Innovative biochemisurgical treatment for stabilisation of an end-stage chronic wound in a complex vascular compromized patient.

INTRODUCTION: Treating advanced peripheral arterial occlusive disease (e.g. PAOD IV) poses a significant challenge, as conventional treatments quite often fall short at this stage. However, a range of interventions can be considered to postpone amputation. This study presents an example of advanced stage of Peripheral Artery Occlusive Disease (PAOD) stage IV, encompassing a history of a high thigh amputation on the left side, coupled with pronounced wound healing disorders. PRESENTATION OF CASE: Our patient, 55 years old, smoker and ASA Class III is in a left sided above-the knee-amputation situation. He presented to our outpatient clinic with blistering in the stump area, caused by non-proportinate pressure from the prosthesis. With an emerging septic course and advanced peripheral arterial occlusive disease (PAOD) at Fontaine class IV, revascularization was unfeasible in the left iliac artery axis and groin arteries. Additionally, a stage PAOD IV presents itself with poorly healing wounds on the right side which our patient still uses to support his transfers in and out bed and his wheelchair. Multiple surgical stump revisions and femur shortenings and diverse wound treatments were performed all were unsatisfying for patient and practitioners. We introduced a novel biochemisurgical treatment in our teaching hospital. DISCUSSION: Desiccating-agent-A is an innovative dehydrating agent with potent desiccating characteristics upon application to organic substances. Its formulation involves blending 83% methane sulfonic acid with proton acceptors and dimethyl sulfoxide, as outlined in patent application. The case description results in an illustrated follow up period of 16 months and is presented in line with the recommendations of the consensus-based surgical case reporting guideline development. CONCLUSION: The goal of achieving a secondary healing trend is to establish stability within the wound area or achieve complete healing. This endeavor becomes particularly intricate when severe blood circulation compromise exists. Nonetheless, progress in wound treatment measures has made it feasible to achieve this aim by fostering the formation of dry and clean necrotic tissue. This dry and clean wound is now manageable in a patient's home situation, allowing for effective care and a better chance at preventing further severe complications.

Noncovalent Interactions in Halogenated Pyridinium Salts of the Weakly Coordinating Anion [Al(OTeF5 )4 ].

The synthesis and the first structural characterization of the halogenated pyridinium salts [C5 F5 NH]+ , [C5 F4 ClNH]+ , [(C5 F5 N)2 H]+ , [(C5 Cl5 N)2 H]+ of the weakly coordinating anion (WCA) [Al(OTeF5 )4 ]- , showing noncovalent interactions in the solid state, are presented. The salts were characterized by the multinuclear NMR and IR spectroscopy as well as X-ray diffraction. Hirshfeld surface analysis and solid state structures reveal various intermolecular anion-π and σ-hole interactions between the corresponding halogenated pyridinium cations and the anion [Al(OTeF5 )4 ]- .

Improved Access to Organo-Soluble Di- and Tetrafluoridochlorate(I)/(III) Salts.

A facile one-pot gram-scale synthesis of tetraalkylammonium tetrafluoridochlorate(III) [cat][ClF4 ] ([cat]=[NEt3 Me]+ , [NEt4 ]+ ) is described. An acetonitrile solution of the corresponding alkylammonium chloride salt is fluorinated with diluted fluorine at low temperatures. The reaction proceeds via the [ClF2 ]- anion which is structurally characterized for the first time. The potential application of [ClF4 ]- salts as fluorinating agents is evaluated by the reaction with diphenyl disulfide, Ph2 S2 , to pentafluorosulfanyl benzene, PhSF5 . The CN moieties in acetonitrile and [B(CN)4 ]- are transferred in CF3 groups. Exposure of carbon monoxide, CO, leads to the formation of carbonyl fluoride, COF2 , and elemental gold is dissolved under the formation of tetrafluoridoaurate [AuF4 ]- .

Matrix-isolation and comparative far-IR investigation of free linear [Cl3]- and a series of alkali trichlorides.

