Photopolymerized Zwitterionic Hydrogels with a Sustained Delivery of Cerium Oxide Nanoparticle-miR146a Conjugate Accelerate Diabetic Wound Healing

In the United States, $87 billion per year is spent on the care of diabetic ulcers alone. Although the pathophysiology of diabetic wound healing is multifaceted, high systemic levels of inflammation and increased reactive oxygen species are often implicated in the wound healing impairment. Zwitterionic materials have been demonstrated to reduce inflammation and increase extracellular matrix deposition in wound beds, and here, we demonstrate a fabrication method for photopolymerized zwitterionic hydrogels that also enables sustained drug delivery over time. A therapeutic molecule of interest that is examined in this work is cerium oxide nanoparticle tagged with microRNA-146a (CNP-miR146a) to combat both oxidative stress and inflammation. The hydrogels are composed of zwitterionic and nonzwitterionic monomers, and the hydrogel formation occurs in the absence of a crosslinker. The hydrogels exhibit a wide range of stiffness and mechanical properties depending on their monomer content. Additionally, these hydrogels exhibit sustained release of nanoparticles and proteins. Finally, when employed in an in vivo diabetic mouse wound healing model, the zwitterionic hydrogels alone and laden with the CNP-miR146a conjugate significantly improved the rate of diabetic wound healing. Overall, these materials have excellent potential to be used as a topical treatment for chronic diabetic wounds.

The novel fetal MRI O/E CLV versus O/E LHR in predicting prognosis in congenital diaphragmatic hernias: can we teach an old dog new tricks?

PURPOSE

In congenital diaphragmatic hernia (CDH), ultrasound (U/S) measurements of the contralateral lung commonly provide the observed-to-expected lung-to-head ratio (O/E LHR) and are used to determine the severity of pulmonary hypoplasia. Fetal magnetic resonance imaging (MRI) measurement of the observed-to-expected total lung volume (O/E TLV) has been used as an adjunct to O/E LHR in predicting outcomes. Since O/E LHR only measures the contralateral lung, we sought to investigate if MRI measurements of the contralateral lung volume (O/E CLV) can accurately predict outcomes in CDH. We hypothesize that O/E CLV is a better predictor of CDH outcomes than O/E LHR.

METHODS

We identified all infants with a prenatal diagnosis of CDH at our fetal center who had both MRI and U/S measurements. Using lung volume ratios of right-left 55:45, we calculated O/E CLV from O/E TLV. We used receiver-operating characteristic (ROC) curves to calculate the area under the curve (AUC) to compare the predictive accuracy of O/E CLV to O/E LHR for ECMO support, as well as survival to both discharge and 1 year.

RESULTS

Seventy-four patients had complete prenatal imaging with 39% requiring ECMO support. The median O/E CLV was 48.0% and the median O/E LHR was 42.3%. O/E CLV was a better predictor of the need for ECMO support (AUC 0.81 vs. 0.74). O/E CLV was a better predictor of survival to discharge (AUC 0.84 vs. 0.64) and 1-year survival (AUC 0.83 vs. 0.63) than O/E LHR.

CONCLUSION

O/E LHR is a well-validated standard for predicting outcomes and guiding prenatal counseling in CDH. We provide evidence that fetal MRI measurements of the contralateral lung volume corrected for gestational age were more accurate in predicting the need for ECMO and survival. Future prospective studies validating O/E CLV regarding outcomes and ECMO utilization are warranted.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Evaluation of skin care concerns and patient's perception of the effect of NanoSilk Cream on facial skin

BACKGROUND

Skin aging is an inevitable process with one of the key features of aging being dryness or flakiness of the skin. Previous in vivo and in vitro testing has highlighted that a silk-based product may be effective in improving moisture retention in skin.

METHODS

We evaluated the safety and efficacy of our silk-based product through a combination of objective- including scanning electron microscopy (SEM) and EpiDerm Skin Irritation tests - and subjective tests - including direct evaluation of patient's own perception of their skin.

RESULTS

In alignment with previous studies, patients reported significant concerns about aging, wrinkling, or saggy skin. We found that our silk-based product was safe and effective in improving hydration and resilience of facial skin and a majority of participants stated they would continue to use this product, when commercially available.

CONCLUSION

Our novel silk-based product, NanoSilk Cosmo, is safe for use on human facial skin and it improves skin resiliency and hydration.

Changes to mental healthcare for working age adults: impact of a crisis team and an assertive outreach team

Aims and Method

To investigate changes to admissions, compulsory detentions, diagnosis, length of stay and suicides following introduction of crisis resolution home treatment and assertive outreach teams.

Results

There was a 45% reduction in admissions with an increase in the median length of stay from 15.5 to 25 days. Bed occupancy fell by 22%. The number of suicides remained constant. Detentions under sections 2 and 3 of the Mental Health Act 1983 increased whereas those under sections 5(2) and 5(4) declined.

