Aims
Among people with diabetes, 10–25% will experience a foot ulcer. Research has shown that supplementation with arginine, glutamine and β‐hydroxy‐β‐methylbutyrate may improve wound repair. This ...study tested whether such supplementation would improve healing of foot ulcers in persons with diabetes.
Methods
Along with standard of care, 270 subjects received, in a double‐blinded fashion, (twice per day) either arginine, glutamine and β‐hydroxy‐β‐methylbutyrate or a control drink for 16 weeks. The proportion of subjects with total wound closure and time to complete healing was assessed. In a post‐hoc analysis, the interaction of serum albumin or limb perfusion, as measured by ankle–brachial index, and supplementation on healing was investigated.
Results
Overall, there were no group differences in wound closure or time to wound healing at week 16. However, in subjects with an albumin level of ≤ 40 g/l and/or an ankle–brachial index of < 1.0, a significantly greater proportion of subjects in the arginine, glutamine and β‐hydroxy‐β‐methylbutyrate group healed at week 16 compared with control subjects (P = 0.03 and 0.008, respectively). Those with low albumin or decreased limb perfusion in the supplementation group were 1.70 (95% CI 1.04–2.79) and 1.66 (95% CI 1.15–2.38) times more likely to heal.
Conclusions
While no differences in healing were identified with supplementation in non‐ischaemic patients or those with normal albumin, addition of arginine, glutamine and β‐hydroxy‐β‐methylbutyrate as an adjunct to standard of care may improve healing of diabetic foot ulcers in patients with risk of poor limb perfusion and/or low albumin levels. Further investigation involving arginine, glutamine and β‐hydroxy‐β‐methylbutyrate in these high‐risk subgroups might prove clinically valuable.
What's new?
This manuscript constitutes, to our knowledge, the first multi‐centre, multinational, randomized trial evaluating the potential efficacy of oral nutritional supplementation on wound healing in diabetes.
Objectives. This study sought to assess the feasibility, safety and efficacy of sustained intracoronary delivery of dexamethasone by a novel polymer-coated eluting stent.
Background. Development of ...techniques to provide sustained local drug delivery has focused on polymers as matrices for drug incorporation and elution.
Methods. A tantalum wire stent was coated with dexamethasone (0.8 mg) suspended in a matrix of either low (∼80 kD) or high (∼321 kD) molecular weight poly-l-lactic acid (PLLA 0.4 mg). Uncoated stents, stents coated with PLLA or stents coated with dexamethasone in PLLA were overexpanded by 30% to the normal vessel diameter in the coronary arteries of juvenile farm pigs. Animals were euthanized 28 days later, and neointimal thicknesses were measured. Additional pigs underwent placement of stents coated with high molecular weight PLLA–dexamethasone for assessment of arterial tissue and serum concentrations of dexamethasone at 1 h and 1, 2, 10 and 28 days after stent implantation.
Results. In vitro dexamethasone release occurred over the first 6 days. Stents coated with low molecular weight PLLA produced an intense inflammatory neointimal response. Stents utilizing the high molecular weight PLLA were well tolerated within the coronary vessel during the 28-day experiment. However, dexamethasone did not decrease neointimal hyperplasia. Dexamethasone concentrations in the arterial tissue were ∼300,000-fold higher than those in the serum 24 h after stent implantation, remaining ∼3,000-fold higher at 28 days.
Conclusions. The eluting stent utilizing high molecular weight PLLA appeared to be a well tolerated and effective means of providing sustained, site-specific drug delivery to the porcine coronary artery wall for at least 28 days.
(J Am Coll Cardiol 1997;29:808–16)
Mesoporous catalysts were synthesized from the precursor NbCl5 and surfactant CTAB (cetyltrimethylammonium bromide), using different synthesis routes of, in order to obtain materials with different ...properties which are capable of promoting the epoxidation of cyclohexene. The materials were characterized by X ray diffractometry (XRD), thermogravimetry (TG), acidity via pyridine adsorption, Hammet titration and N2 adsorption/desorption. The characterization data indicate that the calcination process of the catalysts was efficient for elimination of the surfactant, but it caused a collapse of the structure, causing a Brunauer Emmett Teller (BET) specific area decrease (ClNbS-600, 44 and ClNbS-AC-600, 64 m2 g−1). The catalysts that have not been calcined showed high BET specific areas (ClNbS 198 and ClNbS-AC 153 m2 g−1). Catalytic studies have shown that mild reaction conditions promote high conversion. The catalysts ClNbS and ClNbS-AC showed high conversions of cyclohexene, 50 and 84%, respectively, while the calcined materials showed low conversion (<30%). The epoxide formation was confirmed by nuclear magnetic resonance (NMR).
Metallurgical analysis is widely used in the field of heat treatment of metals to ensure the quality of the treatments carried out on a wide variety of industrial parts and treatments carried out. It ...is therefore a valuable tool for subcontractors of the heat treatment industry to monitor their production and treatment response on various parts. Through different examples, we will present actual cases that involve in particular automotive parts.