Here we discuss the reaction products of laser ablated alkali chlorides and elemental chlorine. Salt ablation using this technique combined with matrix-isolation spectroscopy allows for the formation and characterization of novel anionic species. The laser ablation of solid MCl with M = Cs, Rb, and K in the presence of Cl2 produced free [Cl3]- ions which were isolated in solid noble-gas matrices. For M = Cs, Rb, K, and Na, the ion pairs M+[Cl3]- are the main reaction products. Trends in the formation and bonding of these trichloride anions will be discussed. In contrast to the trifluoride analogues, the isolated ion pairs M+[Cl3]- feature a systematic distortion due to metal coordination.

Differential modulation of the lipid metabolism as a model for cellular resistance to fumonisin B1-induced cytotoxic effects in vitro.

Differential sensitivity of primary hepatocytes and Chang cells to the cancer promoter fumonisin B1 (FB1)-induced cytotoxic effects were investigated in relation to changes in membrane lipid distribution. In contrast to primary hepatocytes, Chang cells were resistant to FB1-induced cytotoxic effects. This was associated with a high cholesterol (Chol) and sphingomyelin (SM) and low phosphatidylcholine (PC) content, resulting in a significant (P<0.05) decrease in phosphatidylethanolamine (PE)/PC ratio, increased Chol/total phosphoglyceride (TPG) ratios and low total polyunsaturated fatty acids (PUFA) content in PC and PE, suggesting a more rigid membrane structure. High levels of C18:1 and reduced polyunsaturated fatty acid (PUFA) levels are likely to provide selective resistance to FB1-induced oxidative stress. FB1-associated lipid changes included decreases in SM and Chol, increases in sphinganine (Sa) and PE with the increases in key saturated, monounsaturated, and PUFAs in PE as key role players in the differential responses to FB1-induced cell growth responses in cells.

Summarization of Injury and Fatality Factors Involving Children and Youth in Grain Storage and Handling Incidents.

This article summarizes data gathered on 246 documented cases of children and youth under the age of 21 involved in grain storage and handling incidents in agricultural workplaces from 1964 to 2013 in the U.S. that have been entered into the Purdue Agricultural Confined Space Incident Database. The database is the result of ongoing efforts to collect and file information on documented injuries, fatalities, and entrapments in all forms of agricultural confined spaces. While the frequency of injuries and fatalities involving children and youth in agriculture has decreased in recent years, incidents related to agricultural confined spaces, especially grain storage and handling facilities, have remained largely unchanged during the same period. Approximately 21% of all documented incidents involved children and youth (age 20 and younger), and more than 77% of all documented incidents were fatal, suggesting an under-reporting of non-fatal incidents. Findings indicate that the majority of youth incidents occurred at OSHA exempt agricultural worksites. The states reporting the most incidents were Indiana, Iowa, Nebraska, Illinois, and Minnesota. Grain transport vehicles represented a significant portion of incidents involving children under the age of 16. The overwhelming majority of victims were male, and most incidents (50%) occurred in June, October, and November. Recommendations include developing intervention strategies that target OSHA exempt farms, feedlots, and seed processing facilities; preparing engineering design and best practice standards that reduce the exposure of children and youth to agricultural confined spaces; and developing gender-specific safety resources that incorporate gender-sensitive strategies to communicate safety information to the population of young males with the greatest risk of exposure to the hazards of agricultural confined spaces.

Induction of an altered lipid phenotype by two cancer promoting treatments in rat liver.

Changes in lipid metabolism have been associated with tumor promotion in rat liver. Similarities and differences of lipid parameters were investigated using the mycotoxin fumonisin B1 (FB1) and the 2-acetylaminofluorene/partial hepatectomy (AAF/PH) treatments as cancer promoters in rat liver. A typical lipid phenotype was observed, including increased membranal phosphatidylethanolamine (PE) and cholesterol content, increased levels of C16:0 and monounsaturated fatty acids in PE and phosphatidylcholine (PC), as well as a decrease in C18:0 and long-chained polyunsaturated fatty acids in the PC fraction. The observed lipid changes, which likely resulted in changes in membrane structure and fluidity, may represent a growth stimulus exerted by the cancer promoters that could provide initiated cells with a selective growth advantage. This study provided insight into complex lipid profiles induced by two different cancer promoting treatments and their potential role in the development of hepatocyte nodules, which can be used to identify targets for the development of chemopreventive strategies against cancer promotion in the liver.

