The Role of Vacuum Assisted Closure in Patients with Pressure Ulcer and Spinal Cord Injury: A Systematic Review

BACKGROUND

Patients with spinal cord injury (SCI) tend to develop pressure ulcers (PrUs) because of prolonged immobility. This study assessed the efficacy of vacuum assisted closure for healing of PrUs in individuals with SCI.

METHODS

In a systematic review, CINAHL, PubMed, Cochrane Clinical Trials, DARE, MEDLINE, Scopus, Embase, Science Direct, PsycInfo and Spinal Cord Journal were searched in March 2019. The search combined related terms for pressure ulcer, spinal cord injury, and vacuum assisted closure. Each database was searched from its inception with no restrictions on year of publication.

RESULTS

The search yielded 7 studies for inclusion in a qualitative analysis. The studies included a variety of methodologies, specifically 2 randomized controlled trials, 2 assessor-blinded crossover and retrospective cohort study, 1 prospective non-randomized trial, 1 randomized case study and 1 case report. The meta-analysis was unsuccessful. Only descriptive results mean±SD were reported as well as time to heal and time to discharge after admission.

CONCLUSION

The studies that we included in our qualitative synthesis showed that vacuum assisted closure promoted the healing of PrUs in individuals with SCI.

Multiple Exostoses Syndrome and Basilar Artery Aneurysm: A Case Report

BACKGROUND

Hereditary multiple exostoses (HME) is an inherited genetic condition, characterized by the formation of multiple osteochondromas, developing throughout childhood and into puberty. Vascular complications associated with HME are uncommon.

METHODS

A case of a patient with HME who was admitted to hospital with subarachnoid hemorrhage (SAH), as a result of acute rupture of a basilar tip aneurysm (BTA), will be presented. Relevant literature on this topic will be systematically reviewed.

RESULTS

We describe a rare case of a 48-year-old male patient presenting multiple exostoses in both upper and lower limbs, with no familial history of such lesions. The patient experienced an episode of loss of consciousness, followed by tonal seizures, after a short (five-day) history of headache, proved finally to be secondary to SAH due to rupture of a BTA. There was no antecedent of trauma, neck manipulation, or previous infection. Aneurysm was successfully treated with the intravascular procedure (aneurysm occlusion with coil). Progressively, the patient recovered from dysphasia and tetraparesis, almost completely, following the appropriate treatment and rehabilitation program.In the systematic review, eight cases (including the one presented) of vertebrobasilar vascular system stroke secondary to solitary spinal osteochondroma or multiple osteochondromas were found, but only the present case was associated with basilar artery aneurysm.

CONCLUSION

Despite the fact that the etiopathogenesis of basal artery aneurysm presentation in a patient with osteochondromas remains unknown, medical society needs to be aware of this rare condition, as SAH may be a severe complication.

Performance indices selection for assessing anaerobic power during a 30 second vertical jump test

AIM

The aim of the present study was to assess the validity of jump height (h), absolute (VPOWERABS) and relative to body mass (VPOWERREL) performance indices when elicited of a modified 30 s Bosco vertical jump test (VJT) based on the absolute (WPOWERABS) and relative (WPOWERREL) power values of a 30 s Wingate test (WAnT).

METHODS

Nineteen physical education students with mean ± SD age 21 ± 3 y, body mass 73.8 ± 7 kg and height 1.8 ± 0.06 m performed a 30 s VJT on a force plate and a 30 s WAnT on a Monark cycle ergometer. Performance data were expressed in W and W.kg-1 of body mass for WPOWERABS and WPOWERREL; in cm, W and W.kg-1 for h, VPOWERABS and VPOWERREL, respectively. The performance indices' values were expressed as means and SDs of the 30 s duration of both tests, as well as in 4 time intervals of 7.5 s (0-7.5 s, 7.5-15 s, 15-22.5 s, and 22.5-30 s).

RESULTS

WPOWERABS and h were significantly (P<0.05) correlated in the 4 time intervals (0-7.5 s: r=0.51; 7.5-15 s: r=0.36; 15-22.5 s: r=0.39) and in the overall duration of the test (0-30 s: r=0.38). Significant correlation was also revealed between VPOWERABS and WPOWERABS, but only for the interval 0-7.5 s (r=0.48).