We show that there is a strong interdependence between material and heat treatment, one being related to each other, a successful treatment depends both on the metallurgical quality of the material and the production quality of the heat treatment process. We will discuss the type of treatments like: vacuum hardening or under protective atmosphere, surface induction hardening, carburizing, nitriding and brazing.
The remaining limitations of ultrasonographic imaging in accurately quantifying internal carotid stenosis or diagnosing internal carotid occlusion may be overcome by enhancing the echogenicity of ...flowing arterial blood with contrast agents. This study assessed the usefulness of the intravenous (transpulmonary) contrast medium SH U 508 A in improving the characterization and quantification of severe internal carotid stenosis.
We examined 32 patients (30 had vessels with a stenosis of greater than 70% luminal narrowing and 2 had vessel occlusions) using a 7.5-MHz linear-array transducer for color Doppler-assisted duplex imaging before and after injection of the contrast medium.
The SH U 508 A-induced increase in carotid blood echogenicity began 11 +/- 2 (mean +/- SD) seconds after the start of the bolus injection, peaked at 21 +/- 2 dB, and showed a half-life of 75 seconds. Quantitative vascular measurements (cross-sectional luminal area reduction and plaque length, respectively) obtained before and after contrast application were highly correlated (r > .90). Visualization of the entire length of the intrastenotic residual flow lumen, however, was significantly improved by contrast enhancement (52% versus 83%, P = .01).
This pilot study on patients with extracranial carotid artery disease suggested that ultrasonic contrast media may be most useful in improving the ultrasonography-based diagnosis of internal carotid occlusion.
Laser-induced interstitial thermotherapy (LITT) using a neodymium:yttrium aluminum garnet (Nd: YAG) laser is a new therapeutic approach in the treatment of brain tumors. The purpose of our study was ...to determine the value of MRI in monitoring LITT.
Eight patients with intracerebral tumors were treated with LITT. The light guide was inserted via an applicator sheath that was implanted stereotaxically with CT guidance. The laser irradiation was performed within the MR unit and monitored by repetitive measurements of a T1-weighted 2D-FLASH sequence.
During therapy in all patients, typical changes of signal intensity were seen. A gradually increasing central zone of high signal intensity was surrounded by an increasing peripheral area of reduced signal intensity. The diameter of an enhancing rim at the outer border of the peripheral area after Gd-DTPA was considered as the total lesion size. The lesion size as determined on 2D-FLASH scans during LITT accounted for 88-100% (mean 93.5%) of total lesion size on T1-weighted images after Gd-DTPA acquired immediately after therapy. On T2-weighted images the signal intensities of the two zones were vice versa. Follow-up studies showed a decrease of total lesion size (15-87%).
Our results demonstrate that MRI is feasible and effective in monitoring LITT. However, the role of LITT in the therapeutic workup of brain tumors still has to be defined in future clinical studies.
The high-resolution solution structure and dynamics of a cofacially aligned porphyrin−phenylene−quinone compound have been determined using 1H NMR spectroscopy and simulated annealing calculations. ...Members of this class of π-stacked assemblies feature a 1,8-naphthyl pillaring motif that enforces sub van der Waals interplanar separations between juxtaposed porphyryl, aromatic bridge, and quinonyl components of the donor−spacer−acceptor compound; this structural motif gives rise to a comprehensive set of structurally significant NOE signatures that can be used as constraints in quantitative structural calculations. Examination of such data using ab initio simulated annealing analytical methods shows that 5-8‘-(4‘ ‘-8‘ ‘‘-(2‘ ‘‘ ‘,5‘ ‘‘-benzoquinonyl)-1‘ ‘‘-naphthyl-1‘ ‘-phenyl)-1‘-naphthyl-10,20-diphenylporphyrin displays an unusual degree of conformational homogeneity in the condensed phase, and represents a rare example where such an analysis determines unequivocally a single unique structure in solution.
There is a great deal of misunderstanding about how schools in America function and what goes on in the typical classroom. Parents, even relatively young parents, perceive that public schools are ...just like when they attended. This faulty perception is held by a large portion of the general public. In addition a number of aspects of schooling have come under close scrutiny by critics of the public schools, resulting in a heated debate throughout the nation. It is the purpose of this book to provide parents and others who are interested in the operation of public schools an alternative way of looking at publically supported education and the issues surrounding better educational practice.The framework for this volume is the published articles of the author over the past 20 years in his weekly newspaper column, A Different Perspective. While no attempt is made to be comprehensive, the 13 chapters cover a broad range of issues facing the schools. The reader is treated to a fascinating look at the viewpoint of an experienced observer of these public institutions. The author has changed his perspective over the two decades on only a few issues. The book was written with the average reader in mind. It does not contain a large amount of educational jargon, although the issues are approached with enough depth to be useful to the professional educator. Throughout the entire volume the author maintains strong support for public schools.
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