Worker hazards associated with the use of grain vacuum systems.

Over the past two decades, there has been more widespread use of pneumatic handling of grain at commercial grain storage facilities and on farms as these operations have increased grain storage capacity and handle larger volumes of grain and feed In some cases, manufacturers have suggested that the use of these systems is a safer alternative to removing residual grain manually in conjunction with the use of sweep augers. The use of grain vacuum systems has also been increasingly documented as a strategy in responding to grain storage fires and human entrapment and engulfment in flowing grain. With greater utilization of these machines have come reports of entrapments and engulfments. This article summarizes 27 such documented incidents, including 21 fatalities, that resulted from the use of portable grain vacuum systems. It includes specific recommendations for engineering, educational, and regulatory strategies to reduce the risks associated with the use of these systems.

Dietary PUFA and cancer.

The aim of the present paper is to give a brief overview on the role of dietary fat in carcinogenesis and as possible anticancer agents. Dietary fat is an essential nutrient and important source for the essential fatty acids (FA), linoleic and α-linolenic acids, which contribute to proper growth and development. However, dietary fat has been associated with the development of colorectal, breast, prostate, endometrial and ovarian cancers, with the type and quality of fat playing an underlying role. Tumour growth is the disruption of the homoeostatic balance regulating cell differentiation, proliferation and apoptosis and is associated with altered lipid metabolism. Animal cancer models and human cancer biopsy tissue demonstrate that a characteristic lipid profile is associated with the growth and development of neoplastic lesions. This entails alterations in membrane cholesterol, phospholipid and PUFA metabolism. Particularly, alterations in cell membrane FA metabolism involving the n-6 and n-3 PUFA, are associated with changes in membrane structure, function, cellular oxidative status, activity of enzymes and signalling pathways. These events are a driving force in sustaining the altered growth of cancerous lesions and provide unique targets for intervention/cancer modulation. Challenges in utilising FA in cancer modulation exist regarding intake and effect on cell structure and biochemical interactions within the cell in the prevention of cancer development. Therefore, utilising dietary PUFA in a specific n-6:n-3 ratio may be an important chemopreventive tool in altering the growth characteristics of cancer cells.

[Pulmonary capillary blood volume and membrane components of pulmonary diffusion capacity in patients with chronic obstructive bronchitis (COPD)]. / Pulmonales kapilläres Blutvolumen und Membrankomponente der pulmonalen Diffusionskapazität bei Patienten mit chronisch obstruktiver Bronchitis (COPD).

Reduced pulmonary diffusion capacity is a hallmark of COPD, although the relative contribution of the subcomponents of pulmonary diffusion--membranous component (Dm) and capillary volume (Vc)--is unknown. These components can be measured with the method of NO single-breath diffusion (DLNO). In a prospective study, pulmonary function tests including spirometry, body plethysmography and single-breath measurements of diffusion capacity with CO and NO were performed in 183 patients with COPD of varying severity. There was a severity-dependent decrease in DLCO. Furthermore, Dm as well as Vc was positively correlated with the severity of COPD measured by FEV1. In all stages of COPD, reduction of Vc was more pronounced than constriction of Dm. In patients with most severe COPD, the preponderance of the reduction of Vc was significantly more marked than in milder stages.We conclude that Dm as well as Vc contributes to the reduction of DLCO in COPD, with a predominance of Vc at all stages of COPD. This confirms the idea that the loss of pulmonary capillaries in COPD is functionally relevant.

Endurance training in MS: short-term immune responses and their relation to cardiorespiratory fitness, health-related quality of life, and fatigue.

