Thomas H. Leung,1,2 Lillian F. Zhang,1 Jing Wang,1 Shoucheng Ning,3 Susan J. Knox,3 and Seung K. Kim1,4,5
1Department of Developmental Biology, 2Department of Dermatology, 3Department of Radiation Oncology, 4Howard Hughes Medical Institute, and 5Department of Medicine, Oncology Division, Stanford University School of Medicine, Stanford, California, USA.
Nuclear factor-κB (NF-κB) regulates cellular responses to inflammation and aging, and alterations in NF-κB signaling underlie the pathogenesis of multiple human diseases. Effective clinical therapeutics targeting this pathway remain unavailable. In primary human keratinocytes, we found that hypochlorite (HOCl) reversibly inhibited the expression of CCL2 and SOD2, two NF-κB–dependent genes. In cultured cells, HOCl inhibited the activity of inhibitor of NF-κB kinase (IKK), a key regulator of NF-κB activation, by oxidizing cysteine residues Cys114 and Cys115. In NF-κB reporter mice, topical HOCl reduced LPS-induced NF-κB signaling in skin. We further evaluated topical HOCl use in two mouse models of NF-κB–driven epidermal disease. For mice with acute radiation dermatitis, topical HOCl inhibited the expression of NF-κB–dependent genes, decreased disease severity, and prevented skin ulceration. In aged mice, topical HOCl attenuated age-dependent production of p16INK4a and expression of the DNA repair gene Rad50. Additionally, skin of aged HOCl-treated mice acquired enhanced epidermal thickness and proliferation, comparable to skin in juvenile animals. These data suggest that topical HOCl reduces NF-κB–mediated epidermal pathology in radiation dermatitis and skin aging through IKK modulation and motivate the exploration of HOCl use for clinical aims.
Eric Clayman, MD; Zackery Beauchamp, BS; Jared Troy, MD
Abstract
Background. Orthopedic hardware infections often require hardware removal or replacement. In some situations, hardware removal is not possible or would require amputation. Thus, a method of in-situ hardware salvage could significantly improve patient outcomes. Hypochlorous acid is a broad-spectrum antimicrobial solution with rapid effectiveness in biofilm impairment.
Methods. This article presents 2 patients with orthopedic hardware infection. Patient A had recurrent draining sinuses from an intramedullary nail in the femur. The orthopedic surgery team recommended above-knee amputation if hardware salvage was not possible. Patient B had a degloving injury of the right upper extremity with radius and ulna fractures that required revascularization and free flap coverage; when hardware infection developed, hardware removal would have required external fixator placement. In both patients, hypochlorous acid was used intraoperatively during debridement to soak the hardware for 5 minutes. Closed suction drains were placed along the hardware, and postoperative instillations of hypochlorous acid were placed through the drains for 5 minutes 1 to 2 times a day for 4 days for Patient A and 7 days for Patient
Results. On follow-up at 10 months for Patient A and at 9 months for Patient B, there was no evidence of recurrent hardware infection. Hardware was successfully salvaged in both patients.
Conclusions. Hypochlorous acid is an effective and safe topical antimicrobial agent for recurrent infections due to hardware-associated biofilm. Postoperative instillations of 0.025% hypochlorous acid through closed suctions drains may improve hardware salvage rates and optimize
Keywords PhaseOne Hypochlorous Acid Hardware Salvage Infected Hardware Biofilm
擅长：1. 烧伤/烫伤/手术疤痕美学修复; 2. 创面/伤口/溃疡/皮肤缺损美学修复; 3. 全身体表肿瘤/包块手术治疗。
擅长疾病：1.面部轮廓整形;2.面部年轻化;3.身体塑形;4.先天性和创伤后畸形修复、体表肿瘤切除及器官再造。如：黄褐斑、瘢痕疙瘩、减肥 。教授，整形外科副主任，医学博士后，毕业于西安第四军医大学临床医学系，毕业后留校。
在成人大面积烧伤的休克复苏、感染防治、多器官功能障碍综合征的防治、严重电烧伤和吸入性损伤的救治以及小儿重度和特重度烧伤的救治等方面有较高造诣。获黑龙江省科技进步三等奖2项，哈尔滨市科技进步二等奖1项，三等奖2项。
担任欧洲糖尿病学会会员、美国糖尿病学会会员、欧洲糖尿病学会糖尿病足研究组发起会员、中华医学会糖尿病学分会第2届足病学组组长、中国人民解放军内分泌学会副主任委员、北京内分泌学会副主任委员、北京糖尿病防治协会副理事长、北京市朝阳区预防医学会副会长、国家卫生部全国慢性病综合防治示范点专家组成员、中国疾病控制中心慢病中心糖尿病专家、第四军医大学兼职教授，悉尼大学客座教授，第四军医大学硕士研究生导师，中南大学湘雅三医院硕士研究生导师主任医师。
擅长诊治各种危急重症烧伤、烧伤后疤痕挛缩、功能畸形整复、各类急慢性伤口、复杂难愈性创面、伤口早期微创美容及早期抗疤治疗等
浙江大学临床医学二系教授，浙江大学医学院附属第二医院主任医师，毕业于日本金泽医科大学。
伤口世界平台生态圈，以“关爱人间所有伤口患者”为愿景，连接、整合和拓展线上和线下的管理慢性伤口的资源，倡导远程、就近和居家管理慢性伤口，解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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