Application Of Negative Pressure Research Articles

Application of Negative Pressure by the Ocular Pressure Adjusting Pump to Provide a Sustained Reduction in IOP.

To evaluate the sustainability of IOP reduction with continuous negative pressure application over an extended duration with use of the Ocular Pressure Adjusting Pump. Prospective, controlled, open-label, randomized, single site, pilot study. Subjects with primary open-angle glaucoma (OAG) were enrolled. One eye of each subject was randomized to receive negative pressure application; the fellow eye served as a control. The study eye negative pressure setting was programmed for 60% of the baseline IOP. Subjects wore the Ocular Pressure Adjusting Pump for 8 consecutive hours and IOP measurements occurred at 2-hour intervals for a total of 5 IOP measurements (08:00, 10:00, 12:00, 14:00, 16:00). Nine subjects successfully enrolled and completed the study. The mean programmed negative pressure setting was -12.0mmHg. At baseline, the mean IOP in the study eye was 21.4 ± 4.3mmHg. The mean IOP reduction in the study eye at hours 0, 2, 4, 6, and 8 was 8.1 (37%), 6.4 (28%), 6.3 (29%), 7.3 (34%) and 6.7 (31%), respectively. All IOP measurements during negative pressure application were reduced from baseline. There were no serious adverse events. The Ocular Pressure Adjusting Pump provides a sustained reduction in IOP while the device is worn with negative pressure applied with an IOP reduction exceeding 25% across 8hours of continuous wear.

Critical Closing Pressure (Pcrit) and Negative (Subatmospheric) Expiratory Pressure (NEP) for Diagnosis of Pharyngeal Collapsibility in Patients With Obstructive Sleep Apnea (OSA)

The determination of critical closing pressure (Pcrit) is the diagnostic gold standard for assessing the severity of pharyngeal instability. Pcrit measurements are typically performed during natural nocturnal sleep (NREM Stage 2) in combination with polysomnography. However, determining Pcrit during sleep is time-consuming and impractical for routine use. Alternatively, Pcrit measurements can also be done during drug-induced sleep. A disadvantage of this method is the varying doses of propofol needed to induce sleep, which can affect muscle tone differently. As an alternative to these methods, the application of negative pressure during wakefulness (NEP test) has proven effective. In this test, the patient is administered a subatmospheric pressure of -5 or -10 cmH2O via mask at the beginning of expiration, and the change in expiratory airflow in the pharynx is measured. NEP test can be performed in both sitting and lying position. According to current knowledge, the NEP test appears to be a diagnostic procedure comparable to critical closing pressure (Pcrit) for assessing upper airway collapsibility.

Manometric Intraocular Pressure Reduction with Negative Pressure Using Ocular Pressure Adjusting Pump Goggles

The Ocular Pressure Adjusting Pump is a novel, non-invasive and non-pharmacological intraocular pressure (IOP)-lowering device consisting of goggles attached to a negative pressure (NP) pump. This study aimed to determine the effect of negative pressure in Ocular Pressure Adjusting Pump goggles on IOP using continuous direct manometry. Prospective, single-arm, single center, basic physiological research trial. Adult patients undergoing cataract surgery. Direct manometry was performed via an anterior chamber cannula attached to an IOP sensor. This was placed just prior to each subject's previously scheduled cataract surgery. IOP was continuously monitored every 0.5 seconds through the following sequence of 30 seconds each: baseline IOP measurement, NP -10 mmHg, NP off, NP -20 mmHg, and NP off. IOP response to application of negative pressure. All seventeen subjects had a dose-dependent reduction in IOP, with a mean IOP decrease from 16.9 to 11.3 (33%) with -10 mmHg of NP and from 15.7 to 7.7 (51%) mmHg with -20 mmHg of NP. IOP returned to baseline for each cycle when NP was discontinued. There were no patients with increased IOP. Negative pressure with the Ocular Pressure Adjusting Pump results in a consistent dose-dependent reduction in IOP, with return to baseline IOP when NP is discontinued.

