High-Pressure Injection Injury to the Hand - A Case Report.

High-pressure injection injuries to the hand can be surgical emergencies. The injected material and subsequent edema increase the risk for infection, ischemia, compartment syndrome, and limb loss. This is a case report of a 53-year-old male who presented to the emergency department with a superficial two-centimeter laceration to the dorsum of his left hand. He had no obvious signs of infection and the surrounding structures were neurovascularly intact. The patient had been using a gas-powered pressure washer when he sustained the injury to his hand. Physical exam revealed marked crepitus throughout the left hand extending up to the mid forearm. Radiographs of the left hand and left forearm demonstrated extensive subcutaneous emphysema. Hand surgery was emergently consulted and recommended admission for serial exams and antibiotics. This case illustrates a key point: despite initially benign presentations, high-pressure injection injuries should be approached as emergent processes that can be easily overlooked if the proper history and appropriate diagnostic measures are not executed. Topics: Hand, orthopedics, x-ray, high-pressure injection injury.

Leukotoxin (LtxA/Leukothera) induces ATP expulsion via pannexin-1 channels and subsequent cell death in malignant lymphocytes.

Leukotoxin (LtxA) (Trade name, Leukothera) is a protein that is secreted from the oral bacterium Aggregatibacter actinomycetemcomitans, which targets and kills activated white blood cells (WBCs) by binding to lymphocyte function associated antigen-1 (LFA-1). Interaction between LtxA and Jurkat T-cells results in cell death and is characterized by increased intracellular Ca2+, activation of caspases, clustering of LtxA and LFA-1 within lipid rafts, and involvement of the Fas death receptor. Here, we show that LtxA can kill malignant lymphocytes via apoptotic and necrotic forms of cell death. We show that LtxA causes activation of caspases and PARP, cleavage of pannexin-1 (Panx1) channels, and expulsion of ATP, ultimately leading to cell death via apoptosis and necrosis. CRISPR-Cas9 mediated knockout (K/O) of Panx1 in Jurkat cells prevented ATP expulsion and resulted in resistance to LtxA for both apoptotic and necrotic forms of death. Resistance to necrosis could only be overcome when supplementing LtxA with endogenous ATP (bzATP). The combination of LtxA and bzATP promoted only necrosis, as no Panx1 K/O cells stained positive for phosphatidylserine (PS) exposure following the combined treatment. Inhibition of LtxA/bzATP-induced necrosis was possible when pretreating Jurkat cells with oATP, a P2X7R antagonist. Similarly, blockage of P2X7Rs with oATP prevented the intracellular mobilization of Ca2+, an important early step in LtxA induced cell death. We show that LtxA is able to kill malignant lymphocytes through an apoptotic death pathway which is potentially linked to a Panx1/P2X7R mediated necrotic form of death. Thus, inhibition of ATP release appears to significantly delay the onset of LtxA induced apoptosis while completely disabling the necrotic death pathway in T-lymphocytes, demonstrating the crucial role of ATP release in LtxA-mediated cell death.

Antibacterial effect and proposed mechanism of action of a topical surgical adhesive.

BACKGROUND: Medical adhesives effectively hold closed approximated skin edges of wounds from surgical incisions, including punctures from minimally invasive surgery. In addition, they have been reported to be antibacterial against gram-positive bacteria. METHODS: Using membrane filtration to capture all organisms after contact with 2-octyl cyanoacrylate product for 3 minutes, we quantified the number of survivors. Controls were performed to rule out that the noted level of kill was caused by carryover product in the test system. RESULTS: We found that the product kills >7 logs of gram-positive and gram-negative bacteria. The mechanism of action for the antibacterial effect is described as a function of very low water content. CONCLUSIONS: As an antibacterial agent, the risk of nosocomial infection is greatly diminished, and an uneventful clinical result is facilitated. Bacterial growth cannot occur in the formulation and on contact death rapidly ensues as cellular water diffuses from the cell into the product.

Antiviral activity of theaflavin digallate against herpes simplex virus type 1.

Tea is the second most consumed drink in the world. The beneficial effects of tea have been mostly attributed to its catechin content. Black tea is derived from the leaves of Camellia sinensis plant, and it is rich in theaflavin polyphenols, in particular theaflavin (TF1), theaflavin-3-monogallate (TF2A), theaflavin-3'-monogallate (TF2B), and theaflavin-3,3'-digallate (TF3). Vero and A549 cells were used to evaluate the effect of purified individual black tea theaflavins as anti-herpes simplex virus 1 agents. With the rise of HSV resistant strains, there is a critical need to develop novel antiherpesviral treatments. Results of the cytotoxicity assay tested by MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxy-phenyl)-2-(4-sulfophenyl)-2H-tetrazolium] showed that TF1, TF2, and TF3 are not toxic to Vero and A549 cells at a concentration up to 75 µM. The antiviral activity of the individual theaflavins was tested by plaque reduction assay, MTS assay, flow cytometric analysis and confocal microscopy observations. The results showed that TF1, TF2, and TF3 exhibit potent, dose-dependent anti-HSV-1 effect, with TF3 being the most efficient in both Vero and A549 cells. A concentration of 50 µM TF3 and above was sufficient to inhibit >99% of the production of HSV-1 viral particles. The anti-HSV-1 effect of TF3 is due to a direct effect on the virions, and treating Vero or A549 cells with TF3 for 1h prior to infection, or treating the cells at different times post infection does not inhibit HSV-1 production. TF3 is stable at vaginal pH, indicating its potential to be a promising natural and affordable remedy against herpes simplex viral infections.