INTRODUCTION: It is hypothesized that systemically administered antibiotics penetrate wound sites more effectively during negative pressure wound therapy (NPWT). However, there is a lack of clinical data from patients who receive NPWT for deep sternal wound infection (DSWI) after open-heart surgery. Here, we evaluated vancomycin penetration into exudate in this patient group. PATIENTS AND METHODS: For this prospective observational study, we enrolled 10 consecutive patients treated with NPWT for post-sternotomy DSWI. On the first sampling day, serum and exudate samples were synchronously collected at 0 (pre-dose), 0.5, 1, 2, 3 and 6 h after vancomycin administration. On the following three consecutive days, additional samples were collected, only before vancomycin administration. RESULTS: The ratio of average vancomycin concentration in wound exudate to in serum was higher for free (unbound) (1.51 ± 0.53) than for total (bound + unbound) (0.91 ± 0.29) concentration (p = 0.049). The percentage of free vancomycin was higher in wound exudate than serum (0.79 ± 0.19 vs. 0.46 ± 0.16; p = 0.04). Good vancomycin wound penetration was maintained on the following three days (vancomycin trough exudate-to-serum concentration ratio > 1). The total hospital stay was significantly longer in patients with DSWI (46 ± 11.6 days) versus without DSWI (14 ± 11.7 days) (p < 0.001). There was no in-hospital or 90-day mortality. Two patients experienced late DSWI recurrence. All-cause mortality was 4.8% during a median follow-up of 2.5 years. CONCLUSION: Vancomycin effectively penetrates wound exudate in patients receiving NPWT for DSWI after open-heart surgery.The protocol for this study was registered at ClinicalTrials.gov on July 16, 2024 (NCT06506032).
- MeSH
- antibakteriální látky * farmakokinetika aplikace a dávkování MeSH
- exsudáty a transsudáty metabolismus mikrobiologie MeSH
- infekce chirurgické rány * MeSH
- kardiochirurgické výkony * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři MeSH
- sternotomie * škodlivé účinky MeSH
- sternum chirurgie MeSH
- terapie ran pomocí řízeného podtlaku * metody MeSH
- vankomycin * aplikace a dávkování farmakokinetika MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
PURPOSE: Subretinal (SR) injection in porcine models is a promising avenue for preclinical evaluation of cell and gene therapies. Targeting of the subretinal fluid compartment (bleb) is critical to the procedure, especially if treatment of the cone-rich area centralis is required (i.e., visual streak [VS] in pigs). To our knowledge, this study is the first to investigate the influence of injection site placement on VS involvement in the pig eye. METHODS: We performed 23-gauge pars plana vitrectomy followed by SR injection in 41 eyes of 21 animals (Sus scrofa domesticus). In 27 eyes (65.9%), the injection site was placed superior to the VS, and in 14 eyes (34.1%) it was placed inferior to it. Using intraoperative imaging, blebs were classified based on their propagation behavior relative to the VS. RESULTS: In 79% of cases, blebs from inferior injection sites developed away from the VS, exhibiting a mean ± SEM vertical anisotropy (AP) of 0.67 ± 0.11. In contrast, blebs from superior injection sites tended to develop toward the VS with an AP of 1.27 ± 0.18 (P = 0.0070). Blebs developed away from the VS in only 41% of injections (P = 0.0212). Inferior blebs were orientated close to 0° (horizontal), whereas superior blebs displayed varied orientations with a mean angle of 56° (P = 0.0008). CONCLUSIONS: Bleb propagation was anisotropic (i.e., directionally biased) and dependent on injection site placement. Superior injection sites led to superior VS detachment. Morphological analysis suggested increased adhesion forces at the VS and superior vascular arcades. This study will aid the planning of surgeries for targeted subretinal delivery in pig models.
BACKGROUND: Systemically administered antibiotics are thought to penetrate the wounds more effectively during negative pressure wound therapy (NPWT).To test this hypothesis total and free antibiotic concentrations were quantified in serum and wound exudate. METHODS: UHPLC-MS/MS methods were developed and validated for the determination of ceftazidime, cefepime, cefotaxime, cefuroxime, cefazolin, meropenem, oxacillin, piperacillin with tazobactam, clindamycin, ciprofloxacin, sulfamethoxazole/trimethoprim (cotrimoxazole), gentamicin, vancomycin, and linezolid. The unbound antibiotic fraction was obtained by ultrafiltration using a Millipore Microcon-30kda Centrifugal Filter Unit. Analysis was performed on a 1.7-μm Acquity UPLC BEH C18 2.1 × 100-mm column with a gradient elution. RESULTS: The validation was performed for serum, exudates and free fractions. For all matrices, requirements were met regarding linearity, precision, accuracy, limit of quantitation, and matrix effect. The coefficient of variation was in the range of 1.2-13.6%.and the recovery 87.6-115.6%, respectively. Among the 29 applications of antibiotics thus far, including vancomycin, clindamycin, ciprofloxacin, oxacillin, cefepime, cefotaxime, cotrimoxazole, and gentamicin, total and free antibiotic concentrations in serum and exudate were correlated. CONCLUSION: This method can accurately quantify the total and free concentrations of 16 antibiotics. Comparison of concentration ratios between serum and exudates allows for monitoring individual antibiotics' penetration capacity in patients receiving NPWT.