CONCLUSION

A 30 s VJT is valid against a 30 s WAnT only when h is used as performance indices. The selection of the appropriate unit of measurement is important for assessing effort distribution in maximum effort tests of short duration.

Significant improvement of portopulmonary hypertension after 1-week terlipressin treatment

Cirrhosis associated with moderate and severe portopulmonary hypertension carries a poor prognosis. Optimal management has not yet been defined. Current treatment options, such as prostacyclin analogues, endothelin antagonists, and phosphodiesterase-5 inhibitors, are characterized by slow onset of action and various adverse effects, particularly in patients with advanced cirrhosis. Here, we report the significant reduction of pulmonary arterial pressure after 1-week terlipressin treatment in a patient with concomitant hepato-renal syndrome. Terlipressin could be a novel and safe treatment for portopulmonary hypertension.

Field data analysis and application of a complex water column biogeochemical model in different areas of a semi-enclosed basin: towards the development of an ecosystem management tool

The Pagasitikos gulf ecosystem is studied through the analysis of experimental field data acquired during several monitoring projects and the application of a complex biogeochemical model. The gulf was separated into three different parts (internal, top central-external, bottom central-external) according to the patterns exhibited by the key ecosystem indicators. Unlike other semi-enclosed gulfs Pagasitikos can be characterised as meso-oligotrophic undergoing periods of P or N limitation. Although the signal of nutrient inputs is not very clear in the field data, their importance is assessed through simulation. Increased phosphate concentrations either due to mixing or due to anthropogenic activities can result in phytoplanktonic blooms with significant contribution by diatoms. The effect of hydrodynamic patterns on primary production has been demonstrated through ecosystem modeling indicating that due to long stratification periods, all nutrients released through the benthic regeneration are trapped in the deeper layers, developing a microbial food web. However when the thermocline erodes nutrients find their way up in the upper layers of the euphotic zone and the system turns into more classical type with primary producers growing significantly faster.

Wireless and Web-based medical monitoring in the home

A remote medical monitoring system is described, which continuously monitors patients' state of health. The system uses the services provided by intranets and the Internet to allow remote supervision of patients, who may be domiciled in their own home. A hardware/software prototype system has been constructed to demonstrate the use of non-invasive and minimally intrusive sensors attached to patients. Continuous real-time data is acquired, stored and processed. A wireless system or wires connect these monitor devices to the World Wide Web and, on request, information is delivered to authorized medical staff via a web browser or Wireless Application Protocol-enabled mobile telephones. Medical staff may examine real-time data or graphical information and make comparisons with historical data. Parameters may be set to select and control the data acquisition devices. The potential exists for augmentation of patient health by development of novel sensors and low-power electronic circuitry, and this research continues.

Assessing marine ecosystem response to nutrient inputs

The response of the Pagasitikos Gulf to enrichment caused by run-off fertilizers and the development and evolution of harmful algal blooms is investigated through ecosystem modelling. A standard generic complex model has been developed to describe the ecosystem processes of Pagasitikos and has been validated with in situ data. Additionally external nutrient fluxes have been assimilated and incorporated into the ecosystem dynamics. The investigation of spatial effects due to nutrient enrichment is investigated along a North-South transect. When externally forced the model successfully assimilates the external river inputs producing nutrient and chlorophyll-a concentrations, which are in good agreement with the in situ data. The nutrient inputs result in a more stable ecosystem at the north part of the Gulf and in the development of eutrophic conditions. The changes in the ecosystem functioning with emphasis on the nutrient cycling, the increase of primary production, and the modes of operation are investigated and discussed.

