Journal of International Medical Research

Wound healing remains a challenging clinical problem and correct, efficient wound management is essential. Much effort has been focused on wound care with an emphasis on new therapeutic approaches and the development of technologies for acute and chronic wound management. Wound healing involves multiple cell populations, the extracellular matrix and the action of soluble mediators such as growth factors and cytokines. Although the process of healing is continuous, it may be arbitrarily divided into four phases: (i) coagulation and haemostasis; (ii) inflammation; (iii) proliferation; and (iv) wound remodelling with scar tissue formation. The correct approach to wound management may effectively influence the clinical outcome. This review discusses wound classification, the physiology of the wound healing process and the methods used in wound management.

Oxidative stress is implicated in the pathogenesis of many diseases; however, currently used antioxidants have a high toxicity that constrains administration to a narrow window of therapeutic dosage. There is a clear need for more effective and safer antioxidants. Diatomic hydrogen (H₂) was proposed as a novel antioxidant that selectively reduces levels of toxic reactive-oxygen species. Recently, many studies have reported that H₂ (inhaled or orally ingested, typically as approximately 0.8 mM H₂-saturated water), can exert beneficial effects in diverse animal models of ischaemia–reperfusion injury, and inflammatory and neurological disease. In the clinic, oral administration of H₂-saturated water is reported to improve lipid and glucose metabolism in subjects with diabetes or impaired glucose tolerance; promising results have also been obtained in reducing inflammation in haemodialysis patients and treating metabolic syndrome. These studies suggest H₂ has selective antioxidant properties, and can exert antiapoptotic, anti-inflammatory and antiallergy effects. This review summarizes recent research findings and mechanisms concerning the therapeutic potential of H₂.

The efficacy and tolerability of the imidazopyridine hypnotic, zolpidem, were investigated in 119 elderly psychiatric inpatients complaining of insomnia in a double-blind, parallel-group, placebo-controlled trial. After a 7-day placebo washout period, patients were randomized to receive 10 or 20 mg/day zolpidem, or placebo for 21 days; thereafter, all patients received placebo for 7 days. Sleep was assessed by patient observation on days 0, 1, 7, 14, 21, 22 and 28. Compared with placebo, 20 mg/day zolpidem significantly improved total duration of sleep between day 0 and day 21, and this was maintained at day 28. After 10 or 20 mg/day zolpidem, there was also a trend towards improvement in all other sleep parameters, which remained above baseline at day 28. Zolpidem was well tolerated with no withdrawal symptoms during the second 7-day placebo treatment period. Daytime drowsiness was reported in three patients receiving 20 mg/day zolpidem and in one receiving 10 mg/day zolpidem, but there was no significant increase in daytime drowsiness between days 0 and 21. Ataxia occurred in two, one and one patient, respectively, treated with 20 mg/day zolpidem, 10 mg/day zolpidem and placebo. The incidences of other adverse events or effects on clinical and laboratory parameters were minimal and similar in all three treatment groups. It is concluded that, in elderly psychiatric patients, 10 mg/day zolpidem can be used to treat insomnia and can be safely added to concomitant psychotropic treatment without inducing daytime drowsiness.

L'efficacité et la tolérabilité du zolpidem, hypnotique de la classe des imidazopyridines ont été étudiées chez 119 patients âgés hospitalisés souffrant de troubles psychiatriques et se plaignant d'insomnie dans une étude en double aveugle à groupes parallèles, contrôlée par placebo. Après une période de washout par placebo de 7 jours, les patients ont été randomisés de manière à recevoir d'abord 10 ou 20 mg par jour de zolpidem ou du placebo pendant 21 jours; puis tous les patients recevèrent du placebo pendant 7 jours. Le sommeil a pu être évalué par l'observation des patients aux jours 0, 1, 7,14, 21, 22 et 28. Comparé au placebo, le zolpidem à la dose de 20 mg par jour a significativement augmenté la durée totale du sommeil entre le 1er et le 21ème jour, et cet effet était toujours présent au 28ème jour. Après 10 ou 20 mg par jour de zolpidem, on a également relevé une tendance à l'amélioration de tous les autres paramètres du sommeil, qui étaient toujours au-dessus de leurs valeurs de base au 28ème jour. Le zolpidem a été bien toléré et on n'a pas observé de syndrome de manque sevrage lors de la seconde période de traitement de 7 jours par placebo. Une somnolence diurne a été observée chez trois patients recevant 20 mg par jour de zolpidem, et chez un patient recevant 10 mg par jour, mais il n'y pas eu d'augmentation significante de la somnolence diurne entre jour 0 et jour 28. Une ataxie est apparue chez duex patients traité par 20 mg par jour de zolpidem, un patient traiteá par 10 mg par jour de zolpidem, et un patient traité par placebo. Les incidences des autres effets secondaires ou l'action sur les paramètres cliniques ou biologiques s'est révélée minime et similaire pour les trois groupes de patients. L'étude a conclu que, chez les patients âgés souffrant de troubles psychiatriques, un traitement par 10 mg par jour de zolpidem pouvait être utilisé pour traiter l'insomnie et peut être adjoint en toute sécurité à un traitement psychotrope concomitant sans induire de somnolence diurne.

