Can dressings soaked with polyhexanide reduce bacterial loads in full-thickness skin grafting? A randomized controlled trial.

BACKGROUND: Polyhexamethylene biguanide (PHMB)-based antiseptic solutions can reduce bacterial loads in different clinical settings and are believed to lower risk of infections. OBJECTIVE: We sought to assess the efficacy of a PHMB-based solution in lowering bacterial loads of full-thickness skin grafting wounds and the risk of surgical site infections (SSIs). METHODS: In this double-blinded clinical trial, 40 patients planned for facial full-thickness skin grafting were randomized 1:1 to receive tie-over dressings soaked with either PHMB-based solution or sterile water. Quantitative and qualitative bacterial analysis was performed on all wounds before surgery, at the end of surgery, and 7 days postoperatively. In addition, all patients were screened for nasal colonization of Staphylococcus aureus. RESULTS: Analysis of wounds showed no statistically significant difference in bacterial reductions between the groups. The SSI rates were significantly higher in the intervention group (8/20) than in the control group (2/20) (P = .028). Higher postoperative bacterial loads were a common finding in SSIs (P = .011). This was more frequent when S aureus was present postoperatively (P = .034), intraoperatively (P = .03), and in patients with intranasal S aureus colonization (P = .007). LIMITATIONS: Assessment of SSIs is largely subjective. In addition, this was a single-center study and the total number of participants was 40. CONCLUSION: Soaking tie-over dressings with PHMB solution in full-thickness skin grafting had no effect on postoperative bacterial loads and increased the risk of SSI development. The presence of S aureus intranasally and in wounds preoperatively and postoperatively increased postoperative bacterial loads, which in turn resulted in significantly more SSIs.

The effect of a nurse led telephone supportive care programme on patients' quality of life, received information and health care contacts after oesophageal cancer surgery-A six month RCT-follow-up study.

BACKGROUND: Following oesophagectomy, a major surgical procedure, it is known that patients suffer from severely reduced quality of life and have an unmet need for postoperative support. Still, there is a lack of research testing interventions aiming to enhance the patients' life situation after this surgical procedure. AIM: The aim of the study was to evaluate the effect of a nurse led telephone supportive care programme on quality of life (QOL), received information and the number of healthcare contacts compared to conventional care following oesophageal resection for cancer. METHOD: The study was designed as a randomized controlled trial (RCT) aiming to test the effect of a nurse led telephone supportive care program compared to conventional care. Patient assessments were conducted at discharge, 2 weeks, 2, 4 and 6 months after discharge and comprised evaluation of QOL, received information and the number of health care contacts. Statistical testing were conducted with repeated measurements analysis of variance to test if there were differences between the groups during follow-up. RESULT: The results show that the intervention group was significantly more satisfied with received information for items concerning the information they received about things to do to help yourself, written information and for the global information score. The control group scored significantly higher on the item regarding wishing to receive more information and wish to receive less information. No effect of the intervention was shown on QOL or number of health care contacts. CONCLUSION: Proactive nurse-led telephone follow-up has a significant positive impact on the patients' experience of received information. This is likely to have a positive effect on their ability to cope with a life that may include remaining side effects and adverse symptoms for a long time after surgery.

Characterization of two distinct aryl hydrocarbon receptor (AhR2) genes in Atlantic salmon (Salmo salar) and evidence for multiple AhR2 gene lineages in salmonid fish.

The aryl hydrocarbon receptor (AhR) mediates the toxicity of several environmental contaminants, e.g. 2,3,7,8-tetrachlorodibenzo-p-dioxin, and other halogenated hydrocarbons in vertebrates. This receptor initiates the transcription of several biotransformation enzymes, which in turn are responsible for causing severe harm to biological tissue. Here we describe the isolation and complete characterization of the first two AhR genes from the teleost fish Atlantic salmon (Salmo salar). The predicted amino acid sequences contain regions characteristic of other vertebrate AhRs including basic helix-loop-helix (bHLH) and PER-ARNT-SIM (PAS) domains but show little similarity to other vertebrate AhRs across the C-terminal half. Furthermore, they do not contain distinct Q-rich domains as found in the mammalian AhR, which is in line with previously described fish AhR genes. The salmon cDNAs encode 1106 and 1107 putative residues, respectively, approximately 50 amino acids longer than previously characterized AhR genes. Phylogenetic analyses demonstrated that the two salmon AhR sequences cluster within the AhR subfamily of the bHLH-PAS family, in a clade containing fish AhR2 genes. Although the two AhR2 forms are 92% identical at the amino acid level, the distribution of sequence differences and the presence of both forms in 30 tested individuals suggest that they are not allelic but derived from separate loci. Interestingly, they are not orthologs of the rainbow trout (Oncorhynchus mykiss) AhR2 alpha and beta genes and the new salmon loci are therefore here designated AhR2 gamma and AhR2 delta. In line with this, PCR with DNA from rainbow trout revealed a new trout AhR locus that was more similar to the two salmon genes than to the trout AhR2 alpha and beta genes, suggesting that the rainbow trout possesses at least three distinct AhR2 genes. The presence of multiple AhR genes in these species is probably a consequence of the genome duplications that occurred in the early evolution of fish and later also specifically in the salmonid lineage. Reverse transcription-PCR analyses revealed that both AhR2 gamma and AhR2 delta are transcribed in the liver, spleen and muscles of adult salmon.