Ragweed sensitization alters pulmonary vascular responses to bronchoprovocation in beagle dogs

In ragweed (RW)-sensitized beagle dogs, we tested the hypothesis that reactivity of the pulmonary vasculature was enhanced with aerosolized histamine (Hist) and RW. Seven dogs were neonatally sensitized with repeated intraperitoneal RW injections, and 12 dogs were controls (Con). The dogs were anesthetized with intravenous chloralose, mechanically ventilated, and instrumented with femoral arterial and pulmonary artery catheters. Specific lung compliance (CLsp), specific lung conductance (Gsp), systemic vascular resistance index, and pulmonary vascular resistance index (PVRI) were measured before and after bronchoprovocation with Hist and RW. After Hist inhalation (5 breaths of 30 mg/ml), both Con and RW dogs had significant (P < 0.05) decreases in CLsp (-51 +/- 4 and -53 +/- 5%, respectively) and Gsp (-65 +/- 5 and -69 +/- 3%, respectively), but only RW-sensitized dogs had a significant increase in PVRI (38 +/- 10%). After RW inhalation (60 breaths of 0.8 mg/ml), only RW-sensitized dogs had significant increases (62 +/- 20%) in PVRI and decreases in Gsp (-77 +/- 4%) and CLsp (-65 +/- 7%). We conclude that, compared with Con, RW-sensitized beagle dogs have increased pulmonary vasoconstrictive responses with Hist or RW inhalation.

[Histological study of different organs in clinically healthy Amazon parrots]

Histologic examination of organs of clinically healthy amazons was carried out. Only variations from the chicken are presented, among others: Occurrence of a complex of vessels and many Herbst' corpuscles in the nasal cavity; evidence of a thick muscular layer as well as many Herbst' corpuscles and nerve fibers as the cover of the syrinx; demonstration of muscular trabeculae in the parabronchia; detection of an artery accompanying the testes with muscular layers reaching into the adventitia and many nerve fibers; very small numbers of active lymph follicles within the white pulp of the spleen.

Therapeutic interchange of ampicillin-sulbactam for cefoxitin

A therapeutic interchange program based on microbial patterns within an institution is described. A change in anaerobic susceptibility patterns, increased prevalence of enterococcal infections, and cost factors provided the rationale for the therapeutic interchange of ampicillin-sulbactam for cefoxitin. Ampicillin-sulbactam was recommended for prophylaxis in intraabdominal or gynecological surgery as well as for treatment for gynecological infections. Cefoxitin was restricted to penicillin-allergic patients and women who were pregnant or breast-feeding. The transition from cefoxitin to ampicillin-sulbactam proceeded smoothly as a result of preliminary education of pharmacists and physicians. Pharmacists participated in continuing-education programs and received concise guidelines for the interchange and follow-up instructions; physicians learned of the program from the drug newsletter published by the pharmacy department. Three months after the program began, only one physician was resistant to the interchange. After the program began, 11 antimicrobials, including cefoxitin, were used less frequently and ampicillin-sulbactam use increased. No adverse clinical consequences from the interchange were detected. A therapeutic interchange program based on institution-specific microbial patterns and educational efforts by the pharmacy department produced a change in physician prescribing.

Effects of discontinuous drug administration on the development of dopamine receptor supersensitivity during chronic trifluoperazine or cis-flupenthixol administration to rats

Rats received continuous or discontinuous administration of trifluoperazine or cis-flupenthixol in drinking water for up to 12 months. Continuous and discontinuous trifluoperazine administration had no consistent effect on apomorphine-induced stereotyped behaviour and there was no difference between drug treatments. Continuous and discontinuous cis-flupenthixol administration enhanced apomorphine-induced stereotypy, but there was no difference in the effect of the two drug treatments. Both continuous and discontinuous administration of trifluoperazine increased the number of specific striatal 3H-spiperone binding sites (Bmax). Over the period of treatment there was no difference in the effects of the different treatments. Continuous or discontinuous cis-flupenthixol intake did not increase Bmax after 6 or 12 months intake. Continuous or discontinuous neuroleptic treatment produced no difference in functional striatal dopamine receptor activity as judged by apomorphine-induced stereotyped behaviour. Ligand binding studies also suggest that the overall change in striatal receptor function is not affected by the use of a discontinuous drug regime.

