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Investigation of adhesion of modern wound dressings: a comparative analysis of 56 different wound dressings

Introduction In the process of chronic wound care, adhesive wound dressings may cause pain and injury in the wound environment during dressing changes. At present, no standardized test procedures are available for the investigation of adhesion of wound dressings. Therefore, our study aimed to test the adhesion of different wound dressings on steel as well as on healthy skin. Methods Within an open, comparative study, the adhesive areas of 56 wound dressings were investigated. The adhesives were categorized into acrylate (n = 23), silicone (n = 9), hydrocolloid (n = 17) and polyurethane groups (n = 7). Using an especially modified testing machine, the adhesion of the wound dressings was measured on steel as well as on the skin of healthy study participants, in compliance with the European EN 1939:2003 standard. Results The energy required to remove the wound dressings from human skin, was measured in Newton (N) and the following median values were obtained: hydrocolloid (2.25 N) > acrylate (1.14 N) > polyurethane (0.9 N) > silicone (0.7 N). The subjective pain intensity during the removal of the wound dressings was recorded using the visual analogue scale (VAS) with values ranging from 0 to 10. For hydrocolloid, it was 6.8, for acrylate 4.9, for polyurethane 3.1 and for silicone 2.5 points VAS. In comparison with human skin, the adhesion of wound dressings was significantly higher on steel (P < 0.0001), but was different for the different groups of wound dressings. Moreover, there was a statistically significant correlation between the adhesion and pain intensity (correlation coefficient 0.806; P = 0.01). Conclusion The knowledge about the widely differing adhesion properties of different wound dressings on the skin of patients should nowadays be considered during the individual selection of the applied products. Based on these data, different types of wound dressings could be developed, guaranteeing a good adhesion and a low traumatic risk when removed.     

Current standards in the diagnostics and therapy of hair diseases – hair consultation

Hair and scalp diseases present an extensive diagnostic and therapeutic task. Treating them is often a challenge for the physician in daily practice. Unclear diagnoses, chronic conditions with long‐lasting therapies and the uncertainty of the patient may often lead to unsatisfying situations for both the patient as well as the doctor. The complaints can be divided into (1) hair loss, (2) increased hair growth and (3) abnormal hair quality. A structured history and the objectification of the clinical findings with the help of standardized diagnostic methods and score systems or classifications enable a diagnosis in most patients already at the first visit. Moreover, such structured processes strengthen the treatment satisfaction and compliance of both the patient and the therapist. In the meantime, diagnostic measures and clinical practice guidelines are available for the most common hair disorders. Expertise in basic psychosomatic care and an empathetic approach to the fears and concerns as well as practical advice for the daily contact with hair disorders should be integrated as separate elements in the management of hair diseases; in most cases they are gratefully welcomed by the patients. The aim of this article is to provide the physician with a guideline for the structured management of a hair patient. An overview of recent new developments and the currently available clinical practice guidelines for diagnosis and therapy of hair disorders is presented.     

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Einzelreferate und Buchbesprechungen

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Activation of serotonin receptors promotes microglial injury-induced motility but attenuates phagocytic activity

Microglia, the brain immune cell, express several neurotransmitter receptors which modulate microglial functions. In this project we studied the impact of serotonin receptor activation on distinct microglial properties as serotonin deficiency not only has been linked to a number of psychiatric disease like depression and anxiety but may also permeate from the periphery through blood-brain barrier openings seen in neurodegenerative disease. First, we tested the impact of serotonin on the microglial response to an insult caused by a laser lesion in the cortex of acute slices from Cx3Cr1-GFP-/+ mice. In the presence of serotonin the microglial processes moved more rapidly towards the laser lesion which is considered to be a chemotactic response to ATP. Similarly, the chemotactic response of cultured microglia to ATP was also enhanced by serotonin. Quantification of phagocytic activity by determining the uptake of microspheres showed that the amoeboid microglia in slices from early postnatal animals or microglia in culture respond to serotonin application with a decreased phagocytic activity whereas we could not detect any significant change in ramified microglia in situ. The presence of microglial serotonin receptors was confirmed by patch-clamp experiments in culture and amoeboid microglia and by qPCR analysis of RNA isolated from primary cultured and acutely isolated adult microglia. These data suggest that microglia express functional serotonin receptors linked to distinct microglial properties.     

