The immunologic efficacy of low-dose recombinant interleukin-2 (rIL-2) administered subcutaneously (sc) once a day in combination with highly active antiretroviral therapy (HAART) was assessed in a ...pilot study in patients with advanced human immunodeficiency virus (HIV) disease. Twenty-five persons with ≤250 CD4 cells/µL and plasma HIV-1 RNA levels ≤500 copies/mL for >24 weeks were randomly assigned to receive sc rIL-2 (3 X 10⁶ IU once a day) with their previous antiretroviral regimen (n =13) or to continue with the same treatment (n = 12). The level of CD4 T cells was significantly higher in the IL-2 group at week 24 (105 ± 65/µL; P<.05) but not in the control group (30 ± 78/µL). Memory T cells initially contributed to the CD4 T cell increase at week 4 (P < .05). Naive T cell increases (99 ± 58/µL) in the IL-2 group became statistically significant at week 24 compared with the control group (28 ± 27/µL; P < .05). Subcutaneous rIL-2 once a day in combination with HAART was well tolerated and improved immunologic surface markers in patients with advanced HIV infection.
We assessed the efficacy of adding indinavir in patients with advanced HIV-1 infection, who were previously exposed to different reverse transcriptase (RT) nucleoside analogues. Twenty-five patients ...with an initial median CD4 cell count of 20 cells/mm3 (range, 0-80 cells/mm3) were treated with indinavir (800 mg three times per day) for 24 weeks. The median initial viral load was 5.4 log (range, 3.6-6.7 log). Of these patients, 56% (14 of 25) had an initial decrease in viral load of >1 log and sustained response of >0.5 log of HIV-1 RNA from baseline. Twelve of these 14 responder patients (85%) showed a sustained RNA response undetectable by NASBA assay, and no genotypic changes in protease were detected at week 24. In those with a temporary or absent response to indinavir, either resistant viruses or lack of compliance was observed. In compliant patients (15 of 16), relatively small increases in 50% inhibitory concentration (IC50) to indinavir and only two to three amino acid changes were sufficient to produce treatment failure. Phenotypic drug-resistant assays at 24 weeks revealed cross-resistance to ritonavir in all the patient isolates and to saquinavir in one third of the isolates. We observed an initial and persistent response to the addition of indinavir in patients with advanced disease and prolonged antiretroviral treatment. Therapy failure, as defined by increases in viral RNA, was associated with either lack of compliance or the development of low level indinavir-resistant virus. Clinical studies need to be designed to determine to what extent these viruses may respond to other protease inhibitors.
Aim
To evaluate the relationship between the pressure exerted on the heel of one foot resting directly on a mattress, versus that exerted on the other heel, protected by a pillow beneath the Achilles ...tendon area and the changes thus produced in perfusion, oxygenation and temperature in the skin of heels of healthy volunteers lying in a supine position.
Design
Experimental study in a pre‐clinical phase, with healthy volunteer participants and intrapeople control.
Methods
The study was carried out from November 2017 – May 2018. A pressure measurement surface was placed between the participant and the constant low‐pressure support surface. Doppler laser devices were used to measure local temperature and perfusion. The degree of oxygenation was determined using an infrared beam close to the pressure zone in each heel. Both feet rested immobile on the bed, in a natural position, for 2 hr. To ensure intrapeople control, in every case the left heel was raised slightly, compared with the right.
Results
Eighteen participants took part in this study. Analysis of the results obtained showed that capillary blood flow was significantly reduced in the heel subjected to pressure, compared with the other heel, while no significant effects on oxygen saturation or temperature were observed. The variables associated with greater oxygen saturation were capillary blood flow, local temperature and pressure exerted. Fat‐free mass, fat mass and duration of exposure to pressure were all significantly associated with reduced oxygen saturation.
Conclusions
In healthy participants, when the heel is subjected to constant pressure against a constant low‐pressure support surface, there is a significant reduction in blood flow, compared with the heel where pressure is relieved. However, there are no significant differences in temperature or tissue oxygenation.
Impact
Significant reductions in vascular flow were observed; however, the oxygenation and temperature of the heel tissues remained unchanged. These findings, corroborated in real patients, would advance our understanding and facilitate decision‐making on measures to prevent pressure ulcers, such as repositioning or tissue protection.
Trial registration: The protocol is registered in ClinicalTrials.gov (NCT02736838).