Physiologic Validation of the Compensatory Reserve Metric Obtained From Pulse Oximetry Waveforms

Background: The compensatory reserve metric (CRM) provides a novel marker of hemodynamic status in prediction of sudden cardiovascular decompensation during central hypovolemia. The CRM has previously been calculated using arterial waveforms obtained from a photoplethysmographic volume-clamp technique. However, the in-field use of pulse oximetry is becoming more prominent in research and medicine. To improve in-field applicability of the CRM, this project aimed to validate pulse-oximetry derived CRM values relative to physiologic data during simulated hemorrhage through application of lower body negative pressure (LBNP). Methods: Forty-nine healthy adults (25 females) underwent a graded LBNP protocol with the following 5-minute stages: -0, -15, -30, -45, -60, -70, -80, -90, and 100 mmHg, or until the onset of pre-syncopal symptoms (tolerance) was reached. Arterial waveforms were sampled using pulse oximetry (Massimo Radical 7). The CRM was calculated using a validated one-dimensional convolutional neural network. A brachial artery catheter was used to measure intraarterial pressure. A 3-lead ECG was used to measure heart rate. SpO2 was measured using pulse oximetry. Cardiac output and stroke volume were estimated using the photoplethysmographic volume-clamp. Data were binned for the last thirty seconds of each completed stage, and at tolerance. Fixed-effect linear mixed models with repeated measures were used to examine the association between CRM values and physiologic variables. A priori significance was set at P<0.05. Results: The median LBNP stage reached was 70 mmHg (Range: 45-100 mmHg). Relative to baseline, at tolerance there was a 50±12% ( P<0.001) mean reduction in stroke volume, 65±27% ( P<0.001) increase in heart rate, 18±8% ( P<0.001) reduction in mean arterial pressure, 21±7% ( P<0.001) systolic blood pressure, 8±9% ( P<0.001) diastolic blood pressure, and 39±12% ( P<0.001) pulse pressure. The CRM obtained using pulse oximetry was significantly associated with a reduction in stroke volume ( P<0.001), increase in heart rate ( P<0.001), and reductions in systolic ( P=0.033), diastolic ( P=0.036), and pulse pressure ( P=0.002). There was no statistically significant association between CRM and cardiac output ( P=0.421), SpO2 ( P=0.408), or mean arterial pressure ( P=0.214). Conclusion: The CRM obtained using pulse oximetry may be a valid, reliable marker of hemodynamic status with promising in-field applications. Future studies warrant investigation of feasibility and applicability within various contexts ranging from the operating room to the battlefield. The presented work was funded in part by the Congressionally Directed Medical Research Program (Award No. DM180240) and Offce of Naval Research (Awards No. N00014-18-D-7001 and N00014-19-C-2017). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Outcomes of Mastectomy and Immediate Reconstruction Managed with Closed-incision Negative Pressure Therapy Applied Over the Whole Breast.

Incision healing after mastectomy and immediate reconstruction can be supported with closed-incision negative pressure therapy (ciNPT). Studies have reported patients receiving postoperative care with ciNPT after breast surgery exhibited lower rates of dehiscence, infection, necrosis, and seroma, compared with standard dressings. A recent approach to ciNPT involves the application of negative pressure to the incision and a wider area of surrounding tissue. In this retrospective review, we investigated the outcomes of ciNPT using full-coverage dressings over the entire breast after mastectomy and reconstruction. Patients underwent mastectomies and immediate prepectoral breast reconstruction with an implant or tissue expander. After surgery, patients received oral antibiotics and ciNPT with full-coverage foam dressings at -125 mm Hg. All 54 patients (N = 105 incisions) were women, with a mean age of 53.5 years and 29.1 kg per m2 body mass index. Common comorbidities included prior chemotherapy (31.3%) or radiation (21.6%), hypertension (14.8%), and diabetes (5.6%). Procedures included skin-reducing (34.3%), skin-sparing (7.6%), and nipple-sparing (58.1%) mastectomies. Lymph nodes were removed in 38 (36.2%) incisions. All patients were discharged home with ciNPT on postoperative day (POD) 1, and ciNPT was discontinued on POD 5-7. At POD 30, three patients developed seromas, requiring revision. Of these, one required removal of the left tissue expander. The remaining 102 incisions (97.1%) healed without complication. Among this cohort, the use of ciNPT with full-dressing coverage of the breast incisions and surrounding soft tissue was effective in supporting incisional healing after mastectomy and immediate reconstruction.

Local Microbubble Removal in Polydimethylsiloxane Microchannel by Balancing Negative and Atmospheric Pressures.