Neural response to emotional stimuli during experimental human endotoxemia

Increases in peripheral cytokines during acute inflammation may affect various neuropsychological functions. The aim of this functional magnetic resonance imaging (fMRI) study was to investigate the effects of acute endotoxemia on mood and the neural response to emotionally aversive visual stimuli in healthy human subjects. In a double‐blind, randomized crossover study, 18 healthy males received a bolus injection of bacterial lipopolysaccharide (LPS; 0.4 ng/kg) or saline. Plasma levels of pro‐ and anti‐inflammatory cytokines and cortisol as well as mood ratings were analyzed together with the blood‐oxygen‐level dependent (BOLD) response during the presentation of aversive versus neutral pictures. Endotoxin administration induced pronounced transient increases in plasma levels of TNF‐α, IL‐1ra, IL‐6, IL‐10, and cortisol. Positive mood was decreased and state anxiety increased. In addition, activation of right inferior orbitofrontal cortex (OFC) in response to emotional visual stimuli was significantly increased in the LPS condition. Increased prefrontal activation during the presentation of emotional material may reflect enhanced cognitive regulation of emotions as an adaptive response during an acute inflammation. These findings may have implications for the putative role of inflammatory processes in the pathophysiology of depression. Hum Brain Mapp 34:2217–2227, 2013. © 2012 Wiley Periodicals, Inc.     

Going on with optimised feet: Evidence for the interaction between segmental and metrical structure in phonological encoding from a case of primary progressive aphasia

Background: Our knowledge about the interaction between segmental and metrical levels of representation in word production is still largely underspecified. In particular, there is only sparse evidence of how syllables are hierarchically organised into higher‐level prosodic structures such as prosodic feet and words. Furthermore, the question whether stress assignment in German is sensitive to syllable weight is unresolved so far. While quantity‐insensitive accounts state that stress is predominantly assigned to a default position (i.e., to the penultimate syllable) and other stress patterns are exceptional, quantity‐sensitive accounts assume that stress assignment is determined by the weight of the final two syllables.

Aims: Impaired lexical retrieval may lead to regularisations of stress assignment. Such an error pattern will be examined to gain insights into the interrelation between different tiers of prosodic representations (e.g., syllable, foot, prosodic word).

Methods & Procedures: A reading and a repetition task were conducted with German‐speaking patient HT, suffering from primary progressive aphasia, which especially affected her retrieval of lexical information. The material consisted of polysyllabic words with varying stress patterns and syllable structures.

Outcomes & Results: In reading, HT produced hardly any segmental errors, but a substantial amount of stress errors. Importantly, the patient not only over‐generalised the “default” penultimate stress as would have been predicted by quantity‐insensitive approaches. Instead, she over‐applied different stress patterns depending on the weight of the last two syllables. In repetition, HT's output can be characterised as phonological jargon. Crucially, however, she hardly produced any stress errors. Rather, thorough analyses revealed that segmental deviations in her output led to optimised prosodic structures. For instance, insertions of rhyme segments could be observed mainly in strong syllables, i.e., syllables bearing main or secondary stress, whereas deletions occurred predominantly in weak, unstressed syllables.

Conclusions: The present data provide evidence for specific forms of interaction between segmental and metrical knowledge: On the one hand, segmental information influenced the patient's stress assignment errors in reading. On the other hand, prosodic information modified segmental errors even in severe jargon observed in repetition. With respect to the prosodic system of German, the observed error patterns show that the structure of the final syllable determines how syllables of a word are parsed into prosodic feet and, accordingly, which syllable has to be prominent. Thus, our results support quantity‐sensitive approaches of stress assignment.