Как выбрать вариант NPWT на практике (губки или повязки, показания к их использованию в зависимости от цели лечения, выбор аппарата)

NPT is part of the daily management of complex wounds with delayed healing. It is essential in 2018 to understand the mechanisms of action of the various machines available on the wound market in France. In order to put the right indication for a defined clinical problem to know the difference between fixed and heavy techniques, imposing immobilization of the patient due to the need for a permanent connection and the simpler, ambulatory techniques that combine effective negative pressure while allowing a better quality of life. The recent contribution of the instillation has completed the offer by opening the possibility of instilling in the wound variable liquids in their composition and their effect. The recent introduction of a new foam also suggests the possibility of cleaning the wound with a tool hitherto reserved for the promotion of granulation tissue.Терапия отрицательным давлением (NPWT – negative pressure wound therapy) является частью протокола лечения сложных ран при их замедленном заживлении. На сегодняшний день необходимо понимать механизмы действия различных аппаратов для NPWT, которые представлены на рынке. Рекомендации, применимые к конкретным клиническим ситуациям, приведены с учетом разницы между стационарными методами, требующими обездвиживания пациента из-за необходимости постоянного подключения к устройству, создающему отрицательное давление, и более простыми, амбулаторными методами, которые позволяют проводить эффективную NPWT, обеспечивая при этом лучшее качество жизни. Недавнее появление на рынке аппаратов, с помощью которых можно осуществлять ирригационно-инстилляционную терапию, дополнило метод, открыв возможность закапывать в рану жидкости, разные по своему составу и эффекту. Губки последнего поколения в совокупности с NPWT позволяют еще и очищать поверхность раны (ранее они использовались только для стимуляции роста грануляционной ткани)

Comparison of MAPIE versus MAP in patients with a poor response to preoperative chemotherapy for newly diagnosed high-grade osteosarcoma (EURAMOS-1): an open-label, international, randomised controlled trial

Background We designed the EURAMOS-1 trial to investigate whether intensified postoperative chemotherapy for patients whose tumour showed a poor response to preoperative chemotherapy (≥10% viable tumour) improved event-free survival in patients with high-grade osteosarcoma. Methods EURAMOS-1 was an open-label, international, phase 3 randomised, controlled trial. Consenting patients with newly diagnosed, resectable, high-grade osteosarcoma aged 40 years or younger were eligible for randomisation. Patients were randomly assigned (1:1) to receive either postoperative cisplatin, doxorubicin, and methotrexate (MAP) or MAP plus ifosfamide and etoposide (MAPIE) using concealed permuted blocks with three stratification factors: trial group; location of tumour (proximal femur or proximal humerus vs other limb vs axial skeleton); and presence of metastases (no vs yes or possible). The MAP regimen consisted of cisplatin 120 mg/m2, doxorubicin 37·5 mg/m2 per day on days 1 and 2 (on weeks 1 and 6) followed 3 weeks later by high-dose methotrexate 12 g/m2 over 4 h. The MAPIE regimen consisted of MAP as a base regimen, with the addition of high-dose ifosfamide (14 g/m2) at 2·8 g/m2 per day with equidose mesna uroprotection, followed by etoposide 100 mg/m2 per day over 1 h on days 1–5. The primary outcome measure was event-free survival measured in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT00134030. Findings Between April 14, 2005, and June 30, 2011, 2260 patients were registered from 325 sites in 17 countries. 618 patients with poor response were randomly assigned; 310 to receive MAP and 308 to receive MAPIE. Median follow-up was 62·1 months (IQR 46·6–76·6); 62·3 months (IQR 46·9–77·1) for the MAP group and 61·1 months (IQR 46·5–75·3) for the MAPIE group. 307 event-free survival events were reported (153 in the MAP group vs 154 in the MAPIE group). 193 deaths were reported (101 in the MAP group vs 92 in the MAPIE group). Event-free survival did not differ between treatment groups (hazard ratio [HR] 0·98 [95% CI 0·78–1·23]); hazards were non-proportional (p=0·0003). The most common grade 3–4 adverse events were neutropenia (268 [89%] patients in MAP vs 268 [90%] in MAPIE), thrombocytopenia (231 [78% in MAP vs 248 [83%] in MAPIE), and febrile neutropenia without documented infection (149 [50%] in MAP vs 217 [73%] in MAPIE). MAPIE was associated with more frequent grade 4 non-haematological toxicity than MAP (35 [12%] of 301 in the MAP group vs 71 [24%] of 298 in the MAPIE group). Two patients died during postoperative therapy, one from infection (although their absolute neutrophil count was normal), which was definitely related to their MAP treatment (specifically doxorubicin and cisplatin), and one from left ventricular systolic dysfunction, which was probably related to MAPIE treatment (specifically doxorubicin). One suspected unexpected serious adverse reaction was reported in the MAP group: bone marrow infarction due to methotrexate. Interpretation EURAMOS-1 results do not support the addition of ifosfamide and etoposide to postoperative chemotherapy in patients with poorly responding osteosarcoma because its administration was associated with increased toxicity without improving event-free survival. The results define standard of care for this population. New strategies are required to improve outcomes in this setting. Funding UK Medical Research Council, National Cancer Institute, European Science Foundation, St Anna Kinderkrebsforschung, Fonds National de la Recherche Scientifique, Fonds voor Wetenschappelijk Onderzoek-Vlaanderen, Parents Organization, Danish Medical Research Council, Academy of Finland, Deutsche Forschungsgemeinschaft, Deutsche Krebshilfe, Federal Ministry of Education and Research, Semmelweis Foundation, ZonMw (Council for Medical Research), Research Council of Norway, Scandinavian Sarcoma Group, Swiss Paediatric Oncology Group, Cancer Research UK, National Institute for Health Research, University College London Hospitals, and Biomedical Research Centre