Quinolones are a group of antimicrobial agents that were serendipitously discovered as byproducts of the synthesis of chloroquine. Chemical modifications, such as the addition of fluorine or piperazine, resulted in the synthesis of third- and fourth-generation fluoroquinolones, with broad-spectrum antimicrobial actions against aerobic or anaerobic, Gram-positive or Gram-negative bacteria. The efficacy and consequent widespread use of quinolones and fluoroquinolones has led to a steady global increase in resistance, mediated via gene mutations, alterations in efflux or cell membranes and plasmid-conferred resistance. The first plasmid-mediated quinolone resistance gene, qnrA1, was detected in 1998. Since then, many other genes have been identified and the underlying mechanisms of resistance have been elucidated. This review provides an overview of quinolone resistance, with particular emphasis on plasmid-mediated resistance.

The safety and efficacy of 10 or 20 mg/day zolpidem, a new hypnotic belonging to the imidazopyridine class, were studied over a 180-day period in 96 patients with sleep disorders. The treatment was continued for a further 180 days by 49 of these patients. Follow-up information from 21 patients who discontinued treatment after 180 days showed no rebound insomnia or withdrawal signs. Efficacy of treatment with respect to reduction of sleep onset latency and number of nocturnal wakenings, and improvement in duration of sleep, quality of sleep and morning wakenings was found in nearly 90% of patients and was maintained in those patients who continued treatment for 360 days. This efficacy was achieved with a stable percentage of patients receiving 10 mg/day and 20 mg/day zolpidem from day 30 to the final visit. Zolpidem, therefore, has been shown to be an effective and safe hypnotic, and to be devoid of rebound and withdrawal effects.

La sécurité d'utilisation et l'efficacité du 10 ou 20 mg par jour de zolpidem, un nouvel hypnotique appartenant à la classe des imidazopyridines, ont été étudiées sur une période de 180 jours chez 96 patients souffrant de troubles du sommeil. Le traitement s'est poursuivi pendant 180 jours supplémentaires chez 49 de ces patients. Le suivi de 21 patients ayant cessé le traitement au bout de 180 jours n'a montré ni rebond d'insomnie, ni syndrome de sevrage. L'efficacité du traitement se mesure par la reduction du temp d'endormissement et le nombre de réveils noctures, ainsi que l'amélioration de la durée du sommeil, de la qualité du sommeil et du réveil au matin ont été retrouvés chez près de 90% des patients; ces effets se sont maintenus chez les patients qui ont poursuivi le traitement pendant 360 jours. Cette efficacité a été obtenue pour un pourcentage assez constant de patients qui ont reçu 10 mg par jour de zolpidem, puis 20 mg par jour du 30 ème jour à la fin du traitement. Pour ces raisons, le zolpidem, s'est donc révélé être un hypnotique efficace et sûr, dépourvu d'effets de rebond et de sevrage.

OBJECTIVE: To determine risk factors associated with drug resistant tuberculosis (TB) in mainland China. METHODS: PubMed and Chinese BioMedical databases were searched. Cohort, case—control and cross-sectional studies providing effect estimates of risk factors for any-drug resistant or multidrug resistant (MDR) TB were included. RESULTS: The meta-analysis included 16 studies. Any-drug resistant TB was significantly associated with poor quality directly observed treatment, short-course (DOTS) (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.22, 5.79), long term illness > 1 year (OR 2.71, 95% CI 1.34, 5.48), poor treatment adherence (OR 2.00, 95% CI 1.17, 3.40), previous treatment (OR 4.54, 95% CI 2.71, 7.61) and age 40 – 60 years (OR 1.62, 95% CI 1.10, 2.38). MDR-TB was significantly associated with poor quality DOTS (OR 1.84, 95% CI 1.36, 2.49), poor treatment adherence (OR 4.39, 95% CI 2.97, 6.50), previous treatment (OR 3.83, 95% CI 2.12, 6.89) and poverty (OR 1.87, 95% CI 1.38, 2.52). CONCLUSIONS: Previous treatment, poor quality DOTS, poor treatment adherence, long term illness, age 40 – 60 years and poverty are associated with a greater risk of drug resistant TB in mainland China.

We aimed to determine the effect of ondansetron and dexamethasone on preventing post-operative nausea and vomiting (PONV). Sixty women undergoing laparoscopic gynaecological surgery were randomized to receive ondansetron 4 mg, dexamethasone 8 mg or saline. Drugs were administered 2 min before induction of anaesthesia, and anaesthesia and post-operative analgesic regimens were standardized. The incidence of PONV in the first 24 h after the operation was 35% in the ondansetron group, 55% in dexamethasone group and 85% in the control group. A significant difference between the groups was only seen in the first 3 h post-operatively. In this period, ondansetron was significantly more effective than dexamethasone and saline, but no differences were seen between dexamethasone and saline. In all treatment groups, post-operative visual analogue scale scores, sedation scores and usage of analgesics were similar. In conclusion, ondansetron, but not dexamethasone, prevented PONV in the first 3 h after gynaecological laparoscopic surgery.