Long-term experiments using organoids and tissues are crucial for drug development. Microfluidic devices have been regularly used in long-term experiments. However, microbubbles often form in these devices, and they may damage and starve cells. A method involving the application of negative pressure has been reported to remove microbubbles from microfluidic devices composed of polydimethylsiloxane; however, negative pressure affects the cells and tissues in microfluidic devices. In this study, a local microbubble removal method was developed using a microfluidic device with 0.5 mm thin polydimethylsiloxane sidewalls. The thin sidewalls counterbalanced the negative and atmospheric pressures, thereby localizing the negative pressure near the negatively pressurized chamber. Microbubbles were removed within 5 mm of the negatively pressurized chamber; however, those in an area 7 mm and more from the chamber were not removed. Using the local removal method, a long-term perfusion test was performed, and no contact was confirmed between the bubbles and the simulated tissue for 72 h.

IMPROVING SURGICAL STRATEGIES FOR TREATING EXTENSIVE SOFT TISSUE WOUNDS RESULTING FROM MINE AND EXPLOSIVE TRAUMA

Introduction.Since February 24, 2022, a primary focus of surgical care in Ukraine has been to provide assistance to citizens affected by Russian aggression. A significant proportion of wounds and injuries sustained in this context involves mine-explosive wounds, manifesting as soft tissue damage in the form of lacerations, shrapnel injuries, and wounds of varying degrees of contamination and size.
 The widespread adoption of Vacuum-Assisted Closure (VAC) therapy for wounds characterized by extensive muscle and skin defects involves the localized application of negative pressure to damaged tissues. Typically, this precedes planned autodermoplasty, which, despite being a scheduled intervention, follows urgent surgical corrections. These interventions offer a distinct opportunity for individuals with substantial soft tissue injuries— and, as evidenced by experience, not limited to them— to restore their pre-injury quality of life.
 The aim of this study is to enhance the quality of life for individuals affected by mine-explosive injuries and extensive soft tissue wounds.
 Materials and methods. The outcomes of surgical treatment of 57 civilian victims afflicted by landmine-explosive wounds and extensive soft tissue injuries were examined. These individuals underwent treatment at the Surgical Department of the Regional Clinical Hospital" during the period 2022 – 2023. Among the cohort, 34 were women, constituting 59%, while 23 were men, representing 41%, the ages of the patients ranged from 34 to 74 years.
 Results and discussion. All 57 patients initially underwent surgical treatment of wounds, involving the removal of foreign bodies if present, necrectomy, and subsequent application of the second-stage Vacuum-Assisted Closure (VAC) therapy. The VAC therapy was used to cleanse the wounds and reduce their surface area. Continuous VAC therapy was administered at a negative pressure ranging from 50 mmHg (on the anterior abdominal wall and the back surface of the chest) to 110 mmHg (on tissues of the lower extremities). The replacement of the VAC dressing occurred every 3-5 days, contingent upon the quantity and quality of the exudate, with typically 2-3 changes required. The third stage involved the application of free autodermoplasty utilizing a perforated skin flap. Mechanical wound treatment was performed iteratively until the level of "bloody dew" was reached.
 We suggest that all these stages are essential for achieving favorable treatment outcomes, irrespective of any severe accompanying pathology that may arise. Indeed, comorbidity stands out as a defining factor that distinguishes the civilian population qualitatively from the military category.
 Conclusions. The application of Vacuum-Assisted Closure (VAC) therapy followed by autodermoplasty in the management of extensive soft tissue injuries caused by mine-explosive incidents significantly enhances the efficacy of surgical treatment and reduces the period of patient incapacitation, presenting clear economic benefits. Autodermoplasty, in particular, holds a commendable position within the realm of reconstructive surgery for mine and explosive wounds. Within this context, autodermoplasty emerges as a surgical intervention that not only yields positive aesthetic outcomes but also facilitates an accelerated adaptation of the affected body part. This, in turn, contributes to an improved quality of life for victims of mine-explosive trauma grappling with substantial soft tissue damage.

