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INTRODUCTION: Surgical site infection (SSI) after minor skin excisions has a significant impact on patient morbidity and healthcare resources. Skin antisepsis prior to surgical incision is used to prevent SSI, and is performed routinely worldwide. However, in spite of the routine use of skin antisepsis, there is no consensus regarding which antiseptic agents are most effective. The AVALANCHE trial will compare Aqueous Versus Alcoholic Antisepsis with Chlorhexidine for Skin Excisions. METHODS AND ANALYSIS: The study design is a prospective, randomised controlled trial (RCT) with the aim of investigating the impact of two different antiseptic preparations on the incidence of superficial SSI in patients undergoing minor skin excisions. The intervention of 0.5% chlorhexidine gluconate (CHG) in 70% alcohol will be compared with that of 0.5% CHG in aqueous solution. The trial will be conducted in four Australian general practices over a 9-month period, with 920 participants to be recruited. Consecutive patients presenting for minor skin excisions will be eligible to participate. Randomisation will be on the level of the patient. The primary outcome is superficial SSI in the first 30â days following the excision. Secondary outcomes will be adverse effects, including anaphylaxis, skin irritation, contact dermatitis and rash and patterns of antibiotic resistance. ETHICS AND DISSEMINATION: The study has been approved by the James Cook University Human Research Ethics Committee (HREC). Findings will be disseminated in conference presentations and journals and through online electronic media. DISCUSSION: RCTs conducted in general practice differ from hospital-based projects in terms of feasibility, pragmatism and funding. The success of this trial will be cemented in the fact that the research question was established by a group of general practitioners who identified an interesting question which is relevant to their clinical practice and not answered by current evidence. TRIAL REGISTRATION NUMBER: ACTRN12615001045505; Pre-results.
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Antiinfecciosos Locales/administración & dosificación , Clorhexidina/análogos & derivados , Etanol/administración & dosificación , Medicina General , Procedimientos Quirúrgicos Menores/métodos , Solventes/administración & dosificación , Infección de la Herida Quirúrgica/prevención & control , Agua/administración & dosificación , Clorhexidina/administración & dosificación , Humanos , QueenslandRESUMEN
A viable human cytomegalovirus (HCMV) mutant was generated harbouring a glycoprotein B (gB) in which the carboxyl-terminal amino acids DRLRHR (aa 885-900) were changed to AALREE. Characterization of the phenotype of the recombinant virus revealed significant reduction of infectious progeny release and only moderate reduction of viral DNA replication indicating its diminished specific infectivity. This observation was in line with immunogold labeling of extracellular virions demonstrating that the amount of gB protein was markedly reduced in the envelope of the mutant virus. Our results suggest that the conserved carboxyl-terminus of the gB molecule is critical for HCMV maturation.
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Citomegalovirus/genética , Proteínas del Envoltorio Viral/genética , Adaptación Fisiológica , Células Cultivadas , Citomegalovirus/patogenicidad , Fibroblastos , Humanos , Mutagénesis Sitio-Dirigida , Mutación , Proteínas del Envoltorio Viral/química , Proteínas del Envoltorio Viral/fisiología , Replicación ViralRESUMEN
We report on experiments giving evidence for quantum effects of electromagnetic flux in barium alumosilicate glass. In contrast to expectation, below 100 mK the dielectric response becomes sensitive to magnetic fields. The experimental findings include both lifting of the dielectric saturation by weak magnetic fields and oscillations of the dielectric response in the low temperature resonant regime. As the origin of these effects we suggest that the magnetic induction field violates the time reversal invariance leading to a flux periodicity in the energy levels of tunneling systems. At low temperatures, this effect is strongly enhanced by the interaction between tunneling systems and thus becomes measurable.
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Two cases of serious envenomation by the northern Australian box-jellyfish (Chironex fleckeri) are reported. The first-aid measures and the subsequent management and follow-up of patients are discussed. In addition to its known life-saving effects, the early administration of the specific antivenom appears to be the best treatment for the savage pain of the sting, and may also result in a reduction of subsequent skin scarring.