Unprecedented genomic diversity of AhR1 and AhR2 genes in Atlantic salmon (Salmo salar L.).

Aryl hydrocarbon receptor (AhR) genes encode proteins involved in mediating the toxic responses induced by several environmental pollutants. Here, we describe the identification of the first two AhR1 (alpha and beta) genes and two additional AhR2 (alpha and beta) genes in the tetraploid species Atlantic salmon (Salmo salar L.) from a cosmid library screening. Cosmid clones containing genomic salmon AhR sequences were isolated using a cDNA clone containing the coding region of the Atlantic salmon AhR2gamma as a probe. Screening revealed 14 positive clones, from which four were chosen for further analyses. One of the cosmids contained genomic AhR sequences that were highly similar to the rainbow trout (Oncorhynchus mykiss) AhR2alpha and beta genes. SMART RACE amplified two complete, highly similar but not identical AhR type 2 sequences from salmon cDNA, which from phylogenetic analyses were determined as the rainbow trout AhR2alpha and beta orthologs. The salmon AhR2alpha and beta encode proteins of 1071 and 1058 residues, respectively, and encompass characteristic AhR sequence elements like a basic-helix-loop-helix (bHLH) and two PER-ARNT-SIM (PAS) domains. Both genes are transcribed in liver, spleen and muscle tissues of adult salmon. A second cosmid contained partial sequences, which were identical to the previously characterized AhR2gamma gene. The last two cosmids contained partial genomic AhR sequences, which were more similar to other AhR type 1 fish genes than the four characterized salmon AhR2 genes. However, attempts to amplify the corresponding complete cDNA sequences of the inserts proved very difficult, suggesting that these genes are non-functional or very weakly transcribed in the examined tissues. Phylogenetic analyses of the conserved regions did, however, clearly indicate that these two AhRs belong to the AhR type 1 clade and have been assigned as the Atlantic salmon AhR1alpha and AhR1beta genes. Taken together, these findings demonstrate that multiple AhR genes are present in Atlantic salmon genome, which likely is a consequence of previous genome duplications in the evolutionary past of salmonids. Plausible explanations for the high incidence of AhR genes in fish and more specifically in salmonids, like rapid divergences in specialized functions, are discussed.

Diuretic treatment of nocturnal enuresis.

OBJECTIVE: Nocturnal polyuria is considered a major pathogenetic factor in nocturnal enuresis, and the antidiuretic drug desmopressin, given at bed-time, is consequently recognized as a first-line treatment alternative. The aim of this open, non-randomized study was to see whether diuretic medication, given in the afternoon, could give similar therapeutic benefit. MATERIAL AND METHODS: Sixty-three children suffering from primary, monosymptomatic, nocturnal enuresis were included in the study by their primary care paediatrician. After 14 days without any treatment and 14 days for which 0.4 mg of desmopressin was given orally at bed-time, the children were given furosemide 1 mg/kg in the afternoon for 14 consecutive days. The numbers of wet and dry nights were recorded. RESULTS: The numbers of wet nights at baseline, during desmopressin treatment and during furosemide treatment were 10.2+/-3.5, 6.4+/-4.6 and 8.2+/-4.5, respectively. Both drugs were significantly better than no treatment, but only a small proportion of patients became completely dry: 24% on desmopressin and 12% on furosemide. Desmopressin was significantly better than furosemide. Three children who showed no therapeutic effect on desmopressin treatment had a favourable response to furosemide. CONCLUSION: Furosemide, given in the afternoon, has minor therapeutic potential in nocturnal enuresis.