Optimisation of the blood supply at the flap donor site through the application of cutaneous negative pressure

At present, perforator flaps are a very popular technique in reconstructive surgery. However, in spite of the fact that perforator flaps provide favourable aesthetic results, their use is often related to complications in the form of transplanted tissue perfusion disorders.
 Objective — to investigate the possibility of optimising the blood supply at the flap donor site through the application of cutaneous negative pressure (NP).
 Materials and methods. The study was carried out from 2019 to 2021. A single‑arm clinical trial consisted of 20 individuals who presented with deep wound defects requiring flap coverage. A dynamic thermography study was conducted to examine the chosen donor site before and after dressing with NP.
 Results. The temperature measurements obtained from the two selected warm perforator points and the point in the cool area between perforators prior to the application of NP showed a steady downward trend in temperature. Specifically, the temperature in the cool area was observed to be lower by an average of –1.89 °С and –2.12 °С as compared to warm points. The application of local NP had an impact on trend analysis of skin temperature, which demonstrated a significant decrease in the differences between values seen in the cool and warm areas. This effect was already noted after the first day of the NP system application, as evidenced by the everyday data collection. The «levelling» of temperature curves was associated with temperature rises both in the cool area and at the perforator exit points.
 Conclusions. The findings obtained from thermography analysis suggest that the application of NP has the potential to enhance blood circulation in the intended donor area. Therefore, it is plausible to discuss the possibility of improved microcirculation in the skin and the beneficial effect of local cutaneous NP application on the state of anastomoses between perforators.

Single-Incision, Four-Compartment Fasciotomy and Application of Negative Pressure Dressing for Compartment Syndrome of the Leg.

The video described by this article presents a safe and effective technique for single-incision, 4-compartment fasciotomy of the leg in a patient with a tibial plateau fracture and clinically diagnosed compartment syndrome. We also demonstrate a technique for the application of a negative pressure wound dressing when delayed closure or coverage is planned.

Postoperative swelling after elbow surgery: influence of a negative pressure application in comparison to manual lymphatic drainage—a randomized controlled trial

PurposePostoperative soft tissue swelling is a significant factor influencing outcomes after elbow surgery. It can crucially affect important parameters such as postoperative mobilization, pain, and subsequently the range of motion (ROM) of the affected limb. Furthermore, lymphedema is considered a significant risk factor for numerous postoperative complications. Manual lymphatic drainage is nowadays part of the standardized post-treatment concept, basing on the concept of activating the lymphatic tissue to absorb stagnated fluid from the tissue into the lymphatic system. This prospective study aims to investigate the influence of technical device-assisted negative pressure therapy (NP) on early functional outcomes after elbow surgery. NP was therefore compared to manual lymphatic drainage (MLD). Is a technical device-based NP suitable for treatment of lymphedema after elbow surgery?MethodsA total of 50 consecutive patients undergoing elbow surgery were enrolled. The patients were randomized into 2 groups. 25 participants per group were either treated by conventional MLD or NP. The primary outcome parameter was defined as the circumference of the affected limb in cm postoperative up to seven days postoperatively. The secondary outcome parameter was a subjective perception of pain (measured via visual analogue scale, VAS). All parameters were measured on each day of postoperative inpatient care.Results and conclusionNP showed an overall equivalent influence compared to MLD in reducing upper limb swelling after surgery. Moreover, the application of NP showed a significant decrease in overall pain perception compared to manual lymphatic drainage on days 2, 4 and 5 after surgery (p < 0.05).ConclusionOur findings show that NP could be a useful supplementary device in clinical routine treating postoperative swelling after elbow surgery. Its application is easy, effective and comfortable for the patient. Especially due to the shortage of healthcare workers and physical therapists, there is a need for supportive measures which NP could be.

Closed Incision Negative Pressure Wound Therapy Assisted Full Thickness Graft Aite Wound Dressing to Prevent Surgical Site Infection

Closed incision Negative Pressure Wound Therapy (CiNPWT) which is a topical application of negative pressure over the wound plays a key role in healing and prevention of surgical site infections. We have used full thickness graft following post burn contracture release. We then applied negative pressure wound therapy over to this flap to assess its efficacy and safety in aiding healing.

Effects of cutaneous negative pressure application on skin microcirculation and state of anastomoses between perforators: A preliminary study

Effects of cutaneous negative pressure application on skin microcirculation and state of anastomoses between perforators: A preliminary study

Lung recruitment by continuous negative extra-thoracic pressure support following one-lung ventilation: an experimental study.

