If a tissue biopsy from a chronic wound is sampled for culture, the antibacterial properties of local anesthetics may pose a problem in producing false-negative results. The purpose of this study was to investigate the effects of EMLA (AstraZeneca) and lidocaine on common wound pathogenic bacteria. An in vitro study of a total of 25 clinical isolates and ATCC reference strains of Staphylococcus aureus (including methicillin-resistant S. aureus), Escherichia coli, Pseudomonas aeruginosa, and Streptococcus pyogenes was conducted. The isolates were exposed to the local anesthetic drugs (and some of their contents separately) at 35 degrees C over a 24-hour period and time-kill curves were recorded. No culture media were used and saline was used for controls. EMLA was found to have a rapid acting and powerful antibacterial effect and should not be used before culturing tissue samples. Lidocaine 1% was found not to inhibit the bacterial strains when exposure time was held below 2 hours. We conclude that culturing tissue from a wound biopsy is safe within 2 hours when a pure, preservative-free lidocaine 1% solution is used.

No abstract

Intramuscular injections of paraffin oil can cause foreign body granuloma formation and hypercalcemia. Macrophages with the ability to produce high levels of 1,25(OH)2D3 may induce the mineral disturbance, but no major series of patients have been published to date. Here, medical history, physical evaluation, biochemical, and urinary analysis for calcium homeostasis were obtained from 88 males, who 6 years previously had injected paraffin or synthol oil into skeletal muscle. Moreover, granuloma tissue from three men was cultured for 48 hours ex vivo to determine 1,25(OH)2D3 production supported by qPCR and immunohistochemistry of vitamin D metabolism and immune cell populations after treatment with 14 different drugs. The 88 men were stratified into men with hypercalcemia (34%), whereas normocalcemic men were separated into men with either normal (42%) or suppressed parathyroid hormone (PTH) (24%). All men had high calcium excretion, and nephrolithiasis was found in 48% of hypercalcemic men, 22% of normocalcemic men with normal PTH, and 47% of normocalcemic men with suppressed PTH. Risk factors for developing hypercalcemia were oil volume injected, injection of heated oil, high serum interleukin‐2 receptor levels, and high urine calcium. High 1,25(OH)2D3/25OHD ratio, calcium excretion, and low PTH was associated with nephrolithiasis. The vitamin D activating enzyme CYP27B1 was markedly expressed in granuloma tissue, and 1,25(OH)2D3 was released in concentrations corresponding to 40% to 50% of the production by human kidney specimens. Dexamethasone, ketoconazole, and ciclosporin significantly suppressed granulomatous production of 1,25(OH)2D3. In conclusion, this study shows that injection of large oil volumes alters calcium homeostasis and increases the risk of nephrolithiasis. Hypercalciuria is an early sign of disease, and high granulomatous 1,25(OH)2D3 production is part of the cause. Prospective clinical trials are needed to determine if ciclosporin, ketoconazole, or other drugs can be used as prednisolone‐sparing treatment. © 2020 American Society for Bone and Mineral Research (ASBMR).

No abstract

No abstract

This study proposes the first scientifically developed undergraduate core curriculum in plastic surgery. It comprises of a consensus of competences a recently graduated medical doctor should be expected to possess.

Endothelin signaling plays an important role in physiology and disease and one of the endothelin receptors, the type B receptor (ETB or EDNRB), is known to be highly plastic, being upregulated in smooth muscle cells by arterial injury and following organ culture in vitro. Herein, we hypothesized that this transcriptional plasticity may arise in part because EDNRB is controlled by ternary complex factors and by the myocardin family coactivator MKL2. In line with this hypothesis we found significant correlations between the ternary complex factors ELK3, FLI1 and EDNRB, and between MKL2 and EDNRB at the mRNA level in human arteries. Overexpression of MKL2 in human coronary artery smooth muscle cells (HCASMC) led to a 30‐ fold induction of EDNRB, and this effect was antagonized by myocardin (MYOCD) which also correlated negatively with EDNRB at the tissue level. Overexpression of ELK3 and FLI1 induced expression of EDNRB, whereas the expression of classical smooth muscle markers was reduced. Depolymerization of actin using latrunculin B (LatB) increased EDNRB on both mRNA and protein levels, and increased calcium responses on stimulation with the ETB‐selective agonist sarafotoxin 6c (S6c) and endothelin 1 (ET‐1). Pretreatment with LatB in organ culture increased S6c and ET‐1‐induced contraction. We also found that ROCK inhibition using Y27632 induced EDNRB expression, and that the effect of LatB is antagonized by MAP‐kinase inhibition. Transcript‐specific primers and promoter reporter assays showed that the EDNRB_2 isoform is regulated by LatB in HCASMC. We finally demonstrate that the mRNA level of EDNRB is increased in rat carotid lesions and human carotid plaques, and that ELK3/FLI1 induction closely parallels EDNRB induction. In all, these studies uncover transcriptional control mechanisms for the endothelin type B receptor (EDNRB) that may explain its plasticity and could be targeted for therapy. Support or Funding Information This study was supported by grants from the Medical Faculty and The Royal Physiographic Society. KKK was supported by Marie Curie ITN Small Artery Remodelling of European Union. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

finds general practitioners wanting in their efforts to stop their patients smoking.' As a result of the government's banding scheme for health promotion activities in general practice we distributed a questionnaire to 6530 of our patients who attended our practice over six months. Altogether 1523 smokers were specifically asked if they would like our help in stopping smoking. A total of 365 replied affirmatively, and 100 of these were invited to attend a midweek evening meeting outlining information and help available to enable them to stop smoking. Twelve patients replied: eight accepted, three declined, and one had already stopped smoking. On the evening six smokers attended. All were counselled on a nearly one to one basis by the health professionals, who included a doctor, a health visitor, a district nurse, a practice nurse, and the district health authority's health promotion coordinator. The health professionals' view on stopping smoking was aired, and a video was shown and carbon monoxide monitoring demonstrated. The group agreed to meet one week later, when five patients attended. Two of these five have continued in their resolve to stop smoking. We are left wondering whether this operation was worthwhile in terms of its cost and the time required and whether our time might have been better used.