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AIMS: Dermatologic evaluation for cardiac implantable electronic devices (CIEDs) has not been established. We sought to ascertain baseline wound scar features using quantifiable surgical tools and scar scales on post-CIED patients. METHODS: A single-center, prospective observational case-control study was performed where 92 study subjects (40 healthy volunteers and 52 post-CIED patients) completed the study. Durometer was used to quantify skin pliability before CIED placement, postprocedure, and 2 weeks postprocedure. Higher durometer readings signified reduced skin pliability. Durometer readings were compared to the patients' contralateral pectoral skin and to a healthy volunteer's cohort skin within the prepectoral region. Patient wounds were observed and graded using the Patient Observer Scar Assessment Scale (POSAS) and Manchester Scar Scale (MSS). RESULTS: Baseline pectoral skin pliability readings were similar in healthy volunteers and CIED patient population. In comparison to preprocedural measurements, surgical site skin pliability decreased in postprocedural and 2 weeks follow-up time points (P-value .004 and <.001, respectively). The increases in durometer readings were higher in the older population (age >75 over time, P = .008). POSAS evaluations showed on average a thin painless hypopigmented scar with moderate stiffness. MSS scar evaluation showed a palpable scar with slight contour differences and color mismatch and appeared to be slightly better in the African American population. There was no difference in scar characteristics with preprocedural use of antiplatelet or anticoagulation or staple closure or gender. CONCLUSIONS: Serial measurements could be of value for development of new strategies for cosmesis and improved wound healing.
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PURPOSE: Electrophysiology procedures pose infection risk and require surgical room sterility. Currently, there is no universally approved protocol for disinfecting lead garments in the electrophysiology laboratory. This study explores the feasibility of using ATP testing to assess the microbial burden of lead aprons and evaluates the impact of a sanitary intervention. METHODS: Adenosine triphosphate (ATP) testing is a well-established hospital standard to quantify biological matter on a surface and, by proxy, the microbial burden. It is measured in RLU (relative light units). Pre-intervention ATP testing was performed on 34 lead garments after use for electrophysiology procedures. The thyroid collar, mid-chest vest, and left axillary areas of the garments were swabbed using a Hygiena SystemSure II luminometer with ATP swabs (Hygiena, Camarillo, CA). These sites were then disinfected with disinfectant wipes (PDI Super Sani-cloth Germicidal Disposable Wipe) and ATP testing was repeated. RESULTS: The mean duration of garment wear was 213 min. The thyroid collars had the highest mean RLU before intervention, followed by the mid-chest vest and the left axillary areas. The intervention was found to significantly decrease ATP readings for all three sites (p = 0.0002, p = 0.0001, p = 0.0002 respectively). Linear regression modeling to assess the impact of intervention showed a significant correlation with pre-intervention ATP values for all three sites but no correlation with fluoroscopy time, fluoroscopy dose, or total time spent within the procedure. CONCLUSIONS: Lead garments harbor microbial contamination after use according to ATP testing. A sanitary intervention can decontaminate lead garments and potentially reduce rates of hospital infection.
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Desinfección , Laboratorios , Adenosina Trifosfato , Electrofisiología , Humanos , Ropa de ProtecciónRESUMEN
The crystal structure of thioredoxin (AaTrx) from the acetic acid bacterium Acetobacter aceti was determined at 1 A resolution. This is currently the highest resolution crystal structure available for any thioredoxin. Thioredoxins facilitate thiol-disulfide exchange, a process that is expected to be slow at the low pH values encountered in the A. aceti cytoplasm. Despite the apparent need to function at low pH, neither the active site nor the surface charge distribution of AaTrx is notably different from that of Escherichia coli thioredoxin. Apparently the ancestral thioredoxin was sufficiently stable for use in A. aceti or the need to interact with multiple targets constrained the variation of surface residues. The AaTrx structure presented here provides a clear view of all ionizable protein moieties and waters, a first step in understanding how thiol-disulfide exchange might occur in a low pH cytoplasm, and is a basis for biophysical studies of the mechanism of acid-mediated unfolding. The high resolution of this structure should be useful for computational studies of thioredoxin function, protein structure and dynamics, and side-chain ionization.