A Prospective Randomized Controlled Two-Arm Clinical Study Evaluating the Efficacy of a Bioelectric Dressing System for Blister Management in US Army Ranger Recruits.

This study focused on a clinically relevant healthcare problem in the military: acute soft tissue wounds, or blisters. The trial was a prospective, controlled, randomized two-arm study evaluating the efficacy of a bioelectric dressing, Procellera®, applied topically two to three times per week for 2 weeks to blisters developed in Ranger trainees during training at Fort Benning, Georgia. A total of 80 US Army Ranger recruits with blister wounds below the knee were randomly assigned to one of two treatment groups (n = 40/group). The primary goal was to assess the clinical efficacy (rate of healing) of administered Procellera in conjunction with the standard-of-care (SOC) treatment, moleskin and Tegaderm ®, on the healing rate of blisters compared with the SOC treatment alone. The secondary end points for efficacy were the quantities of wound fluid biomarkers and bacterial bioburden. The tertiary end point was assessment of pain in the treatment group compared with that of the control group during the 2-week study. The results showed no statistical difference between the SOC and SOC+Procellera groups in wound healing and pain. Wound fluid was reported for 24 participants (64.9%) in the SOC group and 21 participants (56.8%) in SOC+Procellera group at the baseline measurement (ρ = .475); however, the wounds were devoid of fluid on follow-up visits. The mild nature of the wounds in this study was apparent by the low pain scores at the beginning of the study, which disappeared by the follow-up visits. The average wound sizes were 2.2cm2 and 1.5cm2 for the SOC and SOC+Procellera groups, respectively. This trial protocol should be conducted on open softtissue wounds in severe heat. To our knowledge, this is the first clinical study conducted within the US Army Rangers training doctrine.

Relationships between various temperament dimensions, levels of selected cytokines and Posttraumatic Stress Disorder (PTSD) in males, incurred as a result of mechanical injuries of lower extremities.

OBJECTIVES: This analysis addresses the relationships between various temperament dimensions, levels of selected cytokines and PTSD in males, incurred as a result of mechanical injuries of lower extremities. METHODS: PTSD was assessed with a PTSD Factorial Version Inventory. Temperamental traits were evaluated by means of Formal Characteristics of Behaviour - Temperament Inventory (FCB-TI). Cytokine levels were determined using ELISA kits. The study population was selected from among a larger population of 80 persons. 15 persons with signs of inflammation were excluded. PTSD group included 33 persons, 32 subjects were included in the control group. RESULTS: Positive statistical correlation with PTSD was observed for: perseverance and emotional reactivity. On the other hand, negative relationship was shown between PTSD and: briskness, endurance and activity. No statistically significant correlations were revealed between the levels of selected cytokines (sIL-2, IL-6, IL-10, TNF-alpha & IFN-gamma) and temperamental traits. Moreover, this study investigates the relationships between temperamental traits, PTSD and various personality dimensions. CONCLUSIONS: 1. Patients with temperamental traits such as high perseverance and emotional reactivity had a greater risk of PTSD. 2. Patients with temperamental traits such as high briskness, endurance and activity had lower risk of PTSD. 3. The level of cytokines (sIL-2, IL-6, IL-10, TNF-alpha, IFN-gamma) was not dependent on the temperamental traits.

A novel treatment in X-linked agammaglobulinaemia - hyperbaric oxygen therapy in refractory chronic wounds.

Chronic wounds are a rare complication of X-linked agammaglobulinaemia (XLA). Fastidious organisms such as helicobacter bills have been reported in XLA with chronic wounds but sterile chronic wounds also occur. Hyperbaric Oxygen Therapy has been used in chronic wounds but has not previously been reported in primary antibody deficiencies. We present a case of a chronic wound in a patient with XLA refractory to antimicrobial therapy that made a remarkable recovery following Hyperbaric Oxygen Therapy.

Models of lower extremity damage in mice: time course of organ damage and immune response.

BACKGROUND: Post-traumatic inflammatory changes have been identified as major causes of altered organ function and failure. Both hemorrhage and soft tissue damage induce these inflammatory changes. Exposure to heterologous bone in animal models has recently been shown to mimic this inflammatory response in a stable and reproducible fashion. This follow-up study tests the hypothesis that inflammatory responses are comparable between a novel trauma model ("pseudofracture", PFx) and a bilateral femur fracture (BFF) model. MATERIALS AND METHODS: In C57BL/6 mice, markers for remote organ dysfunction and inflammatory responses were compared in four groups (control/sham/BFF/PFx) at the time points 2, 4, and 6 h. RESULTS: Hepatocellular damage in BFF and PFx was highly comparable in extent and evolution, as shown by similar levels of NFkappaB activation and plasma ALT. Pulmonary inflammatory responses were also comparably elevated in both trauma models as early as 2 h after trauma as measured by myeloperoxidase activity (MPO). Muscle damage was provoked in both BFF and PFx mice over the time course, although BFF induced significantly higher AST and CK levels. IL-6 levels were also similar with early and sustained increases over time in both trauma models. CONCLUSIONS: Both BFF and PFx create similar reproducible inflammatory and remote organ responses. PFx will be a useful model to study longer term inflammatory effects that cannot be studied using BFF.

Isolated closed minor-muscle injury of the lower leg did not cause an obvious systemic immune response.

