Nanoparticles Deliver siRNA to Wound Sites to Speed Up Healing (VIDEO)

FL2

Researchers at the Albert Einstein College of Medicine, a part of Yeshiva University, are using novel nanoparticles to significantly speed up the healing of wounds. They discovered that the naturally produced fidgetin-like 2 (FL2) enzyme slows down the migration of cells as they travel toward a wound site. To counteract this process, the investigators developed a silencing RNA (siRNA) drug that inhibits the gene responsible for the production of FL2.

In order to actually deliver the siRNA into the interior of cells before degrading, the researchers encapsulated it in specially designed nanoparticles that keep their cargo fresh and intact before reaching the cell and letting it flow out.

Here’s a time lapse video of burned skin healing with and without the nanoparticle delivered gene inhibitor:

 

From the study abstract in Journal of Investigative Dermatology:

In this study, we identify the previously uncharacterized microtubule-severing enzyme, Fidgetin-like 2 (FL2), as a fundamental regulator of cell migration that can be targeted in vivo using nanoparticle-encapsulated siRNA to promote wound closure and regeneration. In vitro, depletion of FL2 from mammalian tissue culture cells results in a more than two-fold increase in the rate of cell movement, due in part to a significant increase in directional motility. Immunofluorescence analyses indicate that FL2 normally localizes to the cell edge, importantly to the leading edge of polarized cells, where it regulates the organization and dynamics of the microtubule cytoskeleton. To clinically translate these findings, we utilized a nanoparticle-based siRNA delivery platform to locally deplete FL2 in both murine full-thickness excisional and burn wounds. Topical application of FL2 siRNA nanoparticles to either wound type results in a significant enhancement in the rate and quality of wound closure both clinically and histologically relative to controls.

Study in Journal of Investigative Dermatology: Fidgetin-Like 2: A Microtubule-Based Regulator of Wound Healing…

Source: Albert Einstein College of Medicine…

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Importance of Vital Signs during Handoff

Well, I just sent an article that how important is the role of vital signs during pre-hospital or in ED assessment. Annals of EM published an article: Communication of Vital Signs at Emergency Department Handoff: Opportunities for Improvement. In a prospective observational study, authors  observed 1,163

patients sign out during 130 ED shifts. We did not communicate hypotension in 42%, and hypoxia in 74% at our sign out. Interestingly, ED overcrowding was not associated with this communication error. We need to do a better job on sign out and at least start on reminding ourselves about vital signs!

Link to article

TraumaCAD Mobile Hip Replacement Planning for iPad Scores FDA Clearance

macbook-ipad-image-hp-3

Voyant Health, a division of Brainlab, won FDA clearance for its TraumaCad Mobile pre-op othropedic planning and templating tool for total hip replacement procedures. The app runs on iOS devices, as well as through a browser on Mac and Windows, and any other PCs supporting HTML 5.

The software automatically aligns implants and other devices, calculating relevant distances and offsets. It works with a variety of patient markers to maintain proper calibration and comes with templates for various artificial hips, including their different parameters.

App info page: TraumaCad Mobile…

Source: Voyant Health…

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Ultrasound Guided Lp

Ultrasound guided LP

 

Equipment needed:

-       high-frequency (small parts linear probe) for patients with normal weight

-       low-frequency 2-4 MHZ probe (abdominal curvilinear probe) for obese patients

-       transducer gel

-       skin marking pen

-       LP tray

 

Positioning: left lateral decubitus or seated position

 

Technique:

1-   Identify spinous process which signifies the midline of the spine. Probe must be in transverse position, probe marker to clinician’s left side, at level of iliac crest. Spinous process looks like cresent shape hyperechoic structure with posterior acoustic shadowing.

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2

 

2-   Mark the midline with a skin marking pen at the center of the probe. Drag the probe superiorly (head) and inferiorly (feet) and again mark the midline of the spine.

3-   Rotate the transducer to the sagittal (longitudinal) plane, with probe marker pointed at patient’s head. The probe should be parallel with patients spine and in between spinous processes previously marked.  The spinous processes again appear as hyperechoic cresent shapes.

 

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4. Mark the space between the two spinous processes which is the interspinous space, on left and right side of probe.

5. The point of intersection represent the middle of the interspace and most ideal place for LP needle insertion.

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6. Proceed with LP as you usually would. Instruct patient not to move as this may obscure landmarks and skin markings.

 

Reference: http://emedicine.medscape.com/article/1458641-overview#showall   Written by our very own Sinai EM attending’s Suzie Bentley and Danny Duque!

 

https://www.youtube.com/watch?v=ndnZxAcNjdg

First-in-Human Results for New Handheld Autofluorescence Imaging Platform: Real-Time Sampling and Treatment Guidance of Chronic Wound Infections

PRODIGIWe previously reported on PRODIGI, a handheld autofluorescence imaging platform for real-time detection and tracking of bacterial infections in wounds. Canadian molecular imaging scientist Dr. Ralph DaCosta and colleagues at the Princess Margaret Cancer Center, University Health Network (Toronto), have now published first-in-human results describing the use of PRODIGI for point-of-care real-time sampling and treatment guidance of bioburden in chronic wounds.

The PLOS ONE publication describes two single-center, non-randomized trials that assessed the use of PRODIGI for real-time autofluorescence imaging of bacteria in diabetic foot ulcer patients. The team showed that PRODIGI detects the distribution of clinically-relevant levels of bacterial pathogens and wound infection, guides more accurate wound sampling and antimicrobial wound treatment (including debridement), increases the rate of wound closure compared with standard of care, and objectively tracks treatment response over time. By providing a quantitative means of tracking changes in wound bioburden over time, PRODIGI enables identification of wounds that require urgent clinical attention in patients who may be asymptomatic and may not display the traditional signs and symptoms of infection.

This work represents a significant technological and clinical advancement in wound assessment, sampling, treatment guidance, and treatment response tracking. Moreover, it underscores the need to improve conventional wound sampling practices and clinical protocols for wound infection diagnosis and treatment, which currently rely on subjective and sub-optimal assessments.

PRODIGI is approved by Health Canada for clinical testing and is being commercially developed by MolecuLight Inc., a company that is working to bring PRODIGI to the global wound care market.

Flashback: New Autofluorescence Imaging Platform Detects and Tracks Bacteria in Chronic Wounds

Study in PLoS ONE: Point-of-Care Autofluorescence Imaging for Real-Time Sampling and Treatment Guidance of Bioburden in Chronic Wounds: First-in-Human Results

Link: DaCosta Lab

Link: MolecuLight homepage…

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