Lung recruitment maneuvers following one-lung ventilation (OLV) increase the risk for the development of acute lung injury. The application of continuous negative extrathoracic pressure (CNEP) is gaining interest both in intubated and non-intubated patients. However, there is still a lack of knowledge on the ability of CNEP support to recruit whole lung atelectasis following OLV. We investigated the effects of CNEP following OLV on lung expansion, gas exchange, and hemodynamics. Ten pigs were anesthetized and mechanically ventilated with pressure-regulated volume control mode (PRVC; FiO2: 0.5, Fr: 30-35/min, VT: 7mL/kg, PEEP: 5 cmH2O) for 1hour, then baseline (BL) data for gas exchange (arterial partial pressure of oxygen, PaO2; and carbon dioxide, PaCO2), ventilation and hemodynamical parameters and lung aeration by electrical impedance tomography were recorded. Subsequently, an endobronchial blocker was inserted, and OLV was applied with a reduced VT of 5mL/kg. Following a new set of measurements after 1h of OLV, two-lung ventilation was re-established, combining PRVC (VT: 7mL/kg) and CNEP (-15 cmH2O) without any hyperinflation maneuver and data collection was then repeated at 5min and 1h. Compared to OLV, significant increases in PaO2 (154.1 ± 13.3 vs. 173.8 ± 22.1) and decreases in PaCO2 (52.6 ± 11.7 vs. 40.3 ± 4.5mmHg, p < 0.05 for both) were observed 5minutes following initiation of CNEP, and these benefits in gas exchange remained after an hour of CNEP. Gradual improvements in lung aeration in the non-collapsed lung were also detected by electrical impedance tomography (p < 0.05) after 5 and 60min of CNEP. Hemodynamics and ventilation parameters remained stable under CNEP. Application of CNEP in the presence of whole lung atelectasis proved to be efficient in improving gas exchange via recruiting the lung without excessive airway pressures. These benefits of combined CNEP and positive pressure ventilation may have particular value in relieving atelectasis in the postoperative period of surgical procedures requiring OLV.

Negative Pressure Application via a Multi-Pressure Dial to Lower IOP in Patients with Suspected Glaucoma or Open-Angle Glaucoma.

The multi-pressure dial applies localized periocular negative pressure to safely and effectively lower IOP and represents the first non-invasive, non-pharmacologic device for IOP reduction. To evaluate the safety and effectiveness of the Multi-Pressure Dial (MPD) system, a device that applies periocular negative pressure to lower intraocular pressure (IOP). 6 investigational sites, United States. Prospective, assessor-masked, randomized controlled trial. Subjects with suspected glaucoma, ocular hypertension (OHTN), and open-angle glaucoma (OAG) with baseline IOP ≥13 mmHg and ≤32 mmHg were enrolled. One eye of each subject was randomized to receive negative pressure application; the fellow eye served as a control. The study eye negative pressure setting was programmed for 60% of the baseline IOP. The primary effectiveness endpoint was the proportion of study eyes versus control eyes achieving an IOP reduction ≥20% at Day 90. Secondary endpoints included the proportion of eyes achieving an IOP reduction ≥25% at Day 90 as well as the proportion of eyes achieving an IOP reduction ≥20% at Days 30 and 60. 116 eyes of 58 subjects completed the study. At the Day 90 visit, 89.7% (n=52) of study eyes versus 3.4% (n=2) of control eyes achieved an IOP reduction ≥20% ( P <0.001). At Day 90, 77.6% (n=45) of study eyes achieved a ≥25% IOP reduction compared to 1.7% (n=1) of control eyes ( P <0.001). The most commonly reported adverse events were lid (17.2% study eye, 7.8% control eye) and periorbital edema (14.1% study eye, 10.9% control eye). This trial demonstrates that the MPD safely and effectively lowers IOP in a group of patients that included glaucoma suspects, OHTN, and patients with OAG.

The Effect of Upright Lower Body Negative Pressure on Muscle Activity and Hemodynamics during Exercise

