BEVA primary care clinical guidelines: Wound management in the horse.
- 作者列表："Freeman SL","Ashton NM","Elce YA","Hammond A","Hollis AR","Quinn G
BACKGROUND:There are currently no evidence summaries on wounds in the horse. OBJECTIVES:To develop evidence-based guidelines on wound management in the horse. STUDY DESIGN:Evidence review using the GRADE framework. METHODS:Research questions were proposed by a panel of veterinarians, and developed into PICO format. Evidence in the veterinary literature was evaluated using the GRADE evidence-to-decision framework. Searches for human evidence summaries were conducted in the NICE, Cochrane and JBI databases. Final recommendations were based on both veterinary and human evidence. RESULTS AND RECOMMENDATIONS:The research questions were categorised into three areas: A. Wound lavage and topical treatments; B. Wound debridement and closure; C. Therapeutics for wound healing. Three hundred and six veterinary publications were identified across thirteen different topics. Fourteen papers were assessed using the GRADE criteria. Twenty-five human evidence summaries were reviewed. The results were developed into recommendations: Wound lavage and topical treatments: (i) Tap water should be considered instead of saline for lavage; (ii) Povidone iodine lavage should be considered for contaminated wounds; (iii) Topical silver sulfadiazine may not be suitable for acute wounds; (iv) Optimal lavage pressures are around 13 psi. Wound debridement and closure: (i) Debridement pads should be considered for wound preparation; (ii) Larvae debridement should be considered in selected cases; (iii) Hydrosurgery should be considered in acute contaminated wounds. Therapeutics for wound healing: (i) Honey may reduce duration of some phases of wound healing. There was insufficient evidence to draw conclusions on the use of chemical debridement, therapeutic ultrasound, laser therapy, wound closure with staples compared to sutures, or identify optimal concentrations of antiseptic lavage solutions. MAIN LIMITATIONS:Low quality evidence in veterinary literature; majority of recommendations were based on human evidence. CONCLUSIONS:These findings should be used to inform decision-making in equine primary care practice.
背景: 目前没有关于马伤口的证据总结。 目的: 制定马伤口管理的循证指南。 研究设计: 使用GRADE框架进行证据审查。 方法: 由一组兽医提出研究问题，并发展成PICO格式。使用GRADE证据-决策框架评估兽医文献中的证据。在NICE、Cochrane和JBI数据库中搜索人类证据摘要。最后的建议是基于兽医和人类证据。 结果和建议: 研究问题分为三个方面: A.伤口灌洗和局部治疗; B.伤口清创缝合术; C.伤口愈合的治疗方法。在十三个不同的主题中确定了三百零六份兽医出版物。使用等级标准评估14篇论文。审查了25份人类证据摘要。结果发展为建议: 伤口灌洗和局部治疗 :( i) 应考虑用自来水代替盐水进行灌洗; (ii) 对受污染的伤口应考虑用聚维酮碘灌洗; (iii) 局部用磺胺嘧啶银可能不适合急性伤口; (iv)最佳灌洗压力约为13 psi。伤口清创闭合: (一) 伤口准备应考虑清创垫; (二) 选定病例应考虑幼虫清创; (三) 急性污染伤口应考虑水外科手术。用于伤口愈合的治疗剂 :( i) 蜂蜜可减少伤口愈合的一些阶段的持续时间。与缝合线相比，没有足够的证据得出关于使用化学清创术、治疗性超声、激光治疗、用缝钉缝合伤口的结论，或确定最佳浓度的防腐灌洗溶液。 主要限制: 兽医文献中的证据质量低; 大多数建议基于人类证据。 结论: 这些发现应用于指导马初级保健实践中的决策。
METHODS::The ATP binding-cassette superfamily corresponds the mostly transmembrane transporters family found in humans. These proteins actively transport endogenous and exogenous substrates through biological membranes in body tissues, so they have an important role in the regulation of many physiological functions necessary for human homeostasis, as well as in response regulation to several pharmacological substrates. The development of multidrug resistance has become one of the main troubles in conventional chemotherapy in different illnesses including cancer, being the increased efflux of antineoplastic drugs the main reason for this multidrug resistance, with a key role of the ABC superfamily. Likely, the interindividual variability in the pharmacological response among patients is well known, and may be due to intrinsically factors of the disease, genetic and environmental ones. Thus, the understanding of this variability, especially the genetic variability associated with the efficacy and toxicity of drugs, can provide a safer and more effective pharmacological treatment, so ABC genes are considered as important regulators due to their relationship with the reduction in pharmacological response. In this review, updated information about transporters belonging to this superfamily was collected, the possible role of these transporters in cancer, the role of genetic variability in their genes, as well as some therapeutic tools that have been tried to raise against main transporters associated with chemoresistance in cancer.
METHODS:BACKGROUND:Cholinergic neurotransmission regulates neuroinflammation in Parkinson disease (PD). RESEARCH DESIGN AND METHODS:The authors conducted a delayed-start study of donepezil for cognitive decline in non-demented PD patients. The study consisted of a 96-week randomized placebo-controlled double-blind phase 1, followed by a 24-week donepezil extension phase 2. The primary outcome measure was a change in the Mini-Mental State Examination (MMSE) at week 120. RESULTS:A total of 98 patients were randomly allocated to the early-start (donepezil-to-donepezil) and delayed-start (placebo-to-donepezil) groups. Mean (SD) of the baseline MMSE was 27.6 (2.0) and 28.0 (2.1), respectively. MMSE change at week 120 was better in the early-start group than in the delayed-start group, but the difference was not significant. The MMSE declined in apolipoprotein ε4 carriers, but not in non-carriers, and the factor interaction (intervention × ε4 genotype) was highly significant (P < 0.001). Analyzed with the interaction, the difference was significant (group difference 1.95 [0.33 to 3.57], P = 0.018). The MMSE decline slope in phase 1 was significantly better in the early-start group than in the delayed-start group (P = 0.048). CONCLUSIONS:Cognitive function deteriorated in ε4 carriers, but not in non-carriers, and early-start donepezil may postpone cognitive decline in the former.
METHODS::Since the discovery of dental pulp stem cells, a lot of teams have expressed an interest in dental pulp regeneration. Many approaches, experimental models and biological explorations have been developed, each including the use of stem cells and scaffolds with the final goal being clinical application in humans. In this review, the authors' objective was to compare the experimental models and strategies used for the development of biomaterials for tissue engineering of dental pulp with stem cells. Electronic queries were conducted on PubMed using the following terms: pulp regeneration, scaffold, stem cells, tissue engineering and biomaterial. The extracted data included the following information: the strategy envisaged, the type of stem cells, the experimental models, the exploration or analysis methods, the cytotoxicity or viability or proliferation cellular tests, the tests of scaffold antibacterial properties and take into account the vascularization of the regenerated dental pulp. From the 71 selected articles, 59% focused on the "cell-transplantation" strategy, 82% used in vitro experimentation, 58% in vivo animal models and only one described an in vivo in situ human clinical study. 87% used dental pulp stem cells. A majority of the studies reported histology (75%) and immunohistochemistry explorations (66%). 73% mentioned the use of cytotoxicity, proliferation or viability tests. 48% took vascularization into account but only 6% studied the antibacterial properties of the scaffolds. This article gives an overview of the methods used to regenerate dental pulp from stem cells and should help researchers create the best development strategies for research in this field.