Detection of pathogenic bacteria and biomarkers in lung specimens from cystic fibrosis patients.

Diagnosing lung infections is often challenging because of the lack of a high-quality specimen from the diseased lung. Since persons with cystic fibrosis are subject to chronic lung infection, there is frequently a need for a lung specimen. In this small, proof of principle study, we determined that PneumoniaCheckTM, a non-invasive device that captures coughed droplets from the lung on a filter, might help meet this need. We obtained 10 PneumoniaCheckTM coughed specimens and 2 sputum specimens from adult CF patients hospitalized with an exacerbation of their illness. We detected amylase (upper respiratory tract) with an enzymatic assay, surfactant A (lower respiratory tract) with an immunoassay, pathogenic bacteria by PCR, and markers of inflammation by a Luminex multiplex immunoassay. The amylase and surfactant A levels suggested that 9/10 coughed specimens were from lower respiratory tract with minimal upper respiratory contamination. The PCR assays detected pathogenic bacteria in 7 of 9 specimens and multiplex Luminex assay detected a variety of cytokines or chemokines. These data indicate that the PneumoniaCheckTM coughed specimens can capture good quality lower respiratory tract specimens that have the potential to help in diagnosis, management and understanding of CF exacerbations and other lung disease.

Use of a Novel Foam Dressing With Negative Pressure Wound Therapy and Instillation: Recommendations and Clinical Experience.

A new reticulated open-cell foam dressing with through holes (ROCF-CC) has been introduced to assist with wound cleansing by removing thick wound exudate and infectious materials during neg- ative pressure wound therapy with instillation. Due to the limited published evidence supporting use of ROCF-CC dressings with negative pressure wound therapy with instillation and dwell time (NPWTi-d), clinicians have been relying on practical application experience to gain pro ciency with the dressing and NPWTi-d. To help provide general guidelines for safe and e cient use of ROCF-CC dressings with NPWTi-d, a multidisciplinary expert panel of clinicians was convened from September 28 to 29, 2017. Principal aims of the meeting were to develop recommendations based on panel members' experience and lim- ited published results for use of ROCF-CC dressings, appropriate wound and patient characteristics for use, application settings, and clinical techniques to optimize outcomes. An algorithm to guide use of ROCF-CC dressings with NPWTi-d was also created. Panelists recommended the following goals for using ROCF-CC dressings: cleanse wounds when areas of slough or nonviable tissue remain on the wound surface, remove thick exudate, remove infectious materials, promote granulation tissue formation, and help provide a bridge to a de ned endpoint. Negative pressure wound therapy with instillation and dwell time with ROCF-CC dressings may be an appropriate adjunct therapy for wound cleansing, especially in cases when sharp excisional debridement is not available or appropriate. All panel members agreed that controlled clinical and scienti c studies of NPWTi-d with ROCF-CC are needed to further elucidate best practices and e ectiveness in various wound types.

Clinician Panel Recommendations for Use of Negative Pressure Wound Therapy with Instillation.

Addition of an instilled topical wound solution to negative pressure wound therapy (NPWT) is designed to facilitate regular wound cleansing to help improve outcomes of some complex wounds, but the addition of instillation to NPWT adds a level of complexity to the wound care process. The paucity of knowledge and experience with instillation may affect optimal use of this treatment modality. In an effort to address this knowledge gap, a 2-day panel meeting of nurses (N = 11) with experience using negative pressure wound therapy with instillation and dwell time (NPWTi-d) was convened to discuss their usage recommendations for managing wounds with this treatment modality in the acute care setting. Panelists reviewed available evidence and presented recommendations for managing wounds treated with NPWTi-d. Panelists agreed NPWTi-d is primarily suited to prepare surgical or nonsurgical wounds for delayed primary closure and preparing/protecting periwound skin improves maintenance of a tight seal. Educating a team of nurses on basic NPWTi-d troubleshooting, providing a short checklist of tasks to perform every shift, and organizing needed supplies and resources may help continuity of care and prevent problems. Panelists also emphasized the im- portance of wound assessment and documentation and recommend educating the patient, family members, and other members of the patient-care team. Research to compare the safety, ef cacy, and effectiveness of NPWTi-d and other irrigation techniques on patient outcomes and research to validate these recommendations is needed.

The effective management of pressure ulcers.

The challenges of managing pressure ulcers are often not limited to clinical decisions; they may impact other areas that encompass patient care, including financial, emotional, psychosocial, regulatory, and medical-legal aspects. The difficulty in managing these complex factors is magnified by recent gains in understanding of the pathophysiology of wounds related to pressure, which serves as the basis for the etiology, diagnosis, staging, and management of these wounds. This article summarizes the current and evolving knowledge related to pressure ulcers and discusses an algorithm recently developed to assist in clinical management decisions related to patients with pressure ulcers, with emphasis on appropriate utilization of Negative Pressure Wound Therapy delivered by V.A.C. Therapy (KCI USA, Inc.) in patients with Stage III and Stage IV pressure ulcers.

Using negative-pressure wound therapy for positive results.

Learn to use the system to help your patient heal.

Guidelines for managing pressure ulcers with negative pressure wound therapy.

Pressure ulcers are a serious health issue, leading to clinical, financial, and emotional challenges. Numerous treatment modalities are available to promote wound healing, yet clinicians may be unsure how to incorporate these treatment options into an overall plan of care for the patient with a pressure ulcer. A consensus panel of experienced wound care clinicians convened in July 2004 to review the mechanisms of action and research basis for one such treatment modality: negative pressure wound therapy. After answering key questions about this modality, they developed an algorithm to assist the clinician in making decisions about using negative pressure wound therapy appropriately in patients with Stage III and Stage IV pressure ulcers.

BOTOX: a review.

BOTOX cosmetic is proving to be an affordable alternative for thousands of people looking to enhance their appearance without the cost, risks and downtime associated with surgical procedures. Botulinum toxin is a neuromuscular blocking agent produced by Clostridium Botulinum, an anaerobic bacterium. When first discovered BOTOX was pinpointed as the cause of severe paralysis acquired through the ingestion of contaminated food. Paralysis related to BOTOX is caused by chemodenervation, which is a result of blockage of the presynaptic release of acetylcholine at the neuromuscular junction. The corrugator (medial eyebrows), crow's feet, forehead, platysmal neckbands, and the jowl are frequently targeted areas for BOTOX injections. There are no current guidelines for physical limitations following the administration of BOTOX. Side effects associated with BOTOX infections appear to be either local, due to the paralysis of adjacent muscles, or mild flu-like symptoms lasting a few days in a small number of patients.

Positive selection of self-MHC-reactive T cells by individual peptide-MHC class II complexes.

If T cells require specific interactions with MHC-bound peptides during positive selection, then the specificities of T cells selected by one peptide should be distinct from those selected by another. We have examined positive selection of CD4 T cells in four strains of mice, each overexpressing a different peptide-1-A(b)(A(b)) complex. We show that a subset of CD4 T cells is selected by the overexpressed peptide and that the specificities of the CD4 T cells, as measured by reactivity to wild-type antigen-presenting cells, vary greatly depending on which peptide is overexpressed. These differences in specificity are mediated through positive selection not negative selection. Each of the four peptide-A(b) complexes appears to adopt a different conformation, and these differences correlate with the differences in reactivity. Our results suggest that individual peptide-MHC complexes positively select different subsets of self-MHC-reactive T cells and that the conformation of the peptide-MHC complex may contribute to this process.