Methods to Assess the Protective Efficacy of Emollients against Climatic and Chemical Aggressors

Exposure to harsh environmental conditions, such as cold and dry climate and chemicals can have an abrasive effect on skin. Skin care products containing ingredients that avert these noxious effects by reinforcement of the barrier function can be tested using in vivo models. The objective is to use in vivo models to assess the efficacy of emollients in protecting skin against climatic and chemical insults. A first model used a stream of cooled air to mimic cold wind. A second used sodium lauryl sulfate (SLS) under patch as chemical aggressor. In the model with simulated wind exposure, the untreated exposed area had a significant decrease in hydration. In contrast, application of an emollient caused a significant increase in hydration that was maintained after wind exposure. In the second model with SLS exposure, application of a barrier cream before SLS patch significantly reduced the dehydrating effect of SLS with a significant difference in variation between both areas. Application of the cream reduced TEWL, indicative of a physical reinforcement of the skin barrier. The two presented test methods, done under standardized conditions, can be used for evaluation of protective effect of emollient, by reinforcing the barrier function against experimentally induced skin dehydration

Renal glutamine metabolism: studies with the perfused kidney and with isolated cortical tubules

The isolated perfused kidney system was developed in our lab and functionally defined. With this technique kidneys from rats which had been subjected to an NH₄CL induced metabolic acidosis for 7-days and 24-hour recovery from this condition were perfused with glutamine. Rates of ammmoniagenesis and gluconeogenesis were measured. Ammoniagenesis was back to normal after 24 hours of recovery which is what occurs with in vivo NH₃ excretion. This implies an intrarenal adaptation in the 24-hour recovered situation. Acidotic rats were subjected to a metabolic alkalosis following a 7-day acidotic challenge. Isolated kidneys perfused 8-hours after this accelerated recovery was initiated maintained acidotic rates of ammoniagenesis. This is contrary to in vivo NH₃ excretion in rats treated in a similar manner in which a return of NH₃ excretion to normal is observed. Thus, an acute, reversible, extrarenal influence is responsible for the supervision of ammoniagenesis under these conditions. -- With the isolated cortical tubule preparation, rates of ammoniagenesis from glutamine were found to be stimulated by acute acidosis (pH 7.06) and with L-methionine-s-sulfoximime (M.S.O.) an inhibitor of glutamine synthetase (G.S.). In tubules incubated with glutamate NH₄CL and lactate acute acidosis was found to inhibit NH₃ uptake and glutamine synthesis. This reaction to acute acidosis was also demonstrated in cortical tubules from acidotic and 24-hour recovery animals. From these results it is clear that in some way the acute change in H⁺ concentration effectively decreases the activity of G.S. resulting in an apparent stimulation of ammoniagenesis. -- A model is presented which correlates this observation with anatomical heterogenicity and in vivo responses to acute acidosis

Myélites Aiguës Transverses Idiopathiques (étude rétrospective de 16 cas)

Introduction : la myélite aiguë transverse (MAT) idiopathique est une affection inflammatoire aiguë, distincte des MAT infectieuses, des MAT du Lupus ou du Gougerot-Sjögren, des atteintes médullaires de la Sclérose en Plaques. Son pronostic n'est pas bien connu. Objectifs : évaluer sur une population, sélectionnée avec de nouveaux critères diagnostiques, les données cliniques, paracliniques et pronostiques classiquement décrites dans les MAT idiopathiques. Méthode : étude rétrospective (1996-2004) de 16 cas (CHU Angers, Nantes et Rennes), répondant aux critères diagnostiques (cliniques, radiologique.s, biologiques, exclusion des autres causes de MAT), avec enquête téléphonique fin 2004. Résultats : 7 hommes et 9 femmes, âgés de 15 à 75 ans (moyenne de 41 ans +/- 20) répondaient à ces critères. Notre étude a mis en évidence des résultats épidémiologiques, cliniques et paracliniques concordants avec ceux présentés dans les différentes publications sur le sujet. Par contre, le pronostic est meilleur puisque 72 des malades ont pu reprendre une déambulation sans aide. La présentation clinique de certains de nos patients et/ou leur évolution vers d'autres pathologies inflammatoires autoimmunes multifocales, nous amènent à nous interroger sur un continuum entre MAT, Neuromyélite Optique (NMO) et Encéphalomyélite Aiguë Disséminée (EMAD). Conclusion : les MAT idiopathiques ont un assez bon pronostic et pourraient représenter, dans certains cas, une forme particulière de NMO ou d'ADEM.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Budget Impact Analysis of a Home-Based Nutrition Program for Adults at Risk for Malnutrition

