Assessment of the effect of low-cost negative pressure dressing on wound healing

Background: Wound care is a priority element in the management of grade 3 compound fractures and has traditionally relied on the use of dressing products (gauze, foam dressings, alginates, and hydrocolloids) and manual debridement. Paving the way to the future, there are now several alternative therapies, of which negative pressure wound therapy (NPWT) is an emerging treatment. Negative suction dressing has been proven to be superior in wound healing and is faster compared with regular dressing using gauze, hydrocolloids, and local debridement. It leads to faster rates of skin cover spontaneously or with surgical procedures like skin graft and flaps, eventually resulting in early internal fixation of fractured bones, if any.  The present study was designed to assess the effect of the negative pressure dressing technique on wound healing and to compare its effect with that of the conventional dressing technique. Methods: The study was a double-blind randomized control trial conducted after ethics approval. A case record form was used for data collection after obtaining the participants’ informed consent, and a total of 120 patients participated in the study. Results: Low-cost negative pressure dressing has an effect on general conditions, fever, hyperemia, and irregular margins. It was observed to increase granulation tissue formation and decrease pus/serous discharge and was associated with a decreased number of hospital visits due to early healing compared with normal dressing. Conclusions: The low-cost negative dressing technique was effective in healing wounds in type III open fractures and was associated with early recovery compared with the normal dressing technique

Entrepreneuriat dans le secteur informel au Togo : les facteurs de succès des jeunes entrepreneurs

La problématique de l’emploi a fortement marqué les débats ces dernières décennies et reste une préoccupation majeure pour les gouvernants. La question de l’emploi a longtemps demeuré une équation à multiple inconnues surtout pour les pays en voie de développement. A cet effet, pour apporter des réponses au problème de l’emploi en général et celui des jeunes en particulier, l’une des réponses est l’entreprenariat. Ce dernier est plus visible dans le secteur informel que celui dit formel. Ainsi, l’objectif de cet article est de relever les facteurs de succès des entreprises évoluant dans le secteur informel. Ce secteur regorge la plus grande partie des travailleurs des entreprises individuelles (86,4%) contre 13,6% dans d’autres formes juridiques (INSEED, RGE 2018) montrant à suffisance que ce secteur est dominé par les entreprises individuelles. Les unités informelles emploient plus de personnels (58,2%) (INSEED, RGE 2018). La méthodologie qualitative a été adoptée dans cette démarche avec une analyse de contenu. Les enquêtes ont montré que 73% ont plus de cinq (5) ans d’âge. La réussite de toute entreprise dépend de plusieurs facteurs notamment la personnalité du dirigeant ou du promoteur, ses qualifications, son niveau d’étude, l’environnement organisationnel, institutionnel et culturel et même l’aspect spirituel est souvent évoqué

An investigation of toxicities and survival in Hispanic children and adolescents with ALL: Results from the Danaâ Farber Cancer Institute ALL Consortium protocol 05â 001

PurposeThis study compared the relative incidence of treatmentâ related toxicities and the eventâ free and overall survival between Hispanic and nonâ Hispanic children undergoing therapy for acute lymphoblastic leukemia (ALL) on Danaâ Farber Cancer Institute ALL Consortium protocol 05â 001.Patients and methodsSecondary analysis of prospectively collected data from a phase III multicenter study in children and adolescents of 1â 18 years with previously untreated ALL.ResultsBetween 2005 and 2011, 794 eligible patients enrolled on DFCI 05â 001, 730 of whom were included in this analysis (19% [N = 150] Hispanic, 73% [N = 580] nonâ Hispanic). Hispanic patients were more likely to be â ¥10 years of age (32% vs. 24%, P = 0.045) at diagnosis. Toxicity analyses revealed that Hispanic patients had significantly lower cumulative incidence of bone fracture (P < 0.001) and osteonecrosis (ON; P = 0.047). In multivariable risk regression, the risk of ON was significantly lower in Hispanic patients â ¥10 years (HR 0.23; P = 0.006). Hispanic patients had significantly lower 5â year eventâ free survival (EFS) (79.4%; 95% CI: 71.6â 85.2) and overall survival (OS) (89.2%; 95% CI: 82.7â 93.4) than nonâ Hispanic patients (EFS: 87.5%; 95% CI: 84.5â 90.0, P = 0.004; OS: 92.7%; 95% CI: 90.2â 94.6, P = 0.006). Exploratory analyses revealed differences between Hispanic and nonâ Hispanic patients in the frequency of common variants in genes related to toxicity or ALL outcome.ConclusionHispanic children treated for ALL on DFCI 05â 001 had fewer boneâ related toxicities and inferior survival than nonâ Hispanic patients. While disease biology is one explanatory variable for outcome disparities, these findings suggest that biologic and nonâ biologic mechanisms affecting drug delivery and exposure in this population may be important contributing factors as well.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141132/1/pbc26871.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141132/2/pbc26871_am.pd

