A multi-centre clinical evaluation of reactive oxygen topical wound gel in 114 wounds

OBJECTIVE

This article reports the outcomes of the use of Surgihoney RO (SHRO), topical wound dressing in a multi-centre, international setting. The aims were to explore the clinical effects of SHRO, including a reduction in bacterial load and biofilm and improvement in healing in a variety of challenging non-healing and clinically infected wounds.

METHOD

This was a non-comparative evaluation, where both acute and chronic wounds with established delayed healing were treated with the dressing. Clinicians prospectively recorded wound improvement or deterioration, level of wound exudate, presence of pain, and presence of slough and necrosis. Analysis of this data provided information on clinical performance of the dressing. Semi-quantitative culture to assess bacterial bioburden was performed where possible.

RESULTS

We recruited 104 patients, mean age 61 years old, with 114 wounds. The mean duration of wounds before treatment was 3.7 months and the mean duration of treatment was 25.7 days. During treatment 24 wounds (21%) healed and the remaining 90 (79%) wounds improved following application of the dressing. No deterioration in any wound was observed. A reduction in patient pain, level of wound exudate and in devitalised tissue were consistently reported. These positive improvements in wound progress were reflected in the wound cultures that showed a reduction in bacterial load in 39 out of the 40 swabs taken. There were two adverse events recorded: a stinging sensation following application of the dressing was experienced by 2 patients, and 2 elderly patients died of causes unrelated to the dressing or to the chronic wound. These patients' wounds and their response to SHRO have been included in the analysis.

CONCLUSION

SHRO was well tolerated and shows great promise as an effective potent topical antimicrobial in the healing of challenging wounds.

DECLARATION OF INTEREST

Matthew Dryden has become a shareholder in Matoke Holdings, the manufacturer of Surgihoney RO, since the completion of this study. Keith Cutting is a consultant to Matoke Holdings.

Ozanimod (RPC1063) is a potent sphingosine-1-phosphate receptor-1 (S1P1 ) and receptor-5 (S1P5 ) agonist with autoimmune disease-modifying activity

BACKGROUND AND PURPOSE

Sphingosine1-phosphate (S1P) receptors mediate multiple events including lymphocyte trafficking, cardiac function, and endothelial barrier integrity. Stimulation of S1P1 receptors sequesters lymphocyte subsets in peripheral lymphoid organs, preventing their trafficking to inflamed tissue sites, modulating immunity. Targeting S1P receptors for treating autoimmune disease has been established in clinical studies with the non-selective S1P modulator, FTY720 (fingolimod, Gilenya™). The purpose of this study was to assess RPC1063 for its therapeutic utility in autoimmune diseases.

EXPERIMENTAL APPROACH

The specificity and potency of RPC1063 (ozanimod) was evaluated for all five S1P receptors, and its effect on cell surface S1P1 receptor expression, was characterized in vitro. The oral pharmacokinetic (PK) parameters and pharmacodynamic effects were established in rodents, and its activity in three models of autoimmune disease (experimental autoimmune encephalitis, 2,4,6-trinitrobenzenesulfonic acid colitis and CD4(+) CD45RB(hi) T cell adoptive transfer colitis) was assessed.

KEY RESULTS

RPC1063 was specific for S1P1 and S1P5 receptors, induced S1P1 receptor internalization and induced a reversible reduction in circulating B and CCR7(+) T lymphocytes in vivo. RPC1063 showed high oral bioavailability and volume of distribution, and a circulatory half-life that supports once daily dosing. Oral RPC1063 reduced inflammation and disease parameters in all three autoimmune disease models.

CONCLUSIONS AND IMPLICATIONS

S1P receptor selectivity, favourable PK properties and efficacy in three distinct disease models supports the clinical development of RPC1063 for the treatment of relapsing multiple sclerosis and inflammatory bowel disease, differentiates RPC1063 from other S1P receptor agonists, and could result in improved safety outcomes in the clinic.

Structure-activity relationship in a purine-scaffold compound series with selectivity for the endoplasmic reticulum Hsp90 paralog Grp94

Grp94 is involved in the regulation of a restricted number of proteins and represents a potential target in a host of diseases, including cancer, septic shock, autoimmune diseases, chronic inflammatory conditions, diabetes, coronary thrombosis, and stroke. We have recently identified a novel allosteric pocket located in the Grp94 N-terminal binding site that can be used to design ligands with a 2-log selectivity over the other Hsp90 paralogs. Here we perform extensive SAR investigations in this ligand series and rationalize the affinity and paralog selectivity of choice derivatives by molecular modeling. We then use this to design 18c, a derivative with good potency for Grp94 (IC50 = 0.22 μM) and selectivity over other paralogs (>100- and 33-fold for Hsp90α/β and Trap-1, respectively). The paralog selectivity and target-mediated activity of 18c was confirmed in cells through several functional readouts. Compound 18c was also inert when tested against a large panel of kinases. We show that 18c has biological activity in several cellular models of inflammation and cancer and also present here for the first time the in vivo profile of a Grp94 inhibitor.