OBJECTIVE: A common consequence in patients with blunt trauma is a deterioration of the immune system. The specific impacts of a frequently occurring isolated soft tissue trauma on the immune response are described. However, the dimension of trauma needed to cause systemic effects has not been definitely elucidated. METHODS: Mice were traumatized on the lower leg. The extent of soft tissue trauma was quantified by determination of the wet/dry ratio, magnetic resonance imaging (MRI), and serum content of muscle proteins. Five minutes, 3, 24, 36, 48, and 72 h after trauma (a.t.) the ex vivo cytokine-expression of immune-competent cells were measured. RESULTS: Trauma resulted in an early edema that could be quantified by MRI and wet/dry ration. Release of muscle-specific proteins was detected 5 min a.t. The trauma did not cause significant changes of TNF-alpha response of isolated cells to endotoxin. IL6-response of splenocytes to endotoxin was slightly increased 72 h a.t., while IL6-response of peritoneal macrophages to endotoxin was decreased 36 h a.t. CONCLUSION: We describe a standardized trauma model for minor soft tissue injury in mice. Systemic effects on the immune system by traumatized lower leg were not found on the level of circulating cytokines or cellular responses to endotoxin.

Vacuum-assisted closure therapy increases local interleukin-8 and vascular endothelial growth factor levels in traumatic wounds.

BACKGROUND: Clinical observations are suggesting accelerated granulation tissue formation in traumatic wounds treated with vacuum-assisted closure (VAC). Aim of this study was to determine the impact of VAC therapy versus alternative Epigard application on local inflammation and neovascularization in traumatic soft tissue wounds. METHODS: Thirty-two patients with traumatic wounds requiring temporary coverage (VAC n = 16; Epigard n = 16) were included. At each change of dressing, samples of wound fluid and serum were collected (n = 80). The cytokines interleukin (IL)-6, IL-8, vascular endothelial growth factor (VEGF), and fibroblast growth factor-2 were measured by ELISA. Wound biopsies were examined histologically for inflammatory cells and degree of neovascularization present. RESULTS: All cytokines were found to be elevated in wound fluids during both VAC and Epigard treatment, whereas serum concentrations were negligible or not detectable. In wound fluids, significantly higher IL-8 (p < 0.001) and VEGF (p < 0.05) levels were detected during VAC therapy. Furthermore, histologic examination revealed increased neovascularization (p < 0.05) illustrated by CD31 and von Willebrand factor immunohistochemistry in wound biopsies of VAC treatment. In addition, there was an accumulation of neutrophils as well as an augmented expression of VEGF (p < 0.005) in VAC wound biopsies. CONCLUSION: This study suggests that VAC therapy of traumatic wounds leads to increased local IL-8 and VEGF concentrations, which may trigger accumulation of neutrophils and angiogenesis and thus, accelerate neovascularization.

Seronegative spondyloarthropathy initiated by physical trauma.

We undertook this study to demonstrate the pattern of onset and the course of arthritis on the traumatised joint in spondyloarthropathy (SpA) initiated by physical trauma. Among 288 patients with SpA, 12 (4.2%) whose arthropathies were associated with trauma were reviewed retrospectively. There were seven patients with ankylosing spondylitis (AS), three with juvenile onset AS and two undifferentiated SpA. The type of trauma was direct injury to the joint and injuries at other sites, except in spinal surgery, for example. In eight cases the initial evidence of disease was peripheral arthritis. The disease first occurred in traumatised joints in five cases. Only three cases showed recurrent inflammatory episodes in the traumatised joints throughout the disease course. SpA initiated by trauma initially manifested as peripheral arthritis at the traumatised joints in about half of the cases. Inflammatory episodes preferentially involved other joints apart from the traumatised joints throughout the whole course of the disease.

[Bioelectrostimulation in the rehabilitation of patients with gunshot wounds of the peripheral nervous system (a clinico-immunological study)]. / Bioélektrostimuliatsiia v reabilitatsii bol'nykh s ognestrel'nymi raneniiami perifericheskoi nervnoi sistemy (kliniko-immunologicheskoe issledovanie).

Immune homeostasis was studied in 35 patients with gunshot injuries of the peripheral nerves in the process of rehabilitation using bioelectrostimulation of the muscles impaired. Parameters of cellular and humoral immunity were determined. Bioelectrostimulation resulted in the regression of preexisting motor, sensitive, vegetovascular and trophic disorders. Cellular and humoral immunity improved: the number of T-lymphocytes, T-helpers, T-suppressors increased, the immunoregulatory index normalized, levels of B-lymphocytes, immunoglobulins G, circulating immune complexes reduced. Thus, bioelectrostimulation in patients with gunshot injuries of the peripheral nerves corrects the disturbed homeostasis and promotes recovery of the functions lost.

[A means for determining the bactericidal activity of the tissues during the treatment of orthopedic patients by transosseous osteosynthesis methods]. / Sposob opredeleniia bakteritsidnoi aktivnosti tkanei pri lechenii ortopedicheskikh bol'nykh metodami chreskostnogo osteosinteza.

The author suggests a new method for the assessment of the bactericidal activity of local tissues in the treatment of bone fractures or after effects thereof by the transosseous osteosynthesis methods. Tissue components may induce the formation of large sites of delayed growth in standard Micrococcus lysodeikticus cultures. To assess the bactericidal activity of the tissues, a standard diagnostic disk with an antibiotic is placed onto such cultures, this permitting the expression of the tissue bactericidal activity in equivalents of the antibiotic antibacterial effect and determine the low, medium, and high levels of the tissue bactericidal activity with respect to the minimal therapeutic suppressing concentration of this antibiotic. The author suggests that the mechanism of a drastic elevation of the local tissue bactericidal activity in transosseous osteosynthesis is explained by an essential enhancement of local tissue metabolism.

The relationship between serum IgG levels and age, leg injuries, infections and weight gains in dairy calves.

Serum IgG profiles for calves up to 50 days varied markedly depending on the level of passively acquired immunity. A relationship between serum IgG at 5 days of age and prevalence of leg injuries (skin lesions) was found, whereas no associations were seen regarding IgG and diarrhoea or liveweight gain.