The Efficacy of Platelet-rich Plasma Gel and Topical Estradiol Alone or in Combination on Healing of Full-thickness Wounds.

 This randomized study was designed to establish the efficacy of platelet-rich plasma (PRP) gel and topical estradiol alone, or in combination, on healing of full-thickness wounds created on the trunk of rabbits. Fifteen New Zealand white female rabbits and 60 wounds were studied. Four 2.25-cm² full-thickness wounds were created using a template and treatments including a sterile saline solution that were assigned randomly to the wounds. Wounds were bandaged, dressed intermittently, and assessed by wound measurements and a collection of samples at 7, 14, and 21 days to evaluate healing. Variables of interest were hydroxyproline concentration and scored gross and microscopic morphologic characteristics reflective of wound healing. PRP gel + estradiol-treated wounds completely healed faster than wounds given other treatments. Granulation tissue growth to the skin level was faster (P < 0.05) in the PRP gel + estradiol group than the other groups. Only the PRP gel + estradiol group had a significantly lower collagen level than the sterile saline solutions on day 7 (P < 0.05). The PRP gel + estradiol group and estradiol group led to an increase in angiogenesis on day 14 (P < 0.05). Complete epithelization was observed only in the PRP gel + estradiol group compared with the other groups on day 7. PRP gel + estradiol-treatment enhanced healing in full-thickness wounds by reducing the contraction rate with a trend toward accelerating both epithelial migration and the angiogenic response.

Elevated plasma levels of interleukin 1 beta, tumour necrosis factor alpha and monocyte chemotactic protein 1 are associated with pregnancy toxaemia in ewes.

Pregnancy toxaemia is a metabolic disorder that results from an inadequate energy supply to the growing maternal-fetal unit. The mechanism underlying the pathogenesis of the syndrome has not been fully clarified; however, a key role for cytokines and chemokines including interleukin 1 beta (IL-1 beta), tumour necrosis factor alpha (TNF-alpha) and monocyte chemotactic protein 1 (MCP-1) has been indicated in women and experimental animals. However, information on the maternal plasma levels of IL-1 beta, TNF-alpha and MCP-1 in ewes with pregnancy toxaemia is limited. Thus, the present study was designed to determine plasma IL-1 beta, TNF-alpha and MCP-1 concentrations in ewes with severe (n=6) and mild (n=4) naturally occurring pregnancy toxaemia and in uncomplicated pregnant ewes (n=10) using enzyme-linked immunosorbent assay (ELISA). All ewes with pregnancy toxaemia had significantly lower body temperature and respiratory rate than uncomplicated pregnant ewes (p<0.05). With the highest concentrations in severe cases, heart rate, proteinuria and serum uric acid levels as well as plasma IL-1 beta, TNF-alpha and MCP-1 were significantly different among all three groups (p<0.05). The plasma concentrations of IL-1 beta in control ewes and ewes with mild and severe toxaemia were 15.81 +/- 3.90 pg/ml, 23.83 +/- 2.42 pg/ml and 34.55 +/- 8.03 pg/ml, respectively. The plasma concentrations of TNF-alpha in control ewes and ewes with mild and severe toxaemia were 7.71 +/- 1.61 pg/ml, 16.13 +/- 3.63 pg/ml, and 22.85 +/- 3.64 pg/ml, respectively. The plasma concentrations of MCP-1 in control ewes and ewes with mild and severe toxaemia were 101.70 +/- 9.86 pg/ml, 134.75 +/- 6.24 pg/ml, and 157.67 +/- 9.69 pg/ml, respectively. Moreover, plasma IL-1 beta, TNF-alpha and MCP-1 levels were positively correlated with clinical and well-establish biochemical parameters of pregnancy toxaemia, serum uric acid and proteinuria (p<0.01). Concomitant increase of plasma IL-1 beta, TNF-alpha and MCP-1 concentrations along with serum uric acid, proteinuria, and worsening of the clinical signs indicates that such cytokines are involved in the aetiopathogenesis and in perpetuation of the local and systemic inflammatory reactions in pregnancy toxaemia in ewes. Hence, plasma IL-1 beta, TNF-alpha and MCP-1 may potentially serve as markers to monitor prognosis of pregnancy toxaemia in ewes.

Burnout in the neonatal intensive care unit and its relation to healthcare-associated infections.

OBJECTIVE: To examine burnout prevalence among California neonatal intensive care units (NICUs) and to test the relation between burnout and healthcare-associated infection (HAI) rates in very low birth weight (VLBW) neonates. STUDY DESIGN: Retrospective observational study of provider perceptions of burnout from 2073 nurse practitioners, physicians, registered nurses and respiratory therapists, using a validated four-item questionnaire based on the Maslach Burnout Inventory. The relation between burnout and HAI rates among VLBW (<1500 g) neonates from each NICU was evaluated using multi-level logistic regression analysis with patient-level factors as fixed effects. RESULTS: We found variable prevalence of burnout across the NICUs surveyed (mean 25.2±10.1%). Healthcare-associated infection rates were 8.3±5.1% during the study period. Highest burnout prevalence was found among nurses, nurse practitioners and respiratory therapists (non-physicians, 28±11% vs 17±19% physicians), day shift workers (30±3% vs 25±4% night shift) and workers with 5 or more years of service (29±2% vs 16±6% in fewer than 3 years group). Overall burnout rates showed no correlation with risk-adjusted rates of HAIs (r=-0.133). Item-level analysis showed positive association between HAIs and perceptions of working too hard (odds ratio 1.15, 95% confidence interval 1.04-1.28). Sensitivity analysis of high-volume NICUs suggested a moderate correlation between burnout prevalence and HAIs (r=0.34). CONCLUSION: Burnout is most prevalent among non-physicians, daytime workers and experienced workers. Perceptions of working too hard associate with increased HAIs in this cohort of VLBW infants, but overall burnout prevalence is not predictive.

The influence of body mass index and learned resourcefulness skills on body image and lifestyle practises.

We examined the importance of body mass index (BMI-light, medium, heavy) and learned resourcefulness skills (low, medium, high) on body image perceptions and lifestyle practises in 184 undergraduate women who were of relatively normal weight. Significant main effects were observed for the BMI and the learned resourcefulness variables. Supporting previous literature, the heavier and medium weight groups of women were more dissatisfied with their weight and appearance in comparison to the lighter weight group, but all groups shared similar eating attitudes and lifestyle practises. Also as predicted, women with low resourcefulness skills had more eating disturbances, perceived less control over their lifestyle, were more preoccupied with their weight in comparison to the high and, to a lesser extent, the medium groups. Contrary to prediction, heavier weight women with low resourcefulness skills were neither the most dissatisfied with their body shape nor the most susceptible to acquiring unhealthy lifestyle practises and disturbed eating attitudes. Implications for lifestyle counselors are discussed.

Co-incidental Von Willebrands disease and immune thrombocytopenia in pregnancy: treatment with high dose intravenous immunoglobulin.

We report a rare association of Von Willebrands disease and idiopathic immune thrombocytopenia in pregnancy. The major threat to the successful outcome of the pregnancy was posed by the acquired disorder. The use of high dose immunoglobulin allowed a normal delivery, without any adverse effects on mother or child.