Next generation sequencing of the hepatitis C virus NS5B gene reveals potential novel S282 drug resistance mutations

Identifying HCV drug resistance mutations (DRMs) is increasingly important as new direct acting antiviral therapies (DAA) become available. Tagged pooled pyrosequencing (TPP) was originally developed as cost-effective approach for detecting low abundance HIV DRMs. Using 127 HCV-positive samples from a Canadian injection drug user cohort, we demonstrated the suitability and efficiency of TPP for evaluating DRMs in HCV NS5B gene. At a mutation identification threshold of 1%, no nucleoside inhibitor DRMs were detected among these DAA naïve subjects. Clinical NS5B resistance to non-nucleoside inhibitors and interferon/ribavirin was predicted to be low within this cohort. S282T mutation, the primary mutation selected by sofosbuvir in vitro, was not identified while S282G/C/R variants were detected in 9 subjects. Further characterization on these new S282 variants using in silico molecular modeling implied their potential association with resistance. Combining TPP with in silico analysis detects NS5B polymorphisms that may explain differences in treatment outcomes.

One-year adjustable intragastric balloons: results in 73 consecutive patients in the U.K

BACKGROUND

Most intragastric balloons have 6-month approval. We report results with the Spatz Adjustable Balloon: approved for 12 months and adjustable.

METHODS

Seventy-three patients (mean: age 45.5; weight 114.5 kg; BMI 36.6 kg/m2) scheduled for 1-year implantation with Spatz balloon (mean volume 417 ml saline). Adjustments performed for early intolerance and weight loss plateau.

RESULTS

Three patients failed insertion. There were 21 early removals (4 intolerant refusing adjustment; 3 deflations; 14 satisfied patients) leaving 49 patients at 12 months. Results of 70 patients (49 patients at 12 months and 21 patients at <12 months) were a mean 21.6 kg weight loss; 19% weight loss; and 45.7% EWL (excess weight loss). Ten intolerant patients were adjusted and lost additional mean 13.2 kg. Fifty-one patients with weight loss plateau scheduled for adjustment: adjustments failed in 6 and non-response in 7. The adjusted 38 patients lost an additional mean 9.4 kg and at extraction had mean 40.9% EWL with 18.7% weight loss. Three catheter impactions required surgical extraction, and three deflated balloons didn't migrate beyond stomach.

CONCLUSIONS

The Spatz balloon is an effective procedure without mortality; however, it carries a risk of catheter impaction necessitating surgical extraction (4.1%). The failure rate--4.1%; intolerance without ability to adjust balloon--5.5%; major complications occurred in 3 (4.1%); minor (balloon deflations) in 3 (4.1%), and 2 asymptomatic gastric ulcers at extraction (2.7%). The longer implantation period and adjustment option combine to produce greater weight loss, albeit <10% weight loss beyond the pre-adjustment weight loss.

Developing Social Justice Competencies

The social science and education fields are increasingly looking to non-traditional pedagogical methods as a way to increase students’ awareness of social justice issues. Critical inquiry projects, human rights education, and service learning models are some of the theoretically grounded approaches that advocate for novel ways of increasing social justice awareness in education. In this article, we propose a model of social justice consultation training activities that build on key principles of social justice work, core components of social justice competencies, and the American Psychological Association Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists. We present the Climate Initiative case study to illustrate consultation training activities designed to promote social justice competencies. The Climate Initiative was a collaborative project between class members in a multicultural issues in counseling course and a social justice–oriented prison education program. We have included a summary of self-reflection experiences and evaluations of the process by counseling psychology trainees and students. Future recommendations for utilizing the consultation approach as a non-traditional teaching method are also provided.

Can comprehensive specialised end-of-life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK

The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant-led, multidisciplinary team aiming to provide round-the-clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% were for cancer, from a population of about 155 000. Using a mixed method approach, the evaluation comprised: a retrospective analysis of secondary-care use in the last year of life; financial evaluation of the MMSPCS using an Activity Based Costing approach; qualitative interviews with patients, carers, health and social care staff and MMSPCS staff and volunteers; a postal survey of General Practices; and a postal survey of bereaved caregivers using the MMSPCS. The mean cost is about 3000 GBP (3461 EUR) per patient with mean cost of interventions for cancer patients in the last year of life 1900 GBP (2192 EUR). Post-referral, overall costs to the system are similar for MMSPCS and hospice-led models; however, earlier referral avoided around 20% of total costs in the last year of life. Patients and carers reported positive experiences of support, linked to the flexible way the service worked. Seventy-one per cent of patients died at home. This model may have application elsewhere.

Coexistence of spin density waves and superconductivity in (TMTSF)2PF6

We present simultaneous measurements of angular-dependent magnetoresistance and thermopower along all three crystal axes in (TMTSF)2PF6 for pressures to 7.4 kbar and magnetic fields to 35 T. (TMTSF)2PF6 under pressure shows the coexistence of spin density wave and metal-superconducting orders. We suggest that this coexistence results neither in microscopic coexistence nor in a new soliton wall phase, contrary to previous suggestions, but in phase separation into domains of the high-pressure metal and the low-pressure spin density wave phases. Simultaneous measurement of transport along all crystal axes allows us to unambiguously describe the domain structure, whereas the superconducting transition temperature and four independent Fermi surface-sensitive magnetoresistance signatures allow us to unambiguously characterize the coexisting metallic domains.

