RESUMEN
Treatment of burned patients involves early excision of the burn. The approach to this excision has changed since bromelain-based enzymatic debridement was introduced. This treatment option reduces complications from the surgical procedure and improves scar quality. It is indicated for partial and full thickness burns. It is important to agree on the nursing care before, during and after enzymatic debridement treatment to ensure an optimal preparation and maintenance of the wound bed for later treatment to be most successful. A multi-centre Delphi study was conducted with enzymatic debridement nursing care on burned patient experts. A coordinating group developed a 29-item questionnaire based on clinical guidelines and experience. Two question rounds were asked, reaching consensus on answers > 70%. Nine panellists from nine leading burns centres in Spain participated. The aim was to develop a national consensus on enzymatic debridement treatment based on clinical practice and evidence from almost 1500 cases. The experts reached 29 agreements on different aspects of treatment and patient condition: general considerations about the treatment, burned patient admission, treatment prior to enzymatic debridement, applying debridement, removing enzymatic debridement and the post-enzymatic debridement phase. The expert consensus on nursing care of the burn patient and application of bromelain-based enzymatic debridement includes general recommendations for the patient before, during and after application and the planning of localised care after debridement. This consensus document supports knowledge on enzymatic debridement technique, increasing safety in clinical nursing practice and ensuring successful treatment for the patient.
L'excision précoce est la référence dans le traitement des brûlures. Sa technique a été transformée par le débridement enzymatique à la bromélaïne. Cette technique, indiquée dans les brûlures intermédiaires et profondes, réduit les complications chirurgicales et améliore la qualité cicatricielle. La qualité des soins locaux, avant, pendant et après l'application de bromélaïne, est un paramètre important d'efficacité. Nous avons organisé une étude basée sur la méthode Delphi auprès de 9 experts de 9 CTB espagnols. Le groupe de coordination a réalisé un questionnaire à 29 items à partir des recommandations et de leur expérience (quasiment 1 500 cas au total). Deux séances ont été organisées, dans le but d'obtenir les agréments de plus de 70% des participants. Un consensus a été obtenu sur les 29 questions posées, se rapportant aux généralités, aux critères d'admission, au traitement avant bromélaïne, à son application, à son retrait et aux soins ultérieurs. Les recommandations de soins locaux consécutives recouvrent les phases avant, pendant et après utilisation. Elles permettent une amélioration de l'efficacité et de la sécurité du débridement enzymatique.
RESUMEN
OVGP1 is the major non-serum glycoprotein in the oviduct fluid at the time of fertilization and early embryo development. Its activity differs among species. Here, we show that the C-terminal region of recombinant OVGP1 regulates its binding to the extracellular zona pellucida and affects its activity during fertilization. While porcine OVGP1 penetrates two-thirds of the thickness of the zona pellucida, shorter OVGP1 glycoproteins, including rabbit OVGP1, are restricted to the outer one-third of the zona matrix. Deletion of the C-terminal region reduces the ability of the glycoprotein to penetrate through the zona pellucida and prevents OVGP1 endocytosis. This affects the structure of the zona matrix and increases its resistance to protease digestion. However, only full-length porcine OVGP1 is able to increase the efficiency rate of in vitro fertilization. Thus, our findings document that the presence or absence of conserved regions in the C-terminus of OVGP1 modify its association with the zona pellucida that affects matrix structure and renders the zona matrix permissive to sperm penetration and OVGP1 endocytosis into the egg.