Successful and safe use of 2 min cold atmospheric argon plasma in chronic wounds: results of a randomized controlled trial.

BACKGROUND: The development of antibiotic resistance by microorganisms is an increasing problem in medicine. In chronic wounds, bacterial colonization is associated with impaired healing. Cold atmospheric plasma is an innovative promising tool to deal with these problems. OBJECTIVES: The 5-min argon plasma treatment has already demonstrated efficacy in reducing bacterial numbers in chronic infected wounds in vivo. In this study we investigated a 2-min plasma treatment with the same device and the next-generation device, to assess safety and reduction in bacterial load, regardless of the kind of bacteria and their resistance level in chronic wounds. METHODS: Twenty-four patients with chronic infected wounds were treated in a prospective randomized controlled phase II study with 2 min of cold atmospheric argon plasma every day: 14 with MicroPlaSter alpha device, 10 with MicroPlaSter beta device (next-generation device) in addition to standard wound care. The patient acted as his/her own control. Bacterial species were detected by standard bacterial swabs and bacterial load by semiquantitative count on nitrocellulose filters. The plasma settings were the same as in the previous phase II study in which wounds were exposed for 5 min to argon plasma. RESULTS: Analysis of 70 treatments in 14 patients with the MicroPlaSter alpha device revealed a significant (40%, P<0.016) reduction in bacterial load in plasma-treated wounds, regardless of the species of bacteria. Analysis of 137 treatments in 10 patients with the MicroPlaSter beta device showed a highly significant reduction (23.5%, P<0.008) in bacterial load. No side-effects occurred and the treatment was well tolerated. CONCLUSIONS: A 2-min treatment with either of two cold atmospheric argon plasma devices is a safe, painless and effective technique to decrease the bacterial load in chronic wounds.

High bone turnover and accumulation of osteoid in patients with neurofibromatosis 1.

UNLABELLED: Although it is known that neurofibromatosis 1 (NF1) patients suffer from vitamin D deficiency and display decreased bone mineral density (BMD), a systematic clinical and histomorphometrical analysis is absent. Our data demonstrate that NF1 patients display high bone turnover and accumulation of osteoid and that supplementation of vitamin D has a beneficial effect on their BMD. INTRODUCTION: Neurofibromatosis 1 results in a wide range of clinical manifestations, including decreased BMD. Although it has been reported that NF1 patients have decreased vitamin D serum levels, the manifestation of the disease at the bone tissue level has rarely been analyzed. METHODS: Thus, we performed a clinical evaluation of 14 NF1 patients in comparison to age- and sex-matched control individuals. The analysis included dual X-ray absorptiometry osteodensitometry, laboratory parameters, histomorphometric and quantitative backscattered electron imaging (qBEI) analyses of undecalcified bone biopsies. RESULTS: NF1 patients display significantly lower 25-(OH)-cholecalciferol serum levels and decreased BMD compared to control individuals. Histomorphometric analysis did not only reveal a reduced trabecular bone volume in biopsies from NF1 patients, but also a significantly increased osteoid volume and increased numbers of osteoblasts and osteoclasts. Moreover, qBEI analysis revealed a significant decrease of the calcium content in biopsies from NF1 patients. To address the question whether a normalization of calcium homeostasis improves BMD in NF1 patients, we treated four patients with cholecalciferol for 1 year, which resulted in a significant increase of BMD. CONCLUSION: Taken together, our data provide the first complete histomorphometric analysis from NF1 patients. Moreover, they suggest that low vitamin D levels significantly contribute to the skeletal defects associated with the disease.

A first prospective randomized controlled trial to decrease bacterial load using cold atmospheric argon plasma on chronic wounds in patients.

BACKGROUND: Bacterial colonization of chronic wounds slows healing. Cold atmospheric plasma has been shown in vitro to kill a wide range of pathogenic bacteria. Objectives To examine the safety and efficiency of cold atmospheric argon plasma to decrease bacterial load as a new medical treatment for chronic wounds. PATIENTS AND METHODS: Thirty-eight chronic infected wounds in 36 patients were treated in a prospective randomized controlled phase II study with 5 min daily cold atmospheric argon plasma in addition to standard wound care. The patient acted as his or her own control. Bacterial species were detected by standard bacterial swabs and semiquantitative changes by nitrocellulose filters. Plasma setting and safety had been determined in a preceding phase I study. RESULTS: Analysis of 291 treatments in 38 wounds found a highly significant (34%, P < 10(-6)) reduction of bacterial load in treated wounds, regardless of the type of bacteria. No side-effects occurred and the treatment was well tolerated. CONCLUSIONS: Cold atmospheric argon plasma treatment is potentially a safe and painless new technique to decrease bacterial load of chronic wounds and promote healing.

