBs with median pressures higher at the calf (62 mmHg) than at the distal leg (50 mmHg) achieved a significantly higher increase of ejection fraction (median +157%) compared with GCB, (+115%) with a distal pressure of 54 mmHg and a calf pressure of 28 mmHg (P < 0.001).ConclusionsPatients with severe venous incompetence have a greater haemodynamic benefit from NGCB, especially during standing and walking, than from GCB

Compression Stockings with a Negative Pressure Gradient Have a More Pronounced Effect on Venous Pumping Function than Graduated Elastic Compression Stockings

AbstractObjectivesTo measure the effect on the venous pumping function of a stocking providing a negative pressure gradient with higher pressures over the calf in comparison to a conventional graduated elastic compression stocking (GECS) in patients with advanced venous insufficiency.DesignExperimental study.Material30 patients with severe superficial chronic venous insufficiency were enrolled. Two elastic stocking designs exerting a pressure at ankle between 15 and 25 mm Hg were compared; a conventional GECS and a stocking exerting a higher pressure over the calf than over the ankle producing a “progressive” increase in compression (PECS).Methodthe venous calf pumping function was assessed by measuring the ejection fraction (EF) from the lower leg by a plethysmographic method during a standardised exercise. Interface pressure of the 2 compression devices was simultaneously recorded both at B1 = 12 cm above ankle, C = just above widest part of calf.ResultsThe mean increase of EF produced by PECS was +75% (95 CI 48,7-101,3) compared with +32% (95%CI 16,8-48,6) with GECS (P < 0.001). There was a significant correlation between EF and the stocking pressure measured at calf level during standing and walking.ConclusionStockings exerting a higher pressure on the calf than on the ankle show a greater efficacy in increasing the venous ejection fraction from the leg

Bandages or Double Stockings for the Initial Therapy of Venous Oedema? A Randomized, Controlled Pilot Study

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Adjustable Velcro® Compression Devices are More Effective than Inelastic Bandages in Reducing Venous Edema in the Initial Treatment Phase: A Randomized Controlled Trial

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Volume control of the lower limb with graduated compression during different muscle pump activation conditions and the relation to limb circumference variation

Background: The literature supports the use of graduated compression stockings (GCS) for leg edema. Nevertheless, there is a paucity of data on the GCS effect on limb edema related to sitting, standing, and walking. Data of different limb shapes and their impact on GCS-exerted pressure are lacking. This investigation provides evidence-based information on the effect of GCS on edema reduction and the impact of limb circumference gradients on GCS pressure. Methods: Thirty healthy individuals (15 men and 15 women; mean age, 32 ± 5 years) were included. All the participants underwent lower limb volume (Kuhnke formula) measurement, before and after sitting for 30 minutes, wearing below-ankle noncompressive socks. The same assessment was repeated 7 days later, in the same participants, but with wearing of below-knee 16 to 20 mm Hg GCS. At 7-day intervals, 1 week with below-ankle noncompressive socks and 1 week with below-knee 16 to 20 mm Hg GCS, all the participants repeated the same protocol including standing and walking. Ten participants underwent bioimpedance assessment (Biody Xpert II; eBIODY, La Ciotat, France) before and after sitting, standing, and walking. In the same group, B and B1 interface pressure values were measured. Results: Data collection was completed in all 60 limbs. Sitting or walking without GCS led to no significant volume changes, whereas volume was decreased by the use of GCS (−4.8% [P &lt;.00001] and −4.4% [P &lt;.00001], respectively). Standing up without GCS led to an increase in volume (2.7%; P &lt;.0001), whereas limb volume was decreased (4.6%; P &lt;.0001) by use of GCS. Bioimpedance showed extracellular water reduction only while walking with GCS (from 40.55% ± 1.66% to 40.45% ± 1.71%; P &lt;.017). Mean interface pressure was 19 ± 5 mm Hg (B) and 16 ± 5 mm Hg (B1). The interface pressure variation from B to B1 was not homogeneous among participants (mean percentage variation of −13% ± 25%, ranging from −54% to 16%). A negative linear trend between pressure variation and circumference percentage increase was found; the subanalysis excluding the two outliers showed a strong negative linear correlation (Pearson coefficient r = −0.96). Conclusions: GCS led to a significant limb volume reduction irrespective of limb position and muscle pump function. However, extracellular fluid is mobilized only during muscle contraction while walking with GCS. Interestingly, different lower limb circumference variations influence the interface pressure gradient, indicating the importance of proper fitting of both B and B1 during prescription. These data provide a foundation to future investigations dealing with GCS effect on fluid mobilization and with limb geometry impact on compression performance

Preparation of aluminum oxide nanoparticles with different morphologies

Nanoparticles Al[2]O[3] plays a crucial role in application for drug delivery systems. This study are shown that nanospray method offers significant benefits to produce nanopowder from nitrate aluminum and sulfate aluminum with unique characteristic such as size, morphology and properties for using as drug carriers. Nanopowder from nitrate with a temperature velocity 3 K/min have specific surface area 8.96±0.03 m{2}/gr and 24.04±0.14 m{2}/gr for velocity 6 K/min. Particles size of these materials between 100 nm to 1 [mu]m

SARS-CoV-2 nasopharyngeal viral load in individuals infected with BA.2, compared to Alpha, Gamma, Delta and BA.1 variants: A single-center comparative analysis

BACKGROUND: SARS-CoV-2 has evolved, leading to the emergence of new Variants Of Concern (VOCs) with significant impact on transmissibility. Although the transmission process is complex, higher nasopharyngeal viral load (NP-VL) can be considered as a proxy for greater transmissibility. OBJECTIVES: The aim of this analysis was to compare NP-VL across a set of representative VOCs observed in mildly symptomatic patients. STUDY DESIGN: Observational single-center comparative analysis of patients with early mild-to-moderate COVID-19, enrolled within the early treatment access program of Lazzaro Spallanzani Institute (March 2021-March 2022). NP-VL before drug administration was estimated through RT-PCR, based on cycle threshold values (CTs); VOCs were identified by Sanger sequencing. VOCs’ average treatment effect (ATE) was estimated on the CTs fitted in the log2 scale, controlling for potential confounders. RESULTS: A total of 707 patients were included. VOCs were: 10% Alpha, 3% Gamma, 34% Delta, 34% BA.1, 19% BA.2. Mean CTs for BA.1 and BA.2 were lower than Delta and BA.1, respectively. After adjusting for calendar time, age, immunodeficiency and vaccination, CTs for Gamma were lower than those seen for Alpha and higher than Delta, for Delta were similar to BA.1, for BA.2 were lower than Delta and BA.1. CONCLUSIONS: Our analysis shows higher NP-VL of BA.2 compared to previously circulating VOCs, even after controlling for factors potentially contributing to the amount of nasopharyngeal viral RNA, included vaccination, supporting the increased transmissibility of BA.2. Further studies are necessary to clarify this mechanism and to provide guidance for public health measures