Alterations in different populations of striatal dopamine receptors produced by 18 months continuous administration of cis- or trans-flupenthixol to rats

Administration of cis-flupenthixol (0.8-1.2 mg/kg per day) for 18 months enhanced stereotyped behaviour induced by apomorphine, bromocriptine and lergotrile, but not that induced by amphetamine or lisuride. Catalepsy induced by acute administration of haloperidol, trifluoperazine or cis-flupenthixol was reduced by continuous chronic intake of cis-flupenthixol. The number (Bmax) and dissociation constant (KD) of specific [3H]spiperone binding sites on striatal membranes was increased by chronic administration of cis-flupenthixol, but not trans-flupenthixol. In contrast, the Bmax and KD for specific binding of [3H]N,n-propylnorapomorphine were decreased by administration of cis-flupenthixol compared to the effect of the trans-isomer. Specific binding of [3H]piflutixol was unaffected by chronic administration of cis- or trans-flupenthixol, but chronic administration of cis-flupenthixol enhanced stimulation by dopamine of the activity of striatal adenylate cyclase. As a result of chronic continuous administration of cis-flupenthixol dopamine receptors in the striatum appeared to be supersensitive to most dopamine agonists but sub-sensitive to dopamine antagonists. This was reflected by increased numbers of D-2 antagonist receptor sites of decreased affinity, but by a decreased number of agonist sites of higher affinity. The D-1 recognition sites appeared to be unaltered, but activity of adenylate cyclase stimulated by dopamine was enhanced, suggesting post-junctional changes. The D-2 receptors appear to be primarily concerned with altered function of dopamine receptors.

Alterations in cerebral dopamine function caused by administration of cis- or trans-flupenthixol for up to 18 months

Rats received either cis-flupenthixol (0.8-1.2 mg/kg per day) or trans-flupenthixol (0.9-1.2 mg/kg per day) continuously in drinking water for periods up to 18 months. cis-Flupenthixol, but not trans-flupenthixol, initially inhibited apomorphine-induced stereotyped behaviour but by 6 months and thereafter the stereotyped response was enhanced compared to age-matched control animals. Striatal and mesolimbic homovanillic acid and 3,4-dihydroxyphenylacetic acid concentrations were elevated for up to 3 months after starting cis-, but not trans-flupenthixol intake, but thereafter levels generally fell below those for age-matched control animals. Dopamine concentrations were not altered by cis- or trans-flupenthixol administration. The number of striatal [3H]spiperone binding sites (Bmax) was decreased by 40% after 1 months' administration of cis-flupenthixol but this gradually reversed, such that by 18 months a 40% increase in Bmax was apparent. Administration of trans-flupenthixol decreased Bmax up to 3 months but thereafter values were not different from those found in age-matched control animals. The dissociation constant (KD) for [3H]spiperone binding in striatum was not altered by 6 months cis-flupenthixol intake, but then increased as drug administration continued. trans-Flupenthixol administration did not alter striatal KD values. Bmax for [3H]spiperone binding to mesolimbic preparations was not altered by up to 12 months cis-flupenthixol intake, but was decreased after 18 months drug administration. cis-Flupenthixol administration had no effect on mesolimbic KD values. Administration of trans-flupenthixol for up to 18 months did not alter mesolimbic Bmax or KD values for [3H]spiperone binding.(ABSTRACT TRUNCATED AT 250 WORDS)

Persistent increase in striatal dopamine stimulated adenylate cyclase activity persists for more than 6 months but disappears after 1 year following withdrawal from 18 months cis-flupenthixol intake

Administration of cis-flupenthixol to rats for 18 months enhanced apomorphine-induced stereotyped behaviour, increased the number of specific [3H]spiperone binding sites in striatum and potentiated striatal dopamine stimulated cyclic AMP formation, but did not alter specific [3H]piflutixol binding. Following withdrawal of cis-flupenthixol intake, apomorphine-induced stereotypy returned to control values after 1 month and Bmax for [3H]spiperone binding returned to normal after 3 months. In contrast, the increased dopamine stimulated adenylate cyclase activity remained elevated 6 months after drug removal, but was normal 1 year after drug withdrawal.

