Wound healing potential of topical bacteriophage therapy on diabetic cutaneous wounds

Chronic wounds that fail to heal are a common complication of diabetes mellitus and the most common precipitating reason for nontraumatic lower limb amputation. Unfortunately, the bacterial species that cause these infections are becoming more resistant to antibiotics, making them increasingly difficult to treat. We assessed the feasibility of combating chronic bacterial infections with a topically delivered bacteriophage cocktail in two animal models of diabetes mellitus. Microbiological, planimetric, and histological parameters were compared in debrided infected wounds with or without topical bacteriophage treatment. We determined that bacteriophage treatment effectively decreased bacterial colony counts and improved wound healing, as indicated by smaller epithelial and dermal gaps, in Staphylococcus aureus and Pseudomonas aeruginosa infections but was not as effective against Acinetobacter baumannii. Although the improvements were more significant in the rodent model than in the porcine model, our results suggest that topically administered bacteriophage treatment may be effective in resolving chronic infections, especially when applied in conjunction with wound debridement. These findings have important implications for the feasibility of using topical antimicrobial therapies to safely treat chronic infections in diabetes mellitus patients.     

Biomarkers in melanoma: stage III and IV disease

The prognosis associated with Stage III melanoma is variable (17-65% 5-year survival) and primarily influenced by the number of lymph nodes involved, the presence of ulceration in a primary lesion, and the tumor burden present in each lymph node. In patients with metastatic (Stage IV) melanoma, the prognosis remains dismal (6-18% 5-year survival) and is influenced primarily by the sites (and extent) of metastatic involvement. Serum lactate dehydrogenase is the only prognostic biomarker useful in metastatic melanoma and it has been incorporated into the 2002 American Joint Committee on Cancer tumor, node, metastasis staging system. In this review, the known prognostic factors in Stage III and IV melanoma are reviewed. Selected investigational therapies and associated biomarkers are also discussed.     

Associations between gait patterns, brain lesion factors and functional recovery in stroke patients

Brain CT scans and neurological condition were evaluated in 74 stroke patients. Firstly, we found that using a classification-tree technique based on CT scan parameters (an innovative method, analyzing four parameters simultaneously) coincided with our previously proposed kinematic artificial neural network (ANN) classification technique for 71.3% of patients. Lesion size and location were found to be the most significant CT scan predictors of gait classification. Secondly, we sought to gauge post-rehabilitation functional recovery in patients within the same three groups of gait pattern. We found significant differences in scores between the three gait pattern groups, before and after rehabilitation (Kruskal-Wallis test, p<0.001), while significant improvement was observed in each group (Wilcoxon text; p<0.01). We conclude that patient classification into pathological gait groups on the basis of gait or CT scan parameters may serve as an early predictor of future functional outcome.     

The advantages of spinal anesthesia in total hip replacement

This article briefly outlines the spinal anesthesia technique and its potential and benefits for orthopedic surgery. The basic techniques of spinal anesthesia are described. The authors attempt to prove that this method is the best anesthetic technique, if not the method of choice, for total hip replacement surgery.     

Assessment of Synvisc treatment in osteoarthritis

Background. Viscosupplementation is a relatively new method for the treatment of osteoarthritis (OA). The main goal of this project was to assess the safety and clinical utility of Hylan G-F20 (Synvisc(R)) in the treatment of pain associated with osteoarthritis of the knee. The type and frequency of additional therapies used during Synvisc(R) treatment were also assessed. It was a prospective project designed for monitoring Synvisc(R)-prescribing habits in usual medical care.
Material and method. One hundred ninety knee joints in 187 patients were studied (OA symptoms were bilateral in 3 women). Synvisc(R) was indicated for the local treatment of pain in osteoarthritis of the knee. After the diagnosis, Synvisc(R) therapy was started at the recommended dose of 2 ml per intra-articular injection once
a week (at 1-week intervals), three injections in total. The data collected, including medical history, physical examination, radiographic examination and treatment efficacy (overall assessment performed at each visit), were recorded on case report forms designed to facilitate statistical analysis. The physicians completed visual Analogue Scale (VAS) for overall assessment of OA pain at each visit. The clinical outcome was recorded after the end of therapy. The patient data were collected by physicians taking part in this project only.
Results. In 156 cases (82.1%) either a substantial improvement or subsidence of symptoms was observed. In 34 cases (17.9%) the improvement was small or there was no change in the patient's condition. There were local adverse reactions in 2 patients (1.07%). There was no need to cease the treatment, to hospitalise a patient or to start any additional treatment. In 167 patients (89.3%) there was no need to start any non-pharmacological concomitant treatment.
Conclusions. In summary, Synvisc(R) viscosupplementation should be rated among the safest and most effective methods for the treatment of OA, for it alleviates OA-related pain, thus reducing the need for NSAIDs and steroid injections. The use of Synvisc(R) in OA patients alleviates pain regardless of sex and age, the effect being the most pronounced in patients with low- and medium-grade radiographic changes.     