The influences of exercise on cytokine response, health-related quality of life (HR-QoL), and fatigue are important aspects of MS rehabilitation. Physical exercises performed within these programs are often practiced in water, but the effects of immersion have not been investigated. To investigate the influences of short-term immune responses and cardiorespiratory fitness on HR-QoL and fatigue during 3 weeks endurance training conducted on a cycle-ergometer or an aquatic-bike. Randomized controlled clinical trial in 60 MS patients. HR-QoL, fatigue, cardiorespiratory fitness, and short-term immune changes (serum concentrations in response to cardiopulmonary exercise test) of brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), interleukin-6, and the soluble receptor of IL-6 (sIL-6R) were determined at the beginning and end of 3 weeks of training intervention. Subjects performed daily 30 min training at 60 % of their VO2peak. SF-36 total (p = 0.031), physical (p = 0.004), and mental health (p = 0.057) scores show time effects within both groups. Between-group effects were shown for FSMC total (p = 0.040) and motor function score (p = 0.041). MFIS physical fatigue showed time effects (p = 0.008) for both groups. Linear regression models showed relationships between short-term immune responses and cardiorespiratory fitness with HR-QoL and fatigue after the intervention. This study indicates beneficial effects of endurance training independent of the training setting. Short-term immune adaptations and cardiorespiratory fitness have the potential to influence HR-QoL and fatigue in persons with MS. The specific immune responses of immersion to exercise need further clarification.

Enhanced reactivity and related optical changes of Ag nanoparticles on amorphous Al2O3 supports.

Pairs of samples containing Ag nanoparticles (NPs) of different dimensions have been produced under the same conditions but on different substrates, namely standard glass slides and a thin layer of amorphous aluminum oxide (a-Al2O3) on-glass. Upon storage in ambient conditions (air and room temperature) the color of samples changed and a blue-shift and damping of the surface plasmon resonance was observed. The changes are weaker for the samples on-glass and tend to saturate after 12 months. In contrast, the changes for the samples on a-Al2O3 appear to be still progressing after 25 months. While x-ray photoelectron spectroscopy shows a slight sulfurization and negligible oxidation of the Ag for the on-glass samples upon 25 months aging, it shows that Ag is strongly oxidized for the on a-Al2O3 samples and sulfurization is negligible. Both optical and chemical results are consistent with the production of a shell at the expense of a reduction of the metal core dimensions, the latter being responsible for the blue-shift and related to the small (<10 nm initial diameter) of the NPs. The enhanced reactivity of the Ag NPs on the a-Al2O3 supports goes along with specific morphological changes of the Ag NPs and the observation of nitrogen.

Summation of the frequency, severity, and primary causative factors associated with injuries and fatalities involving confined spaces in agriculture.

A project was undertaken to estimate the frequency, severity, and primary causative factors associated with injuries and fatalities involving confined spaces in agriculture, including grain bins, silos, and manure storage and handling facilities. A total of 1255 cases from 41 states were analyzed. These cases were included in the Purdue Agriculture Confined Space Database and occurred during the period 1964-2010. During the period 2001-2010, an average of 51 cases were documented annually. Approximately 71% of all documented cases involved grain, and over 16% of all cases involved children under the age of 16. This article presents a summary of the identified incidents and offers conclusions drawn from the study's findings.

PCR offers no advantage over culture for microbiologic diagnosis in cellulitis.

PURPOSE: Most cases of cellulitis are traditionally attributed to ß-hemolytic Streptococcus and Staphylococcus species, although in most cases, no organism is identified. Development of PCR using the conserved bacterial 16 S rRNA DNA permits identification of bacteria independent of conventional culture approaches and prior use of antibiotics. METHODS: We used PCR-based techniques to identify cellulitis etiology using aspirate samples from affected skin. Saline was infiltrated and aspirated at the site of greatest erythema or at the cellulitic border. Samples were tested for 16 S rRNA DNA, and organism-specific probes used to identify bacteria commonly seen in skin infections. RESULTS: Aspirates from 32 patients were studied, and 16 S rRNA DNA was detected in nine of these patient samples (28.1%). Bacterial species were identified by PCR methods in six of these nine samples (66.6%), with S. aureus and methicillin-resistant S. aureus (MRSA) identified in four and two, respectively, of these samples. Of the patients with positive aspirate bacterial cultures (3/9, 33.3%), S. aureus and coagulase-negative Staphylococcus (CoNS) were present on cultures of two of the three (both 66.6%) positive samples. Only in one of the three positive bacterial cultures did the PCR method detect the same organism as was detected by culture. Among patients with positive provider-collected clinical cultures, MRSA was the predominant organism (11/18, 61.1%) and when present, it was found as the sole organism. Where S. aureus or Streptococcus species were detected by molecular methods, clinical cultures yielded a positive result as well. CONCLUSIONS: PCR-based techniques do not appear to be more sensitive than aspirate cultures for the detection of pathogens in cellulitis.

