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Atlan F, Ashkenazi I, Shehadeh K, Ben-Shabat D, Shichman I, Eisenberg G, Rosenblatt Y, Tordjman D, Pritsch T, Factor S. Early postoperative dressing removal in hand surgery: Novel concepts for individualized surgical dressing management. Hand Surg Rehabil 2021; 40:389-393. [PMID: 33831625 DOI: 10.1016/j.hansur.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/12/2021] [Accepted: 03/21/2021] [Indexed: 11/17/2022]
Abstract
Postoperative dressing protocols after clean surgery without implant vary widely. The purpose of this study was to elucidate whether early postoperative dressing removal is a valid option, as compared to untouched dressing or twice-weekly dressing change approach. A prospective randomized study was conducted on patients who underwent carpal tunnel release (CTR) or trigger finger release (TFR) between January and November 2020. Patients were randomly distributed into 3 groups: surgical dressing untouched until first follow up (SDU); surgical dressing changed twice a week in a health maintenance organization (HMO); and surgical dressing removed at first postoperative day (SDR). Data collected included patient characteristics, pre-and post-operative functional (QuickDASH) and autonomy (Instrumental Activities of Daily Living performance (IADL)) scores, Vancouver scar scale (VSS) and potential complications. Eighty-four patients were included: 28 (33.3%), 29 (34.5%) and 27 (32.1%) in the SDU, HMO and SDR groups, respectively. Deterioration in mean IADL score at 2-week follow-up was statistically significant in the HMO group (mean delta 3.35, p = 0.008). Quick DASH score improved significantly between preoperative and 2-week follow-up values only in the SDU group (mean delta 9.12, p = 0.012). Other parameters, including wound complications, did not differ significantly between groups. Early removal of postoperative dressing and immediate wound exposure was a safe option after CTR and TFR. An untouched bulky dressing correlated with early functional improvement. Finally, iterative dressing change in HMO showed no benefit and led to significant deterioration in early postoperative autonomy. IRB APPROVAL: 0548-18-TLV. LEVEL OF EVIDENCE: I.
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Affiliation(s)
- F Atlan
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel.
| | - I Ashkenazi
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - K Shehadeh
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - D Ben-Shabat
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - I Shichman
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - G Eisenberg
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - Y Rosenblatt
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - D Tordjman
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - T Pritsch
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - S Factor
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
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Kadar A, Eisenberg G, Yahav E, Drexler M, Salai M, Steinberg E. Surgical site infection in elderly patients with hip fractures, silver-coated versus regular dressings: a randomised prospective trial. J Wound Care 2015; 24:441-2, 444-5. [DOI: 10.12968/jowc.2015.24.10.441] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A. Kadar
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - G. Eisenberg
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - E. Yahav
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - M. Drexler
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - M. Salai
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - E.L. Steinberg
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
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Pato A, Eisenberg G, Machlenkin A, Margalit A, Cafri G, Frankenburg S, Merims S, Peretz T, Lotem M, Gross G. Messenger RNA encoding constitutively active Toll-like receptor 4 enhances effector functions of human T cells. Clin Exp Immunol 2015. [PMID: 26212048 DOI: 10.1111/cei.12688] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Adoptive T cell therapy of cancer employs a large number of ex-vivo-propagated T cells which recognize their targets either by virtue of their endogenous T cell receptor (TCR) or via genetic reprogramming. However, both cell-extrinsic and intrinsic mechanisms often diminish the in-vivo potency of these therapeutic T cells, limiting their clinical efficacy and broader use. Direct activation of human T cells by Toll-like receptor (TLR) ligands induces T cell survival and proliferation, boosts the production of proinflammatory cytokines and augments resistance to regulatory T cell (Treg) suppression. Removal of the TLR ligand-binding region results in constitutive signalling triggered by the remaining cytosolic Toll/interleukin-1 receptor (TIR) domain. The use of such TIR domains therefore offers an ideal means for equipping anti-tumour T cells with the arsenal of functional attributes required for improving current clinical protocols. Here we show that constitutively active (ca)TLR-4 can be expressed efficiently in human T cells using mRNA electroporation. The mere expression of caTLR-4 mRNA in polyclonal CD8 and CD4 T cells induced the production of interferon (IFN)-γ, triggered the surface expression of CD25, CD69 and 4-1BB and up-regulated a panel of cytokines and chemokines. In tumour-infiltrating lymphocytes prepared from melanoma patients, caTLR-4 induced robust IFN-γ secretion in all samples tested. Furthermore, caTLR-4 enhanced the anti-melanoma cytolytic activity of tumour-infiltrating lymphocytes and augmented the secretion of IFN-γ, tumour necrosis factor (TNF)-α and granulocyte-macrophage colony-stimulating factor (GM-CSF) for at least 4 days post-transfection. Our results demonstrate that caTLR-4 is capable of exerting multiple T cell-enhancing effects and can potentially be used as a genetic adjuvant in adoptive cell therapy.