Clinical Implications

The introduction of crisis and assertive outreach teams was followed by a reduction in admissions, particularly short admissions. The impact differed according to gender (reduction in female bed occupancy). This and the increased length of stay need to be considered when determining the number of acute psychiatric beds needed.

Cognition in nephropathic cystinosis: pattern of expression in heterozygous carriers

Individuals with cystinosis exhibit specific cognitive deficits in visual spatial function. The purpose of the current study was to examine if obligate heterozygotes of the CTNS mutation have the same pattern of cognitive functioning seen in homozygotes, namely aberrant visual-spatial functioning against a background of relatively intact visual-perceptual functioning and overall cognitive ability. Study participants were 254 adults (100 heterozygotes and 154 controls), ages 17 years 10 months through 74 years 9 months. Tests of intelligence, visual perceptual, and visual spatial functioning were administered. Our results showed that cystinosis heterozygotes demonstrated intelligence within the normal range, and performed similarly to controls on tests of visual-perceptual ability. In contrast, the heterozygotes performed significantly more poorly on each of the visual-spatial tests when compared to controls. Obligate heterozygotes for the CTNS mutation display a similar pattern of visual processing decrements as do individuals with cystinosis. Namely, carriers demonstrate relative weaknesses in visual-spatial processing, while maintaining normal visual perceptual ability and intelligence in the normal range. The visual spatial decrements in heterozygotes were not as marked as those found in individuals with cystinosis, suggesting a gene dosing effect. This study provides an impetus for other studies of gene-behavior relationships in recessive disorders, and may stimulate further interest in the role of aberrant genes on "individual differences" in behavior.

Mental health crisis at home: service user perspectives on what helps and what hinders

This paper presents data which emerged during the process of a participatory research study to identify the perspectives of previous users of a home treatment service. Feedback was sought in order to establish the criteria for the development of a service evaluation questionnaire. Seven themes emerged from the data which were then used as a framework for the evaluation questionnaire. These themes have also been used within this paper to present what our participants told us was important to them when they received a service at home at a time of mental health crisis. Although what is described here is the experience of one group of service users in the North of England, we hope that the views of these participants will create a resonance with providers of other home treatment services and expand the knowledge about which aspects of care at home during mental health crisis are viewed as helpful and those aspects which are not.

The development of an evaluation questionnaire for the Newcastle Crisis Assessment and Home Treatment Service: finding a way to include the voices of service users

The views of users of services have traditionally been sought through the use of 'patient satisfaction' surveys. Because such surveys are often devised by service providers there are concerns that their use as evaluation tools may be flawed due to issues of power and passivity, and that they do not represent active involvement by service users in the feedback loop. The Newcastle Crisis Assessment and Treatment Service offers treatment at home to people in mental health crisis who would otherwise be admitted to hospital. This article reports on the process of inviting previous users of a home treatment service to give their views about what was most important to them about receiving the service. A participatory research approach combining a two-stage modified Delphi study and semi-structured interviews conducted by service user interviewers were employed to gather rich data to inform the construction of a service evaluation questionnaire. The questionnaire is now in routine use for every person who is in receipt of treatment at home. The feedback obtained from the questionnaire will be used to shape and refine the service provided by the team. As a 'live' document through use and feedback, the questionnaire will continue to evolve in order to retain its sensitivity and relevance.

Liposomes: a novel topical delivery system for pharmaceutical and cosmetic applications

This review will highlight work done in our laboratories evaluating topical liposomal delivery in a wide variety of animal models and human skin using both in vivo and in vitro techniques. The mechanism by which liposomes facilitate deposition of drugs into the skin and some potential applications of topically applied liposomes will be discussed. Particular emphasis will be placed on the development of analytical techniques that allow the quantification of drug levels in the various skin strata and in pilosebaceous structures. Appropriate models of skin representing the two cases, as well as those wherein both routes are available for skin deposition, were examined using a wide variety of liposomal preparations containing radiolabeled and fluorescent molecules as marker compounds.

[Coexistence of gastric carcinoid and leiomyosarcoma]

A 74-year-old man is reported in whom hormonally inactive gastric carcinoid coexisted with leiomyoma. The patient was operated on with the preoperative diagnosis of gastric cancer. Microscopic postoperative examination made possible correct diagnosis.

[Use of arterialized temporo-frontal flap in the treatment of advanced forms of facial skin cancer]

Three patients were treated for far advanced facial carcinoma. In all cases one-time reconstruction was done using arterialized temporofrontal flap, and full healing-in of the flap was achieved. The high usefulness of this operation is stressed in reconstructive procedures on the face. Far advances facial carcinoma should be treated surgically, and not disqualified for surgery, as this is frequently the case.