Repeated administration of sulpiride for three weeks produces behavioural and biochemical evidence for cerebral dopamine receptor supersensitivity

Administration of sulpiride (2 X 100 mg/kg i.p.) or haloperidol (5 mg/kg i.p.) to rats for 3 weeks with subsequent withdrawal for 3 or 4 days induced cerebral dopamine receptor supersensitivity. Apomorphine-induced stereotyped behaviour after drug withdrawal was enhanced by pretreatment with either haloperidol or sulpiride both of which increased the number of specific striatal binding sites (Bmax) for [3H]spiperone, [3H]N,n-propylnorapomorphine and [3H]sulpiride. Neither drug altered the dissociation constant (KD) for the ligand binding assays. Striatal dopamine sensitive adenylate cyclase activity was unaltered by such a pretreatment with either haloperidol or sulpiride. The data show that sulpiride, like haloperidol, is capable of inducing behavioural and biochemical supersensitivity of cerebral dopamine receptors.

Kainic acid lesions of striatum and decortication reduce specific [3H]sulpiride binding in rats, so D-2 receptors exist post-synaptically on corticostriate afferents and striatal neurons

Unilateral kainic acid lesions of rat striatum reduced specific striatal [3H]spiperone and [3H]sulpiride binding sites (Bmax) by 52 and 67% respectively compared with the intact side. The dissociation constant (KD) for [3H]spiperone binding was unchanged but that for [3H]sulpiride binding was reduced. Specific striatal [3H]spiperone and [3H]sulpiride binding was reduced by 22 and 37% respectively in unilateral decorticate animals, but there was no change in KD. Unilateral 6-hydroxydopamine lesions of the medial forebrain bundle caused no change in striatal [3H]spiperone binding sites or KD value, but produced a 27% increase in [3H]sulpiride binding sites with no change in KD. These data support the hypothesis of D-2 receptors located on cortico-striate glutamate fibres, but also indicate the presence of both D-1 and D-2 receptors on the cell bodies of striatal neurons.

Subchronic treatment with the tricyclic antidepressant DMI increases isolation-induced fighting in rats

Male rats treated with desmethylimipramine (DMI) (20 mg/kg for 7 days) were more likely than controls to attack an intruder rat placed in their home cage; they were also more likely to submit when attacked by the intruder. These behavioural changes were not seen at lower doses of DMI. Similar results were obtained in experiments in which is drugged animal and a control were placed together in a "neutral" cage; in this paradigm it was also found that lower doses of DMI were effective, provided that either the period of drug treatment was increased, or a delay of 3-4 days after withdrawal of DMI preceded behavioural testing. A dose dependent resistance to handling developed during drug treatment; drugged animals also showed weight loss and decreased open-field activity. In previous studies, acute treatment with tricyclic antidepressants has not been found to increase fighting; the present results underline the importance of chronic drug studies.

Cerebral dopamine function in rats following withdrawal from one year of continuous neuroleptic administration

Continuous administration of trifluoperazine (2.5--3.5 mg/kg/day) or thioridazine (30--40 mg/kg/day) to rats for 12 months enhanced the stereotyped response to apomorphine (0.5 mg/kg s.c.), increased dopamine 1--150 muM) stimulation of striatal adenylate cyclase, increased KD and Bmax for dopamine (10(-4) M) specific 3H-spiperone striatal binding and produced spontaneous mouthing movements. On drug withdrawal, spontaneous locomotor activity was enhanced after 2 weeks and the enhanced stereotyped response was maintained for up to 1 month. Spontaneous mouthing had disappeared 2 weeks after drug withdrawal. The increase in Bmax for 3H-spiperone binding was maintained for up to 3 months after drug removal, but KD reverted to control levels by 2 weeks. In contrast, the dopamine stimulation of striatal adenylate cyclase remained enhanced for the 6 month withdrawal period. Administration of trifluoperazine (0.7--0.9 mg/kg/day) or thioridazine (6--8 mg/kg/day) for 12 months produced a less marked effect than administration of the higher dose. No enhancement of effect was observed on drug withdrawal and the initial changes disappeared rapidly on removal of drug. Supersensitivity of striatal dopamine mechanisms produced by continuous long-term neuroleptic administration differs from that produced by shorter treatment periods since no enhancement of effect occurs on drug withdrawal. The behavioural and biochemical components of the supersensitivity show variable time courses and in particular the enhanced stimulation of striatal adenylate cyclase persists for at least 6 months. Such effects may be of relevance to tardive dyskinesias in man.