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Affiliation(s)
- A Pato
- Laboratory of Immunology, MIGAL - Galilee Research Institute, Kiryat, Shmona.,Sharett Institute of Oncology, Hadassah Hebrew University Hospital, Jerusalem
| | - G Eisenberg
- Sharett Institute of Oncology, Hadassah Hebrew University Hospital, Jerusalem
| | - A Machlenkin
- Sharett Institute of Oncology, Hadassah Hebrew University Hospital, Jerusalem
| | - A Margalit
- Laboratory of Immunology, MIGAL - Galilee Research Institute, Kiryat, Shmona.,Department of Biotechnology, Tel-Hai College, Upper, Galilee
| | - G Cafri
- Laboratory of Immunology, MIGAL - Galilee Research Institute, Kiryat, Shmona.,Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - S Frankenburg
- Sharett Institute of Oncology, Hadassah Hebrew University Hospital, Jerusalem
| | - S Merims
- Sharett Institute of Oncology, Hadassah Hebrew University Hospital, Jerusalem
| | - T Peretz
- Sharett Institute of Oncology, Hadassah Hebrew University Hospital, Jerusalem
| | - M Lotem
- Sharett Institute of Oncology, Hadassah Hebrew University Hospital, Jerusalem
| | - G Gross
- Laboratory of Immunology, MIGAL - Galilee Research Institute, Kiryat, Shmona.,Department of Biotechnology, Tel-Hai College, Upper, Galilee
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Abstract
The objective of this work was to confirm the main role of elastic fibers in differing responses of certain vessels during cooling from 37 to 8 degrees C. Previous results have shown that the nature of the vessel (conduit vessel vs muscular vessel) determines the different behavior (dilatation vs contraction) of isolated vessel segments when temperature decreases from 37 to 8 degrees C. In this work, it has been demonstrated that vessels with a great amount of elastic fibers show a dilatation when cooling. On the other hand, muscular vessels with fewer elastic fibers, such as the renal artery, undergo a contraction. The output of calcium from intracellular stores causes contraction of the renal artery during cooling. In this vessel, vasodilatation occurs only when mechanisms of smooth muscle contraction are inactive, as is the case with vessels that have undergone a cold storage period of 48 h. The results presented in this work confirm that there are two main effects, which directly depend on the vessel origin. In conduit arteries, the decrease of temperature induces a vascular relaxation, dependent on the elastic component of the vessel wall. In muscular vessels, the predominant effect is cooling-induced contraction due to an increase of intracellular calcium. This cooling-induced contraction needs the vessel to be in optimal conditions with an active metabolism of the muscular cells. These results are a crucial issue in the sense of explaining several biomedical mechanisms where hypothermia is implicated. The type of vessel implicated in procedures, such as isolated organ perfusion, extracorporeal circulation, and bypass surgery, must be taken into account.
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Affiliation(s)
- B Herrera
- Unidad de Medicina y Cirugía Experimental, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007 Madrid, Spain
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Lynch T, Eisenberg G, Kernan M. LC/MS determination of the intracellular concentration of two novel aryl phosphoramidate prodrugs of PMPA and their metabolites in dog PBMC. Nucleosides Nucleotides Nucleic Acids 2001; 20:1415-9. [PMID: 11563034 DOI: 10.1081/ncn-100002567] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
LC/MS assays were developed to determine the plasma and intracellular concentrations of two aryl phosphoramidate prodrugs of the nucleotide analog 9-[2-R-(phosphonomethoxy)propyl]adenine. LC/MS was used to demonstrate the presence of high concentrations of PMPA in peripheral blood mononucleocytes following oral administration of prodrugs in dogs. High concentrations of PMPA and active metabolite were detected in MT-2 cells incubated with prodrug using an ion-pairing LC/MS assay.