Circulating TNF receptors 1 and 2 predict stage 3 CKD in type 1 diabetes

Elevated plasma concentrations of TNF receptors 1 and 2 (TNFR1 and TNFR2) predict development of ESRD in patients with type 2 diabetes without proteinuria, suggesting these markers may contribute to the pathogenesis of renal decline. We investigated whether circulating markers of the TNF pathway determine GFR loss among patients with type 1 diabetes. We followed two cohorts comprising 628 patients with type 1 diabetes, normal renal function, and no proteinuria. Over 12 years, 69 patients developed estimated GFR less than 60 mL/min per 1.73 m(2) (16 per 1000 person-years). Concentrations of TNFR1 and TNFR2 were strongly associated with risk for early renal decline. Renal decline was associated only modestly with total TNFα concentration and appeared unrelated to free TNFα. The cumulative incidence of estimated GFR less than 60 mL/min per 1.73 m(2) for patients in the highest TNFR2 quartile was 60% after 12 years compared with 5%-19% in the remaining quartiles. In Cox proportional hazards analysis, patients with TNFR2 values in the highest quartile were threefold more likely to experience renal decline than patients in the other quartiles (hazard ratio, 3.0; 95% confidence interval, 1.7-5.5). The risk associated with high TNFR1 values was slightly less than that associated with high TNFR2 values. TNFR levels were unrelated to baseline free TNFα level and remained stable over long periods within an individual. In conclusion, early GFR loss in patients with type 1 diabetes without proteinuria is strongly associated with circulating TNF receptor levels but not TNFα levels (free or total).     

Comparison of Temporal Parameters of Swimming Rescue Elements When Performed Using Dolphin and Flutter Kick with Fins - Didactical Approach

The aim of this study was an analysis of the time required to swim to a victim and tow them back to shore, while perfoming the flutter-kick and the dolphin-kick using fins. It has been hypothesized that using fins while using the dolphin-kick when swimming leads to reduced rescue time. Sixteen lifeguards took part in the study. The main tasks performed by them, were to approach and tow (double armpit) a dummy a distance of 50m while applying either the flutter-kick, or the dolphin-kick with fins. The analysis of the temporal parameters of both techniques of kicking demonstrates that, during the approach to the victim, neither the dolphin (t_mean = 32.9s) or the flutter kick (t_mean = 33.0s) were significantly faster than the other. However, when used for towing a victim the flutter kick (t_mean = 47.1s) was significantly faster when compared to the dolphin-kick (t_mean = 52.8s). An assessment of the level of technical skills in competitive swimming, and in approaching and towing the victim, were also conducted. Towing time was significantly correlated with the parameter that linked the temporal and technical dimensions of towing and swimming (difference between flutter kick towing time and dolphin-kick towing time, 100m medley time and the four swimming strokes evaluation). No similar interdependency has been discovered in flutter kick towing time. These findings suggest that the dolphin-kick is a more difficult skill to perform when towing the victim than the flutter-kick. Since the hypothesis stated was not confirmed, postulates were formulated on how to improve dolphin-kick technique with fins, in order to reduce swimming rescue time.

Key points

• The source of reduction of swimming rescue time was researched.
• Time required to approach and to tow the victim while doing the flutter kick and the dolphin-kick with fins was analyzed.
• The propulsion generated by dolphin-kick did not make the approach and tow faster than the flutter kick.
• More difficult skill to realize of dolphin-kick than the flutter-kick was postulated.
• The criteria for how improve dolphin kick technique with fins were formulated.

Key words: Swimming, lifesaving, dolphin kick, fins, rescue tow