Erythropoietin Improves the Survival of Fat Tissue after Its Transplantation in Nude Mice

Background: Autologous transplanted fat has a high resorption rate, providing a clinical challenge for the means to reduce it. Erythropoietin (EPO) has non-hematopoietic targets, and we hypothesized that EPO may improve long-term fat graft survival because it has both pro-angiogenic and anti-apoptotic properties. We aimed to determine the effect of EPO on the survival of human fat tissue after its transplantation in nude mice. Methodology/Principal Findings: Human fat tissue was injected subcutaneously into immunologically-compromised nude mice, and the grafts were then treated with either 20 IU or 100 IU EPO. At the end of the 15-week study period, the extent of angiogenesis, apoptosis, and histology were assessed in the fat grafts. The results were compared to vascular endothelial growth factor (VEGF)-treated and phosphate-buffered saline (PBS)-treated fat grafts. The weight and volume of the EPOtreated grafts were higher than those of the PBS-treated grafts, whose weights and volumes were not different from those of the VEGF-treated grafts. EPO treatment also increased the expression of angiogenic factors and microvascular density, and reduced inflammation and apoptosis in a dose-dependent manner in the fat grafts. Conclusions/Significance: Our data suggest that stimulation of angiogenesis by a cluster of angiogenic factors and decreased fat cell apoptosis account for potential mechanisms that underlie the improved long-term survival of fa

Growth factors and interactive dressings in wound repair

The work of Winter in the 1960s established the concept of ‘moist wound healing. This principle has contributed to the development of the plethora of products that are currently available, among which are hydrogels, hydrocolloids, alginates, and foams or films. Some of these products also incorporate antiseptics in their delivery systems. However, it has become evident that ‘moist wound healing’ along may not be sufficient to improve wound healing outcomes. This is because each wound type can have different barriers to healing. Closure of surgical wounds is inhibited by poor perfusion and infection. Delay in healing of a chronic wound, can result from pressure, venous hypertension, poorly controlled diabetes, inadequacy of arterial inflow, vasculitis, repeated trauma or failure to debride necrotic tissue