Purpose: The aim of the study was to evaluate the changes that occur in parameters relating to muscle work and muscle hemodynamicsunder the influence of upright Lower Body Negative Pressure (LBNP) application during walking. Methods: 18 young females were included in this study. All 18 subjects participated in 2 trials of a 12-minute walking exercise on a treadmill equipped with a LBNP chamber, on a constant speed of 5 km/h. The first trial was executed under the application of a LBNP program (3 stages of -15, -25 and -30 mbar), while the second trial was similar, but without the activation of the negative pressure chamber. During both trials, the Vastus Lateralis (VL) muscle hemodynamic conditions were monitored continuously with a Functional Near-Infrared Spectroscopy (fNIRS) device and parallelly, VL activation was monitored via a Surface Electromyography (sEMG). Heart Rate (HR) values were recorded in the beginning and during the10th min of each trial, after which, the difference between the 2 values was calculated. Immediately after the conclusion of each trial, participants were asked to provide a score for perceived exertion using Borg CR-10 scale (10 for maximum exertion). Results: During the LBNP trial, Total Hemoglobin (tHb) and OxyHemoglobin (O2 Hb) concentrations in the Vastus Lateralis (VL), was significantly lower compared to the control (p=0.007, p=0.001), but with a significant increase rate in deoxy-hemoglobin (HHb) (p= 0.001). Tissue Saturation Index (TSI%) showed no significant alteration between trials (p= 0.668). All calculated parameters relating to work output showed a significant difference in the LBNP trial compared to control. HR was increased (p= 0.001), there were an increase in MPF and RMS amplitude in the VL (p=0.006, p &lt; 0.001, respectively) and subjects reported higher rate of perceived exertion (p=0.001). Conclusions: The application of LBNP showed elevated work characteristics, mainly on the work output and less local muscle hemodynamics. This could be a time efficient training tool for stressing the musculoskeletal system, faster improve body composition and potentially enhancing cardio respiratory fitness.

Negative Pressure Wound Therapy for Skin Ulceration and Fistula After Surgery for Oral Cancer

Oral cancer surgery has a high incidence of wound infection. The anatomy and physiology of the oral and maxillary regions are complex, and wounds often require a long time to heal. Negative pressure wound therapy (NPWT) can accelerate wound healing through the application of negative pressure to the wound. However, there are only a few reports on the use of this therapy in the oral and maxillofacial regions. Herein, the authors report 4 cases of skin ulcers and fistulas after oral cancer surgery treated with NPWT. Negative pressure wound therapy was performed in 4 patients (2 males and 2 females) who underwent resection of oral cancer and flap reconstruction and developed postoperative neck ulcers and fistulas. All 4 cases resulted in the healing of the ulcer and the disappearance of the fistula, and no recurrence was observed. Shortening the duration of treatment with NPWT reduces the patient burden and contributes to the prompt initiation of adjuvant therapy.

Modern approaches in the surgical treatment of infectious complications of diabetic foot syndrome

The study analyzed modern Russian and foreign scientific publications devoted to infectious complications in patients with diabetes mellitus and diabetic foot syndrome. The data of the International Diabetes Federation, the state register of patients with diabetes mellitus, demonstrate that the actual prevalence of diabetes mellitus is much higher than the registered data, which predisposes to large annual economic costs for the prevention, diagnosis, and treatment of diabetes mellitus, taking into account the treatment of complications and monitoring the morbidity of the global population. In the treatment of infectious complications in these patients, classical purulent surgeries are widely used, including opening abscesses and phlegmon and drainage of anatomical spaces of the foot. The classifications of infectious complications of diabetic foot syndrome has evolved. Modern surgical methods of treatment of infectious complications in these patients are highlighted. The classical approach to surgical opening and drainage of purulent foci is highly traumatic owing to impaired blood supply and innervation, prolonged postoperative period, and impaired supporting function of the limb, which is irreversible, at least during inpatient stay. The paper also described the use of minimally invasive approaches, including the use of endovide support, for the drainage of deep plantar phlegmon and the performance of staged rehabilitation, including additional treatment methods such as ultrasound cavitation, local application of negative pressure, and ozone therapy.

The Sandwich Technique for Quick and Efficient Application of Negative Pressure Wound Therapy to the Feet and Hands: A Case Report

Introduction. NPWT is a surgical dressing that combines polyurethane foam with the subsequent application of continuous or intermittent negative pressure. NPWT facilitates granulation tissue production by macrostrain, microstrain and, if desired, fluid instillation. Sealing the polyurethane foam over the wound bed is achieved using acrylic drapes; however, this can be difficult to use in some anatomic sites. Failure to achieve an effective seal can necessitate additional supplies, which has led to increased innovation in developing a more effective NPWT seal over the target wound bed. Obtaining an effective pressure seal on the feet or hands can be difficult because these anatomic sites have distinct curvature for each digit, with multiple interdigital web spaces and independent mobility. In this case report, the authors propose a technique to apply either an acrylic drape or combination acrylic and soft silicone drape utilizing the “sandwich technique” to seal NPWT foam quickly and efficiently to the feet or hands.