- MeSH
- antibakteriální látky MeSH
- cefepim MeSH
- cefotaxim MeSH
- chromatografie kapalinová metody MeSH
- ciprofloxacin MeSH
- exsudáty a transsudáty MeSH
- gentamiciny MeSH
- infekce v ráně * MeSH
- klindamycin MeSH
- kombinace léků trimethoprim a sulfamethoxazol MeSH
- lidé MeSH
- oxacilin MeSH
- sternotomie MeSH
- tandemová hmotnostní spektrometrie metody MeSH
- terapie ran pomocí řízeného podtlaku * MeSH
- vankomycin MeSH
- vysokoúčinná kapalinová chromatografie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
The new ultra-high performance liquid chromatography method with tandem mass spectrometry and fluorescence detection allowing fast, selective, and high-throughput analysis of neopterin, kynurenine, tryptophan, and creatinine in gingival crevicular fluid (GCF) has been optimized. Defining the pathophysiology of periodontal disease and identification of potential diagnostic test for active periodontitis remains a significant challenge in the field of oral disease diagnosis. Analysis of GCF provides a non-invasive means of evaluating the role of the host response in periodontal disease. In addition, the analysis of GCF provides an information about current inflammation level of sampled site/tooth. Determination of GCF inflammatory biomarkers such as neopterin, kynurenine, and tryptophan can contribute to diagnosis, evaluation of treatment, and progression of periodontal diseases such as gingivitis and periodontitis. The separation of target analytes was carried out using a column KinetexTM Polar C18 100 Å, (100 × 3.0 mm) packed with 2.6 μm core-shell particles applying an elution with a gradient formed from 0.2% aqueous formic acid and 90% aqueous acetonitrile. Kynurenine, tryptophan, and creatinine were detected using mass spectrometry with electrospray ionization to improve the sensitivity while neopterin was detected using fluorescence detection. The separation of these four substances was achieved after using a very simple sample preparation technique convenient for small amount of biological sample. Only less than 20 μL sample was needed and the separation was completed in 4 min. MS/MS analysis was performed using multiple reaction monitoring (MRM) under a positive ionization mode. Deuterium labeled internal standard was used for the more precise quantification. The lower limits of quantification (LLOQ) for target analytes were 0.50 × 10-3 μmol/L for neopterin, 0.10 μmol/L for kynurenine, and 0.20 μmol/L for tryptophan and creatinine. The within-run and between-run accuracy were in a range of 96.67-114.77% for all quality controls and LLOQ of all analytes. Matrix effect, extraction recovery, and stability testing have all been investigated. The method was tested with real-life samples using GCF collected from patients suffering from periodontitis and from healthy controls. Neopterin levels in patients were significantly higher (P = 0.020) than in healthy subjects and indicate good potential of this method for using in evaluation of periodontal pathogenesis and healing outcomes following a treatment.
Cíl: Cílem tohoto sdělení je prezentovat kazuistiku pacienta se syndromem uveální efuze, u kterého byla provedena hluboká zadní sklerotomie. Kazuistika: 73letý pacient s jednostranným poklesem nejlepší korigované zrakové ostrosti, ablací choroidey a sekundárním odchlípením sítnice na pravém oku byl v listopadu 2017 přijat na naši kliniku k vyšetření. Vstupně byla nejlepší korigovaná zraková ostrost na pravém oku 0,3, na levém oku 1,0. Nitrooční tlak byl na pravém oku 16 mmHg a na levém oku 21 mmHg. Po provedení ultrazvukové biomikroskopie předního segmentu (Accutome, Keeler, USA), ultrazvukové sonografie postiženého oka (Accutome, Keeler, USA), magnetické rezonance, počítačové tomografie, ultrazvukové sonografie břicha a krevních náběrů jsme nález uzavřeli jako syndrom uveální efuze. Zahájili jsme konzervativní léčbu spočívající v perorálním podávání inhibitoru karboanhydrázy v kombinaci s lokálním užíváním analogu prostaglandinu. I přes konzervativní léčbu došlo ke zhoršení nálezu i nejlepší korigované zrakové ostrosti na pravém oku až na 0,05, proto jsme přistoupili k operačnímu řešení – hluboké zadní sklerotomii s perioperačním odebráním vzorku skléry k histologickému vyšetření (průkaz glykosaminoglykanů ve stěně skléry barvením alciánovou modří), které bylo negativní. Tento výsledek histologického vyšetření řadí pacienta ke třetímu typu syndromu uveální efuze (tj. non-nanoftalmický s normální sklérou). Po operaci došlo k přiložení ablace choroidey i odchlípené sítnice a zlepšení nejlepší korigované zrakové ostrosti na pravém oku na 0,3. Po následné operaci katarakty došlo opět k ablaci choroidey a odchlípení sítnice, tentokrát se spontánní úpravou. Pooperačně byla nejlepší korigovaná zraková ostrost na pravém oku 0,5, při poslední kontrole na našem pracovišti 0,6. Závěr: Hluboká zadní sklerotomie je možným řešením u pacientů se syndromem uveální efuze, nereagujících na konzervativní léčbu.