Background: Hospital-based, nutrition-focused interventions have significantly lowered the cost-associated burden of poor nutrition through a reduction in healthcare resource utilization (HCRU). However, for patients at risk for poor nutrition who receive nutritional care at home, limited evidence exists on the economic impact of nutrition-focused interventions. Objective: To estimate the 30-day cost-savings associated with an at-home nutrition-focused quality improvement program in the postacute care setting for patients at risk for poor nutrition from the perspective of a hospital system. Methods: We compared the HCRU of 1546 patients enrolled in a quality improvement program during 1 year versus 7413 patients in a pre-program historical cohort who received care during the 1 year before the quality improvement program implementation. The analysis included the number of 30-day hospitalizations, emergency department and outpatient visits for both cohorts, and the associated costs. The main analysis included the fixed and variable costs for the program, and the costs of oral nutritional supplement and delivery. The costs for hospitalization, emergency department, and outpatient visit costs were based on the 2013 Healthcare Cost and Utilization Project and Medical Expenditure Panel Survey. Results: Based on the 2013 survey, the baseline costs for hospitalization, emergency department, and outpatient visit costs were $18,296,$1312, and $535, respectively. Our health economic analysis about the 30-day overall HCRU has shown that the quality improvement program group resulted in a total cost-savings of$2,408,668 for the 1546 patients in the program and a net savings of $1558 per patient compared with the costs for the pre-quality improvement program historical cohort. Conclusion: The use of a nutrition-focused quality improvement program led to significant 30-day cost-savings, by reducing HCRU for adults who received nutritional-based care at home. The improvements in HCRU highlight the importance of implementing nutrition-focused quality improvement programs for hospital systems that provide care for patients who are at risk for poor nutrition across a variety of care settings

Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation

BackgroundThe number of patients with cardiac implantable electronic device (CIED) is increasing, creating a substantial workload for device clinics. ObjectiveThis study aims to characterize the workflow and quantify clinic staff time requirements for managing patients with CIEDs. MethodsA time and motion workflow evaluation was performed in 11 US and European CIEDs clinics. Workflow tasks were repeatedly timed during 1 business week of observation at each clinic; these observations included all device models and manufacturers. The mean cumulative staff time required to review a remote device transmission and an in-person clinic visit were calculated, including all necessary clinical and administrative tasks. The annual staff time to manage a patient with a CIED was modeled using CIED transmission volumes, clinical guidelines, and the published literature. ResultsA total of 276 in-person clinic visits and 2173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4 to 13.5 minutes for therapeutic devices (pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy) and from 11.3 to 12.9 minutes for diagnostic devices such as insertable cardiac monitors (ICMs). Mean staff time per in-person visit ranged from 37.8 to 51.0 and from 39.9 to 45.8 minutes for therapeutic devices and ICMs, respectively. Including all remote and in-person follow-ups, the estimated annual time to manage a patient with a CIED ranged from 1.6 to 2.4 hours for therapeutic devices and from 7.7 to 9.3 hours for ICMs. ConclusionsThe CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs the implementation of efficiency improvements, including remote solutions. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow

Negatively charged self-assembling DNA/poloxamine nanospheres for in vivo gene transfer

Over the past decade, numerous nonviral cationic vectors have been synthesized. They share a high density of positive charges and efficiency for gene transfer in vitro. However, their positively charged surface causes instability in body fluids and cytotoxicity, thereby limiting their efficacy in vivo. Therefore, there is a need for developing alternative molecular structures. We have examined tetrabranched amphiphilic block copolymers consisting of four polyethyleneoxide/polypropyleneoxide blocks centered on an ethylenediamine moiety. Cryo-electron microscopy, ethidium bromide fluorescence and light and X-ray scattering experiments performed on vector–DNA complexes showed that the dense core of the nanosphere consisted of condensed DNA interacting with poloxamine molecules through electrostatic, hydrogen bonding and hydrophobic interactions, with DNA molecules also being exposed at the surface. The supramolecular organization of block copolymer/DNA nanospheres induced the formation of negatively charged particles. These particles were stable in a solution that had a physiological ionic composition and were resistant to decomplexation by heparin. The new nanostructured material, the structure of which clearly contrasted with that of lipoplexes and polyplexes, efficiently transferred reporter and therapeutic genes in skeletal and heart muscle in vivo. Negatively charged supramolecular assemblies hold promise as therapeutic gene carriers for skeletal and heart muscle-related diseases and expression of therapeutic proteins for local or systemic uses