[Louse-borne-relapsing-fever in refugees from the Horn of Africa; a case series of 25 patients]. / 25 Fälle von Läuserückfallfieber bei Flüchtlingen aus Ostafrika.

Background | Relapsing fever is divided into tick borne relapsing fever (TBRF) and louse borne relapsing fever (LBRF). This report describes 25 refugees from East Africa who were diagnosed to suffer from LBRF within a period of 6 month only at a single hospital in Munich / Germany. Material & Methods | The aim was to point out common clinical features as well as laboratory findings and clinical symptoms before and after initiation of treatment in 25 patients with louse borne relapsing fever (LBRF) who were diagnosed and treated at Klinikum München Schwabing from August 2015 to January 2016. To the best of our knowledge this is the largest case series of LBRF in the western world for decades. Main focus of the investigation was put on clinical aspects. Results | All 25 patients suffered from acute onset of high fever with chills, headache and severe prostration. Laboratory analysis showed high CRP and a marked thrombocytopenia. A Giemsa blood stain was procured immediately in order to look for malaria. In the blood smear spirochetes with typical shape and aspect of borrelia species could be detected.The further PCR analysis confirmed infection with Borrelia recurrentis. Treatment with Doxycycline was started forthwith. The condition improved already on the second day after treatment was started and all were restored to health in less than a week. Apart from a mild to moderate Jarisch-Herxheimer-reaction we didn`t see any side effects of the therapy. Conclusion | LBRF has to be taken into account in feverish patients who come as refugees from East-Africa. It seems that our patients belong to a cluster which probably has its origin in Libya and more patients are to be expected in the near future. As LBRF might cause outbreaks in refugee camps it is pivotal to be aware of this emerging infectious disease in refugees from East-Africa.

Psychosomatic medicine and otorhinolaryngology.

The article gives a clinically oriented survey of psychosomatic aspects in otorhinolaryngology. After a 50-year history of psychosomatic research in this field, the psychosomatic point of view gives a sufficient approach to a lot of diseases in otorhinolaryngology, especially to numerous and frequent diseases of functional origin, but also to problems of coping and psychosocial support. Different indications to psychoanalytic or behavioral psychotherapeutic treatment are discussed.

[Prenatal acoustic perception--a review of the literature from the psychosomatic viewpoint]. / Zur Frage der pränatalen akustischen Wahrnehmung--eine Literaturübersicht aus psychosomatischer Sicht.

In a critical overview on the empirical results to the problem of "Prenatal Hearing" the authors show the development of investigation in the last sixty years. Some conclusions on developmental psychosomatic aspects are discussed.

[Hemiballistic syndrome in a drummer]. / Hemiballistisches Syndrom eines Schlagzeugers.

We report an acute right-sided functional hemiballistic syndrome of the upper and lower limb combined with functional choreatic symptoms of the right forearm and hand of an 59 year old drummer. After a wide range of diagnostic procedures, no somatic reasons could be delineated. Finally a lifetime associated syndrome could be elucidated. We therefore reviewed possible diagnostic and methodical neurological and psychosomatic aspects of functional hemiballism.

'In situ' immune complex nephritis and basic proteins.

This investigation was designed to clarify the potential role of basic antigens in immune complex nephritis. The GBM is negatively charged and binds cationic substances. We studied 1) whether chemically cationised proteins can bind to the GBM, act as planted antigen, and induce 'in situ' immune complex formation or 2) if a pre-formed cationic antigen antibody complex can localise in the GBM. Results obtained with 5 chemically cationised proteins support the first possibility.

Isolation of Bartonella quintana from an HIV-positive patient with bacillary angiomatosis.

Bartonella quintana was grown from a lysis-centrifugation blood culture of an HIV-positive man who presented with lesions of bacillary angiomatosis in skin and bones. The isolate was identified by sodium dodecylsulfate-polyacrylamide gel electrophoresis, 16S rRNA gene sequencing, and amplification of the enterobacterial repetitive intergenic consensus sequences.

[Studies on the modification of performance and metabolic processes in sheep through experimental Fasciola hepatica infections considering low infestation intensity]. / Untersuchungen zur Beeinflussung von Leistungen und Stoffwechselvorgängen beim Schaf durch experimentelle Fasciola hepatica- Infektionen bei Vorliegen einer niedrigen Befallsintensität.

Low experimental infections with Fasciola hepatica (8...17 flukes per animal) in sheep, 6...12 months old, caused less gain weight over a period of 22 weeks. Changes in the number of erythrocytes and in the Hb-concentration were not found. In contrast to the controls the infected sheep showed strong fluctuations in the number of lymphocytes. 3 weeks post infect. a significant eosinophilia was observed, which continued until the end of the investigation. With the beginning of the fourth week post infect. the values of serum albumin were lower, the values of gamma-globulin higher than those of the controls, but there was no statistical significance. The bromosulphalein-test for liver function was negative.