Changes in rat striatal dopamine turnover and receptor activity during one years neuroleptic administration

Administration of trifluoperazine (2.5--3.5 mg/kg/day p.o.) or thioridazine (30--40 mg/kg/day) for up to 1 year initially increased homovanillic acid and 3,4-dihydroxyphenylacetic acid concentrations in striatum. However, by 1 month and thereafter metabolite levels returned almost to control values. Dopamine concentrations were elevated after 3 months administration of both drugs and also after 12 months administration of trifluoperazine. Trifluoperazine administration for 1 month produced a marked increase in the dissociation constant (KD) for striatal 3H-spiperone binding but a reduction in receptor numbers. Thereafter receptor numbers increased at 6 and 12 months in both trifluoperazine and thioridazine treated animals compared to control values. The KD for both drug treated groups returned to normal at 6 months; however, by 12 months drug treated animals again demonstrated high KD values. Dopamine stimulation of striatal adenylate cyclase was inhibited after administration of trifluoperazine or thioridazine for 1 week or 1 month. However, by 6 and 12 months this effect was replaced by an enhanced stimulation. Administration of lower doses of trifluoperazine (0.7--0.9 mg/kg/day p.o.) or thioridazine (6--9 mg/kg/day p.o.) for up to 1 year produced similar although generally less marked changes in these biochemical indices of dopamine function. This study provides evidence of biochemical changes which parallel the behavioural findings of enhanced dopamine receptor activity that occur during continuous long-term neuroleptic administration to rodents.

Stereoselective actions of substituted benzamide drugs on cerebral dopamine mechanisms

Apomorphine-induced locomotor activity in reserpine-pretreated mice was antagonized by pretreatment with (-)-sulpiride and (-)-sultopride. The (+)-enantiomers were inactive. Apomorphine- and amphetamine-induced stereotyped behaviour in rats were antagonized by (-)-sultopride but not by the (+)-enantiomer. Neither enantiomer of sulpiride prevented the onset of the stereotyped response. Both (-)-sulpiride and (-)-sultopride induced increases in striatal and mesolimbic HVA and DOPAC concentrations; (+)-sultopride elevated striatal and mesolimbic DOPAC concentrations but not HVA, while (+)-sulpiride had no effect on HVA or DOPAC in either area. Dopamine concentrations were reduced by the enantiomers of sultopride but not by sulpiride. Low concentrations (10−9 −10−66 M) of the (-)-enantiomers of both drugs displaced [3 H]spiperone from its specific binding site in rat striatal preparations, but the (+)-enantiomers were 40 and 100 times less active. However, neither enantiomer of either drug anatagonized the dopamine-induced stimulation of adenylate cyclase in rat striatal preparations. The data suggest that the central pharmacological activity of sulpiride and sultopride resides in the (-)-enantiomers and that this activity occurs at cerebral dopamine receptors not dependent on adenylate cyclase for functional activity.

A comparison of striatal and mesolimbic dopamine function in the rat during 6-month trifluoperazine administration

Previous work has shown that 6---12 months continuous trifluoperazine (TFP) administration to rats causes striatal dopamine receptor supersensitivity. We have now replicated our original findings in the striatum and report concurrent changes in mesolimbic dopamine function during chronic TFP (2.8---4.0 mg/kg/day) administration for 6 months. Initial inhibition of apomorphine-induced stereotyped behaviour, which lasted for 2 weeks after the beginning of drug administration, was replaced by an exaggerated response to apomorphine (0.5 mg/kg SC) after 6 months drug intake. Striatal dopamine sensitive adenylate cyclase activity was inhibited at 1 and 3 months, but y 6 months was enhanced compared to control values. Mesolimbic adenylate cyclase activity was inhibited after 2 weeks and thereafter returned to control levels. Dopamine-identified 3H-spiperone binding sites (Bmax) in the striatum were increased by 2 weeks, reduced at 1 month and increased again at 6 months. In mesolimbic areas Bmax was increased at 2 weeks and 1 month but thereafter returned to control levels. The dissociation constant (kD) of specific 3H-spiperone binding was increased in the striatum and mesolimbic areas at 1 month and 2 weeks respectively. The results show differential changes in dopamine function in striatal and mesolimbic brain areas during 6 months continuous TFP administration to rats.