Interleukin-1α Induction in Human Keratinocytes (HaCaT): An In Vitro Model for Chemoprevention in Skin.

Long-term exposure to UV irradiation and toxic chemicals is associated with chronic inflammation that contributes to skin cancer development with interleukin-1 alpha (IL-1α), constitutively produced by keratinocytes, playing a pivotal role in skin inflammation. The aim of this study was to investigate the modulation of IL-1α production in the HaCaT keratinocyte cell line. Phorbol 12-myristate 13-acetate failed to induce IL-1α in HaCaT cells, and this might be associated with the specific deficiency known to affect downstream signalling of the MEK/ERK pathway in these cells. The calcium ionophore, ionomycin, slightly enhanced the production of intracellular (icIL-1α), but this resulted in a necrotic release at higher concentrations. UV-B exposure significantly increased the production of icIL-1α in a dose-dependent manner with a maximal induction exhibited at 24 h with minimal necrotic and apoptotic effects. Validation of the HaCaT cell model indicated that the nonsteroidal anti-inflammatory drug (NSAID), ibuprofen, and the glucocorticoid, dexamethasone, inhibited icIL-1α production, and this was associated with a slight inhibition of cell viability. The UV-B-induced keratinocyte cell model provides an in vitro system that could, apart from phorbol ester-like compounds, be utilised as a screening assay in identifying skin irritants and/or therapeutic topical agents via the modulation of IL-1α production.

[Counselling centres for patients with cancer--analysis of service provision in Saxony]. / Psychosoziale Krebsberatungsstellen--eine Analyse der Versorgungsrealität in Sachsen.

OBJECTIVES: The aim of this study was to understand the quantity and quality of psychosocial services offered at counselling centres for outpatients with cancer in Saxony, a federal state of Germany. METHODS: Structured interviews with employees on site at the counselling centres in Saxony (N=30) and an analysis of their yearly reports were undertaken. RESULTS: The majority of the counselling centres (N=25) was situated at local health departments. All institutions document their activities regularly and offer continuous training for their employees. Services include primarily information on and admission to social services whereas psychological and psychotherapeutic services are rare. Considering the guideline criteria for staffing with a ratio of one counsellor per 75,000 inhabitants, a total of 23 counsellors were lacking in the federal state of Saxony at the time of investigation. CONCLUSIONS: The method of situating counselling centres at local health departments ensures good access for almost all cancer patients and relatives seeking counselling. However, due to restricted financial resources the services offered are not sufficient according to the guidelines and solutions for this situation are needed.

Neonatal Trichomonas vaginalis infection: a case report and review of literature.

Neonatal infection with Trichomonas vaginalis is an unusual occurrence. We present a case of T. vaginalis found on routine urinalysis in a five-day-old neonate born at 29 weeks gestational age. The patient was treated with metronidazole and had complete resolution of the infection. This report discusses the significance of diagnosis and treatment of T. vaginalis in the neonate.

Analysis of postural stability following posterior spinal fusion in adolescents with idiopathic scoliosis.

This study uses experimental data acquired from adolescents with idiopathic scoliosis to assess their postural control during quiet standing before and after posterior spinal fusion. Statistically significant differences were seen when comparing the pre- and post-surgical measures of balance calculated from data for three different test conditions.