Infekcije na ekstremitetima kao komplikacije intravenskog korišćenja psihoaktivnih supstanci

Introduction: Infections on the extremities are a common occurrence in psychoactive substance addicts who use the drug intravenously. A significant risk of infection is present due to non-sterile conditions and/or incorrect injection of substances. Other contributing factors in this group of patients are comorbidities, impaired body defense mechanisms, harmful habits, and a lifestyle inconsistent with recommendations for a healthy life. Surgical treatment is essential in solving these complications, but also in repairing skin and soft tissue defects. In the professional literature, in both psychiatric and surgical specialties, few studies dealt with infections as complications in psychoactive substance addicts and surgical procedures in their treatment. Material and method: A retrospective analysis of infections as a complication on the extremities in addicts of psychoactive substances hospitalized in one center for two years was performed. Results: A group of 24 patients was analyzed. All patients were long-term intravenous drug users. The lower extremity was more often affected by infections (which were registered in 14 or 58.33% of patients), while changes on the hands were registered in 10 or 41.67% of patients. Affected limb parts were: the upper arm (4 or 16.67%), forearm (7 or 29.17%), arm (1 or 4.17%), the upper part of the leg (5 or 20.83%), the lower part of the leg (6 or 25%) and foot (3 or 12.5% of addicts). Acute manifestations of infections were: abscesses (8 or 33.33%), phlegmon (5 or 20.83%), cellulitis (2 or 2.24%), tissue necrosis (2 or 2.24%), necrotic fasciitis ( 3 or 12.5%), lymphadenitis (4 or 16.67%) and phlebitis (4 or 16.67% of addicts). All patients were treated surgically during hospitalization; initial surgical treatment included: incisions, debridement, necrectomy, application of negative pressure, sequestrectomy, instillation, and amputation; 13 (54.17%) patients were treated using reconstructive surgical procedures. Conclusion: Surgical treatment of infectious complications in intravenous drug users is necessary in cases of a developed clinical picture and the presence of a systemic infectious response. Surgical treatment is an essential element in the prevention and treatment of infection and the reconstruction of major skin defects.

Topical Potassium Channel Blockage Improves Pharyngeal Collapsibility: A Translational, Placebo-Controlled Trial

Potassium (K+) channel inhibition has been identified in animal models as a potential target to increase pharyngeal dilator muscle activity and to treat OSA. However, these findings have not yet been translated to humans. Does a novel, potent, tandem of P domains in a weak inward rectifying K+ channel (TWIK)-related acid-sensitive K+ (TASK) 1/3 channel antagonist, BAY2586116, improve pharyngeal collapsibility in pigs and humans, and secondarily, what is the optimal dose and method of topical application? In the preclinical study, pharyngeal muscle activity and upper-airway collapsibility via transient negative pressure application was quantified in 13 anesthetized pigs during administration of placebo, 0.3 μg, 3 μg, and 30 μg nasal drops of BAY2586116. In the clinical study, 12 people with OSA instrumented with polysomnography equipment, an epiglottic pressure catheter, pneumotachograph, and nasal mask to monitor sleep and breathing performed up to four detailed upper airway sleep physiology studies. Participants received BAY2586116 (160 μg) or placebo nasal spray before sleep via a double-masked, randomized, crossover design. Most participants also returned for three additional overnight visits: (1) nasal drops (160 μg), (2) half-dose nasal spray (80 μg), and (3) direct endoscopic application (160 μg). The upper-airway critical closing pressure (Pcrit) during sleep was quantified at each visit. Consistent and sustained improvements in pharyngeal collapsibility to negative pressure were found with 3 and 30 μg of BAY2586116 vsplacebo in pigs. Similarly, BAY2586116 improved pharyngeal collapsibility by an average of approximately 2cm H2O vsplacebo, regardless of topical application method and dose (P< .008, mixed model) in participants with OSA. Acute topical application of BAY2586116 improves upper-airway collapsibility in anesthetized pigs and sleeping humans with OSA. These novel physiologic findings highlight the therapeutic potential to target potassium channel mechanisms to treat OSA. ClinicalTrials.gov; No.: NCT04236440; URL: www. gov.