Continuous monitoring of the bronchial epithelial lining fluid by microdialysis

<p>Abstract</p> <p>Background</p> <p>Contents of the epithelial lining fluid (ELF) of the bronchi are of central interest in lung diseases, acute lung injury and pharmacology. The most commonly used technique broncheoalveolar lavage is invasive and may cause lung injury. Microdialysis (MD) is a method for continuous sampling of extracellular molecules in the immediate surroundings of the catheter. Urea is used as an endogenous marker of dilution in samples collected from the ELF. The aim of this study was to evaluate bronchial MD as a continuous monitor of the ELF.</p> <p>Methods</p> <p>Microdialysis catheters were introduced into the right main stem bronchus and into the right subclavian artery of five anesthetized and normoventilated pigs. The flowrate was 2 μl/min and the sampling interval was 60 minutes. Lactate and fluorescein-isothiocyanate-dextran 4 kDa (FD-4) infusions were performed to obtain two levels of steady-state concentrations in blood. Accuracy was defined as [bronchial-MD] divided by [arterial-MD] in percent. Data presented as mean ± 95 percent confidence interval.</p> <p>Results</p> <p>The accuracy of bronchial MD was calculated with and without correction by the arteriobronchial urea gradient. The arteriobronchial lactate gradient was 1.2 ± 0.1 and FD-4 gradient was 4.0 ± 1.2. Accuracy of bronchial MD with a continuous lactate infusion was mean 25.5% (range 5.7–59.6%) with a coefficient of variation (CV) of 62.6%. With correction by the arteriobronchial urea gradient accuracy was mean 79.0% (57.3–108.1%) with a CV of 17.0%.</p> <p>Conclusion</p> <p>Urea as a marker of catheter functioning enhances bronchial MD and makes it useful for monitoring substantial changes in the composition of the ELF.</p

Subgroups of Paediatric Acute Lymphoblastic Leukaemia Might Differ Significantly in Genetic Predisposition to Asparaginase Hypersensitivity.

L-asparaginase (ASP) is a key element in the treatment of paediatric acute lymphoblastic leukaemia (ALL). However, hypersensitivity reactions (HSRs) to ASP are major challenges in paediatric patients. Our aim was to investigate genetic variants that may influence the risk to Escherichia coli-derived ASP hypersensitivity. Sample and clinical data collection was carried out from 576 paediatric ALL patients who were treated according to protocols from the Berlin-Frankfurt-Munster Study Group. A total of 20 single nucleotide polymorphisms (SNPs) in GRIA1 and GALNT10 genes were genotyped. Patients with GRIA1 rs4958351 AA/AG genotype showed significantly reduced risk to ASP hypersensitivity compared to patients with GG genotype in the T-cell ALL subgroup (OR = 0.05 (0.01-0.26); p = 4.70E-04), while no such association was found in pre-B-cell ALL. In the medium risk group two SNPs of GRIA1 (rs2055083 and rs707176) were associated significantly with the occurrence of ASP hypersensitivity (OR = 0.21 (0.09-0.53); p = 8.48E-04 and OR = 3.02 (1.36-6.73); p = 6.76E-03, respectively). Evaluating the genders separately, however, the association of rs707176 with ASP HSRs was confined only to females. Our results suggest that genetic variants of GRIA1 might influence the risk to ASP hypersensitivity, but subgroups of patients can differ significantly in this respect

Localization of AQP5 during development of the mouse submandibular salivary gland