Purpose: Purpose of this article is to present a case report of a patient with uveal effusion syndrome who underwent deep posterior sclerotomy. Case report: A 73-year-old patient with unilateral decrease in the best corrected visual acuity, ablation of choroid and secondary retinal detachment in the right eye was admitted to our clinic for examination in November 2017. At the first examination, the best corrected visual acuity in the right eye was 0.3, in the left eye 1.0. Intraocular pressure was 16 mmHg in the right eye and 21 mmHg in the left eye. After performing ultrasound biomicroscopy of the anterior segment (Accutome, Keeler, USA), ultrasound sonography of the affected eye (Accutome, Keeler, USA), magnetic resonance imaging, computed tomography, abdominal ultrasound and blood tests, we concluded the finding as uveal effusion syndrome. We initiated a conservative treatment consisting of oral administration of carbonic anhydrase inhibitor in combination with topical use of prostaglandin analogue. Despite conservative treatment the best corrected visual acuity of the affected eye decreased to 0.05 so we proceeded to a surgical procedure – deep posterior sclerotomy with perioperative scleral sampling for histological examination (detection of glycosaminoglycans in the sclera wall by Alcian blue staining), which was negative. This histological result ranks the patient as the third type of uveal effusion syndrome (ie, non-nanophthalmic with a normal sclera). After the operation both the ablation of choroid and retinal detachment reattached and the best corrected visual acuity in the right eye improved to 0.3. After the subsequent cataract surgery, the ablation of choroid and retinal detachment occurred again, this time with spontaneous recovery. Postoperatively, the best corrected visual acuity in the right eye was 0.5 and at the last check-up at our clinic 0.6. Conclusion: Deep posterior sclerotomy is a method of choice of surgical treatment for uveal effusion syndrome that does not respond to conservative therapy.
- MeSH
- exsudáty a transsudáty chemie MeSH
- klinické laboratorní techniky MeSH
- lidé MeSH
- mezoteliom diagnóza klasifikace terapie MeSH
- nemoci pleury * diagnóza etiologie klasifikace terapie MeSH
- pleurální dutina patologie MeSH
- pleurální výpotek diagnóza epidemiologie etiologie klasifikace patofyziologie terapie MeSH
- pleuritida diagnóza etiologie klasifikace MeSH
- pneumotorax diagnóza etiologie klasifikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Cysty v oblasti ovarií jsou při současné úrovni zobrazovacích technik nacházeny často jak v klinicky předpokládaném, tak neočekávaném kontextu. Diagnostickému upřesnění povahy cystického útvaru může cytologické vyšetření transvaginálně získaného obsahu napomoci identifi kací struktur výstelky. Zásadní, i když někdy obtížné je odlišení cyst funkčních (folikulárních, korpusluteálních) a implantačních (inkluzních a endometriálních) od cyst nádorových (dermoidních, obecně epitelových tumorů ovaria, cysticky upravených metastáz). I přes skutečnost, že část cystických odběrů zůstává pro absenci defi nujících struktur po cytologickém vyšetření blíže nespecifi kována, má toto vyšetření pro svou minimální invazivitu a doloženou vysokou negativní predikční hodnotu možnost diagnosticky přispět u vhodně zvolených pacientek (zpravidla kontraindikovaných pro rozsáhlejší diagnostické výkony) své místo ve spolupráci klinického specialisty a patologa.
Ovarian cysts are often found in both the clinically predicted and the unexpected context at the current level of imaging techniques. The cytological examination of the transvaginally obtained cystic fl uid can help to diagnose the nature of the cystic lesion via identifi cation the lining structures. It is essential to distinguish functional cysts (follicular, corpusluteal) and implantation (inclusion and endometrial) from tumour cysts (dermoid, epithelial ovarian tumours, cystic metastases). A part of the cystic lesions remains unspecifi ed for the absence of the defi ning structures after the cytological examination. Nevertheless, for its minimal invasiveness, high negative predictive value proven, and the possibility of contributing to diagnosis of selected patients (frequently with contraindications for larger diagnostic procedures), this investigation maintains its position in collaboration of a clinical specialist and a pathologist.
- Klíčová slova
- korpusluteální cysty, nádorové cysty ovaria,
- MeSH
- cystická tekutina cytologie MeSH
- cytodiagnostika metody MeSH
- folikulární cysta diagnóza MeSH
- lidé MeSH
- nádory vaječníků diagnóza MeSH
- ovariální cysty * diagnóza MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