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Affiliation(s)
- T Lynch
- Gilead Sciences, 333 Lakeside Drive, Foster City, California 94404, USA
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Herrera B, Eisenberg G, Desco MM, Holberndt O, Rábano A, Castilla M, García-Barreno P, Del Cañizo JF. Perfusate lactate dehydrogenase level and intrarenal resistance could not be adequate markers of perfusion quality during isolated kidney perfusion. Artif Organs 2000; 24:899-902. [PMID: 11119079 DOI: 10.1046/j.1525-1594.2000.06554.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The main goal of this work was to study the influence of perfusion pressure and flow waveform during kidney perfusion, and the relationship between renal vascular resistance (RVR) and lactate dehydrogenase (LDH) concentration in the perfusate. Simultaneous constant pressure kidney perfusions were performed with either pulsatile or continuous flow at either 30 or 80 mm Hg of constant perfusion pressure. Mean flow, pressure, and RVR were displayed online during perfusion. Perfusate samples for LDH, creatine phosphatase kinase (CPK), and alkaline phosphatase (AP) determinations were taken. At the end of the perfusion, 2 ml of Evans blue was injected into the circuit to obtain images of perfusate distribution, and the kidneys were weighed. Also, hematoxylin/eosine studies were performed, showing more Bowman's space and tubular dilation in kidneys perfused with high pressure. We did not find differences in RVR between kidneys perfused at 30 and 80 mm Hg; nevertheless, perfusate distribution was better in the 80 mm Hg perfusions. We did not find any correlation between enzyme release and RVR in kidneys perfused with different mean pressures. These findings suggest that vascular resistance and LDH concentration cannot be independently considered as adequate markers of perfusate distribution.
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Affiliation(s)
- B Herrera
- Unidad de Medicina y Cirugía Experimental, Hospital General Universitario Gregorio Marañón, Alcorcón, Madrid, Spain
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Abstract
Temperature may have significant influence on vascular tone in such cases as organ preservation, coronary bypass surgery, and extracorporeal circulation. The aim of this research was to study the direct effect of temperature variation on vascular tone in an attempt to elucidate the mechanisms involved. In a first series of experiments, the isometric tension of two different vessels (rat thoracic aorta and pig renal branch artery) was studied at different temperatures. To study the role of calcium in this response, a second series of experiments was performed. In this the vessels were incubated with the intracellular chelator BAPTA/AM. Further experiments were performed to test the effect of cold storage. Our results show that changes in temperature lead to different results in pig renal artery and rat aorta. A decrease in temperature induced a highly reproducible relaxation in rat aorta, whereas pig renal artery presented cooling-induced contraction. Moreover, whereas calcium depletion failed to inhibit cooling-induced relaxation in rat aorta, it did not provoke cooling-induced contraction in pig renal artery. Similar responses were obtained with cold storage and calcium depletion. We intend to demonstrate that, just as the effect of temperature variation on pig renal artery is due to a metabolic mechanism, its effect on rat aorta may be due to structural factors. This hypothesis is supported by the result of histological studies which demonstrate a higher proportion of elastin fibres in rat aorta than in pig renal artery.
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MESH Headings
- Animals
- Aorta, Thoracic/chemistry
- Aorta, Thoracic/drug effects
- Aorta, Thoracic/physiology
- Calcium/physiology
- Chelating Agents/pharmacology
- Cryopreservation
- Egtazic Acid/analogs & derivatives
- Egtazic Acid/pharmacology
- Elastin/analysis
- Isometric Contraction/drug effects
- Isometric Contraction/physiology
- Male
- Muscle Relaxation/drug effects
- Muscle Relaxation/physiology
- Muscle, Smooth, Vascular/chemistry
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/physiology
- Rats
- Rats, Wistar
- Renal Artery/chemistry
- Renal Artery/drug effects
- Renal Artery/physiology
- Reproducibility of Results
- Swine
- Swine, Miniature
- Temperature
- Vascular Resistance/drug effects
- Vascular Resistance/physiology
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Affiliation(s)
- B Herrera
- Unidad de Medicina y Cirugía Experimental, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007 Madrid, Spain
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