目的
评价健康参与者仰卧位时足跟部皮肤的灌注、氧合和温度变化与单足直接躺在床垫上和另一足跟部在跟腱区下枕头保护下所受压力的关系。
设计
临床前阶段的实验研究,有健康志愿者参与者和患者内对照。
方法
本研究于2017年11月‐2018年5月进行。压力测量表面被放置在参与者和恒定低压支撑表面之间。用多普勒激光装置测量局部温度和灌注。氧合程度是用靠近每个脚跟压力区的红外线光束来测定的。两只脚在床上静止,保持自然姿势,持续2小时。为了确保足内控制,在每种情况下,与右脚跟相比,左脚跟略有抬高。
结果
18名参与者参加了这项研究。对所得结果的分析表明,与另一只脚跟相比,受压脚跟的毛细血管血流量明显减少,而对氧饱和度或温度没有明显影响。与更高的氧饱和度相关的变量是毛细血管血流量、局部温度和施加的压力。无脂肪量、脂肪量和压力持续时间均与氧饱和度降低显着相关。
结论
在健康参与者中,当脚后跟承受恒定的压力,与压力减轻的脚后跟相比,脚后跟承受恒定的低压支撑表面时,血流量明显减少。但温度和组织氧合无显著差异。
影响
观察到血管流量显著减少;而足跟组织的氧合和温度则保持不变。这些在真实病人中得到证实的发现,将促进我们对压疮预防措施的理解,并有助于决策,如重新定位或组织保护。
试验注册
该协议已在ClinicalTrials.gov (NCT02736838)注册。
Different surface modifications of polypropylene non‐woven fabric (NWF) by using mineral particles are proposed to increase fabric hydrophilicity. Particles from a zeolitized vitreous breccia are ...selected as an economic mineral having high water absorption capacity. The efficacy of each methodology concerning particle inclusion on and within NWF is studied with different techniques. Scanning electron microscopy and X‐ray diffraction are used to analyze particle presence and coverage. Particle concentration on modified‐NWF is determined by using thermogravimetric analysis. The selection of the surface modification methodology is done considering the particle inclusion efficacy and its scalability to be directly used during NWF fabrication. Particle inclusion on the heat softened NWF followed by the removal of non‐adhered particles is chosen as the selected surface modification methodology to increase NWF hydrophilicity. To guarantee the no‐particle detachment during the use of modified‐NMF, specific assays are performed simulating extreme conditions such handling under water. After these assays, modified‐NWFs have a minimum water absorption capacity of 5.8 g/cm2. It means that 0.25 m2 of modified‐NWF has at least similar absorption capacity than 5 g of silica gel. These modified‐NWFs, obtained from an easy process during NWF fabrication, favor the beneficiation of the raw zeolitized vitreous breccia, leading to a new hydrophilic cloth.
The aim of this work is to obtain tridimensional (3D) networks and bidimensional (2D) layered structures from hydrogels containing high aspect ratio sepiolite nanofibers. In this sense, it is ...proposed an appropriate methodology by applying an oscillating shear strain field to sepiolite hydrogels which were previously obtained by sonication. The gel stability is crucial in the final structure of the spatial arrangement. Then, the influence of sepiolite concentration and shear field on hydrogel stability is assessed by studying its rheological properties in order to determine the process window to obtain 3D or 2D final nanostructure. Three hydrogels with different concentrations (0.002; 0.02 and 0.2 g sepiolite/mL water) of high aspect ratio sepiolite were analyzed. A direct relationship among the hydrogel concentration and stability gives a tool to obtain 2D or 3D nanostructures. Hydrogels with low sepiolite concentration (0.002 and 0.02 g/mL) under shear field break, giving 2D layered structure. Meanwhile, high sepiolite concentration hydrogel (0.2 g/mL) preserves 3D networks since it does not break under the applied shear field. The comparison of final structures, before and after shear field application, was performed by analyzing the corresponding dried hydrogels by Scanning Electronic Microscopy. A versatile method was proposed to prepare 2D and 3D structures from high aspect ratio sepiolite nanofibers. It is possible to tailor the final nanofibers spatial arrangement from a combination of particle concentration and applied shear field. As a consequence, the processing window as shear field for each desired final arrangement can be assessed depending on particle concentration.
•A method for making 2D and 3D nanofiber arrangement from sepiolite hydrogels.•Sonication induced a 3D nanofiber network in sepiolite hydrogel.•Oscillating shear field application on sepiolite hydrogels promote 2D layers.•2D and 3D nanofiber arrangement depends on hydrogels concentration and stability.
In this work, lyophilization and acid treatments were proposed as simple alternatives to defiber sepiolite samples, without affecting their length, in order to be applicable at industrial scale. ...Although it contains carbonates, the main remarkable feature of this clay mineral is its high crystalline development, reaching fiber lengths around 8cm. Proposed alternatives were analyzed comparatively, evaluating mainly the defibering effect. The influence of lyophilization and acid treatments on sepiolite structure and purity was qualitatively studied based on mineral characterization, electronic and optical microscopy, X-ray diffraction and Fourier transform infrared spectroscopy. Results show that acid treatment allowed sepiolite purification by removing carbonates as well as the reduction of fiber length. Lyophilization demonstrated to be an effective defibering process that allowed obtaining individualized fiber from bundle disaggregation, without affecting sepiolite length and flexibility.