U.S. adults are not meeting recommended levels for fish and omega-3 fatty acid intake: results of an analysis using observational data from NHANES 2003-2008

BACKGROUND

The American Heart Association's Strategic Impact Goal Through 2020 and Beyond recommends ≥ two 3.5-oz fish servings per week (preferably oily fish) partly to increase intake of omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). We examined the intake of total fish, fish high in omega-3 fatty acids, α-linolenic acid, EPA, and DHA in U.S. adults (19 + years) using data from the National Health and Nutrition Examination Survey, 2003-2008.

METHODS

Usual intakes from foods alone and from foods plus dietary supplements were determined using the methods from the National Cancer Institute.

RESULTS

Mean usual intake of total fish and fish high in omega-3 fatty acids was 0.61 ± 0.03 and 0.15 ± 0.03 oz/day, 0.43 and 0.07 respectively. Total fish and fish high in omega-3 fatty acids median intake was 0.43 and 0.07 oz/day, respectively. Intake from foods alone for ALA, EPA and DHA was 1.5 ± 0.01 g/d, 23 ± 7 mg/d and 63 ± 2 mg/d, respectively. ALA, EPA and DHA from food only median intakes were 1.4 g/d, 18 mg/d and 50 mg/d, respectively. Intake of ALA, EPA and DHA from foods and dietary supplements was 1.6 ± 0.04 g/d, 41 ± 4 mg/d and 72 ± 4 mg/d, respectively. While intakes of fish high in omega-3 fatty acids were higher in older adults (0.13 ± 0.01 oz/d for those 19-50 yrs and 0.19 ± 0.02 oz/d for those 51+ year; p < 0.01) and in males as compared to females (0.18 ± 0.02 vs 0.13 ± 0.01 oz/d, respectively; p < 0.05), few consumed recommended levels. Males also had higher (p < 0.05) intake of EPA and DHA from foods and dietary supplements relative to females (44 ± 6 vs 39 ± 4 and 90 ± 7 vs 59 ± 4 mg/d, respectively) and older adults had higher intakes of EPA, but not DHA compared to younger adults (EPA: 34 ± 3 vs 58 ± 9, p < 0.05; DHA: 68 ± 4 vs 81 ± 6, p < 0.05).

CONCLUSIONS

As omega-3 fatty acids are deemed important from authoritative bodies, supplementation in addition to food sources may need to be considered to help U.S. adults meet recommendations.

Toward patient-tailored perfusion thresholds for prediction of stroke outcome

BACKGROUND AND PURPOSE

Multiple patient-specific clinical and radiologic parameters impact traditional perfusion thresholds used to classify/determine tissue outcome. We sought to determine whether modified baseline perfusion thresholds calculated by integrating baseline perfusion and clinical factors better predict tissue fate and clinical outcome.

MATERIALS AND METHODS

CTP within 4.5 hours of acute anterior circulation stroke onset and 5- to 7-day MR imaging were performed for 203 patients with stroke, divided into derivation (n = 114) and validation (n = 89) data bases. Affected regions were operationally classified as infarct and noninfarct according to baseline CTP and follow-up FLAIR imaging. Perfusion thresholds were derived for each of the infarct and noninfarct regions, without and with transformation by baseline clinical and radiologic variables by using a general linear mixed model. Performance of transformed and nontransformed perfusion thresholds for tissue fate and 90-day clinical outcome prediction was then tested in the derivation data base. Reproducibility of models was verified by using bootstrapping and validated in an independent cohort.

RESULTS

Perfusion threshold transformation by clinical and radiologic baseline parameters significantly improved tissue fate prediction for both gray matter and white matter (P < .001). Transformed thresholds improved the 90-day outcome prediction for CBF and time-to-maximum (P < .001). Transformed relative CBF and absolute time-to-maximum values demonstrated maximal GM and WM accuracies in the derivation and validation cohorts (relative CBF GM: 91%, 86%; WM: 86%, 83%; absolute time-to-maximum 88%, 79%, and 80%, 76% respectively).

CONCLUSIONS

Transformation of baseline perfusion parameters by patient-specific clinical and radiologic parameters significantly improves the accuracy of tissue fate and clinical outcome prediction.

Equivalency between emulated disc electrodes and conventional disc electrode human electroencephalography

We have previously shown that tripolar concentric ring electrode (TCRE) Laplacian electroencephalography (tEEG) has significantly better signal-to-noise ratio, spatial resolution, and mutual information than disc electrode electroencephalography (EEG). This paper compares the EEG signals acquired simultaneously from the outer ring of the TCRE (oTCRE), shorting all three elements of the TCRE (sTCRE) and disc electrode (disc) concurrently from nearly the same location on the human scalp. We calculated the average correlation for the time series between each pair of signals and average coherence over the pass-band frequencies between all pairs of signals as well. All the correlations and coherences were above 0.99. The results suggest that the oTCRE can be used to record EEG concurrently with tEEG from the same sensor at the same location.