Aquaporin 5 (AQP5) is known to be central for salivary fluid secretion. A study of the temporal-spatial distribution of AQP5 during submandibular gland (SMG) development and in adult tissues might offer further clues to its unknown role during development. In the present work, SMGs from embryonic day (E) 14.5–18.5 and postnatal days (P) 0, 2, 5, 25, and 60 were immunostained for AQP5 and analyzed using light microscopy. Additional confocal and transmission electron microscopy were performed on P60 glands. Our results show that AQP5 expression first occurs in a scattered pattern in the late canalicular stage and becomes more prominent and organized in the terminal tubuli/pro-acinar cells towards birth. Additional apical membrane staining in the entire intralobular duct is found just prior to birth. During postnatal development, AQP5 is expressed in both the luminal and lateral membrane of pro-acinar/acinar cells. AQP5 is also detected in the basal membrane of acinar cells at P25 and P60. In the intercalated ducts at P60, the male glands show apical staining in the entire segment, while only the proximal region is positive in the female glands. These results demonstrate an evolving distribution of AQP5 during pre- and postnatal development in the mouse SMGs

A Novel Role for Aquaporin-5 in Enhancing Microtubule Organization and Stability

Aquaporin-5 (AQP5) is a water-specific channel located on the apical surface of airway epithelial cells. In addition to regulating transcellular water permeability, AQP5 can regulate paracellular permeability, though the mechanisms by which this occurs have not been determined. Microtubules also regulate paracellular permeability. Here, we report that AQP5 promotes microtubule assembly and helps maintain the assembled microtubule steady state levels with slower turnover dynamics in cells. Specifically, reduced levels of AQP5 correlated with lower levels of assembled microtubules and decreased paracellular permeability. In contrast, overexpression of AQP5 increased assembly of microtubules, with evidence of increased MT stability, and promoted the formation of long straight microtubules in the apical domain of the epithelial cells. These findings indicate that AQP5-mediated regulation of microtubule dynamics modulates airway epithelial barrier properties and epithelial function

Nintedanib for Systemic Sclerosis-Associated Interstitial Lung Disease

BACKGROUND: Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis and a leading cause of systemic sclerosis-related death. Nintedanib, a tyrosine kinase inhibitor, has been shown to have antifibrotic and antiinflammatory effects in preclinical models of systemic sclerosis and ILD. METHODS: We conducted a randomized, double-blind, placebo-controlled trial to investigate the efficacy and safety of nintedanib in patients with ILD associated with systemic sclerosis. Patients who had systemic sclerosis with an onset of the first non-Raynaud's symptom within the past 7 years and a high-resolution computed tomographic scan that showed fibrosis affecting at least 10% of the lungs were randomly assigned, in a 1:1 ratio, to receive 150 mg of nintedanib, administered orally twice daily, or placebo. The primary end point was the annual rate of decline in forced vital capacity (FVC), assessed over a 52-week period. Key secondary end points were absolute changes from baseline in the modified Rodnan skin score and in the total score on the St. George's Respiratory Questionnaire (SGRQ) at week 52. RESULTS: A total of 576 patients received at least one dose of nintedanib or placebo; 51.9% had diffuse cutaneous systemic sclerosis, and 48.4% were receiving mycophenolate at baseline. In the primary end-point analysis, the adjusted annual rate of change in FVC was 1252.4 ml per year in the nintedanib group and 1293.3 ml per year in the placebo group (difference, 41.0 ml per year; 95% confidence interval [CI], 2.9 to 79.0; P=0.04). Sensitivity analyses based on multiple imputation for missing data yielded P values for the primary end point ranging from 0.06 to 0.10. The change from baseline in the modified Rodnan skin score and the total score on the SGRQ at week 52 did not differ significantly between the trial groups, with differences of 120.21 (95% CI, 120.94 to 0.53; P=0.58) and 1.69 (95% CI, 120.73 to 4.12 [not adjusted for multiple comparisons]), respectively. Diarrhea, the most common adverse event, was reported in 75.7% of the patients in the nintedanib group and in 31.6% of those in the placebo group. CONCLUSIONS: Among patients with ILD associated with systemic sclerosis, the annual rate of decline in FVC was lower with nintedanib than with placebo; no clinical benefit of nintedanib was observed for other manifestations of systemic sclerosis. The adverse-event profile of nintedanib observed in this trial was similar to that observed in patients with idiopathic pulmonary fibrosis; gastrointestinal adverse events, including diarrhea, were more common with nintedanib than with placebo