Display omitted
•A separation and purification process of sepiolite is proposed.•A method is planned to be efficient in order to be applicable to industrial scale.•Lyophilization and acid treatment were analyzed comparatively.•Acid treatments allow purification, but change the fiber length and crystallinity.•Lyophilization method allows fibers to conserve their initial length.
We present the first mnemonic in Spanish, “PPIENSENLo,” for alarm criteria in secondary headaches in children in order to facilitate their identification, diagnosis, and treatment. A search was ...performed across different electronic databases for a mnemonics that applied to clinical alarm criteria in secondary headaches in children. None were found in English or Spanish. This tool is perhaps useful both for clinical and teaching purposes.
Patient repositioning is a recommended intervention to prevent or treat pressure ulcers (PUs). One option under consideration is the tailored repositioning according to patient characteristics, but ...more knowledge is needed on how different repositioning patterns influence on skin pressure. To determine what degree of inclination of the body in bed generates more pressure in the trochanteric region. Additionally, to analyze the influence of factors such as gender, age and anthropometric characteristics in the variations of this pressure.
Analytical cross-sectional study. Body Mass Index (BMI), lean mass and fat mass were measured in healthy volunteers subject to different inclinations (90°, 60° and 30°) in right lateral decubitus. Pressure was measured with a capacitive surface.
In total, 146 subjects were included, of which 45 were men and 101 women. The results showed pressure differences due to the inclination according to gender and anthropometric values, being statistically significant in men at 90° and 60°, and in women at 30°. (hombres 90° p = 0,026, 60° p = 0,049; mujeres 30° p = 0,036) según prueba Brown-Forsythe.
There are differences in the pressures of the trochanteric zone depending on anthropometric factors and by gender, in different body positions. Obese people exerted a higher pressure in the trochanter area at 30° of body inclination than overweight, normal weight and underweight people, respectively. From the clinical point of view, these findings invite to consider a possible differentiation in the repositioning interventions of the patients, according to gender and BMI, as a preventive strategy for PUs.
•Different distribution of body fat vary the pressure exerted by a degree of inclination and in a certain body plane.•The measurement with capacitive surface shows the differences in the pressures of the trochanter area.•These results may guide towards a more individualized indication of repositioning observations in clinical practice.
To evaluate the changes that take place in the perfusion, oxygenation and local temperature of the skin of the sacrum and trochanter when subjected to direct pressure for 2 h.
Quasi-experimental ...study in the preclinical phase with healthy subjects acting as their own controls (intrasubject control). The outcome variables were measured with a laser Doppler system (local temperature and oxygenation) and by near-infrared spectroscopy (perfusion). The pressure exerted was measured with a capacitive pressure sensor. No more than one week elapsed between the sacrum and trochanter measurements.
The study sample consisted of 18 persons. The comparative analysis of the fluctuations in the parameters measured on the skin of the trochanters and sacrum, according to the time elapsed, revealed a statistically significant increase in temperature and in the pressure exerted. On the other hand, the changes in capillary blood flow and in SaO2 were not statistically significant.
Our study results show that changes found in terms of temperature and pressure should be taking into account when planning personalised repositioning to patients according to biomechanical and biological situations that vary between anatomical areas. In future research, the changes reported could be evaluated in patients with risk factors for the development of pressure ulcers, thus facilitating the introduction of more personalised planning in the care and prevention of these injuries.
•Significant changes in sacral and trochanteric skin temperature have been observed over time.•The external validity of our findings needs to be confirmed by further study in clinical settings.•Future research about risk factors of PU may lead to personalised prevention.
informal caregivers have a high risk of suffering from diseases derived from the chronic stress to which they are subjected for their dedication to the care of their relatives. Such stress has a ...direct influence on the person cared for, mainly affecting the quality of their care. Therefore, the aim of the present study is to assess the association of caregiving on physical and mental perceived health in family caregivers of dependent adults with complex chronic diseases.
a prospective longitudinal cohort study, with a follow-up period of 36 months (HUELLA cohort). The exposed cohort will be formed by family caregivers of dependent patients with complex chronic pathologies. The unexposed cohort will be taken from the general population adjusted for age, sex and health. Outcome variables will include attendance to health services, consumption of psychoactive drugs, dedication to care (only in exposed cohort), concession of the Act on Promotion of Personal Autonomy and Care for dependent persons (exposed only), perceived physical and mental health, depression level, burden level and new diagnosis of chronic pathology of the caregiver during the study.
the expected results will be applicable and will incorporate improvements to the usual health system clinical practice, providing feedback to professionals dedicated to the provision, planning and design of services to family caregivers, as well as to groups and organizations of caregivers.
investments in preventing low-quality informal care are key, mainly through early identification and interventions to support caregivers who suffer from stress, anxiety or depression.
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