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products designed to reduce the harmful effects of MMPs: PromogranTM and DermaxTM These products are dissimilar in their structure and do not act in the same way PromogranTM is made from collagen and oxidised regenerated cellulose and is able to bind MMPs, thus negating their harmful effects DermaxTM is made from ethylene vinyl acetate mesh fabric impregnated with oak bark extract that downregulates MMP production, thus promoting healing As yet, there is limited published evidence for their use Veves et al (2002) undertook a randomised study comparing PromogranTM with standard care in the USA (moistened gauze) in 276 patients with diabetic foot ulcers Overall, there was no statistical difference between the two groups at 12 weeks However, there was borderline signi cance in favour of PromogranTM in a subset of patients with ulcers that had been present less than six months Vin et al.

Yum (Yellow dog Updater, Modified) is another update and patch tool that works with RPM packages. It functions much like the apt-get and up2date tools. Like these tools, Yum fetches RPMs from remote repositories and uses the rpm command to check checksums and to perform the installation. You can download Yum from http://linux.duke.edu/projects/yum/download.ptml. It comes in different versions depending on the version of RPM you have installed. Check your RPM version before you choose a version of Yum to install. Enter the following: puppy# rpm --version RPM version 4.2.2 Yum performs much the same functions as the other tools you have seen in this chapter. For example, to view a list of all the packages available to download, you would use the list option, as follows: puppy# yum list You can configure Yum using the file yum.conf located in the /etc directory. In Listing 1-48 you can see a sample of this file. Listing 1-48. Sample yum.conf File [main] cachedir=/var/cache/yum logfile=/var/log/yum.log distroverpkg=redhat-release

(2002) randomly allocated 73 patients with venous leg ulcers to either PromogranTM or AdapticTM (a low-adherent dressing impregnated with petrolatum emulsion) and followed their progress for 12 weeks Although more ulcers healed with PromogranTM than with AdapticTM, this did not achieve signi cance There was, however, a signi cant reduction in ulcer size in the PromogranTM group A cost modelling study was undertaken by Ghatnekar et al (2002) to determine the cost-effectiveness of PromogranTM for treating diabetic foot ulcers, using costs from France, Germany, Switzerland and the UK Based on the assumption that within the rst three months of treatment, 26% of ulcers were treated with PromogranTM and 207% were treated with standard practice, the authors calculated both recurring and non-recurring costs They estimated that there was potential for cost savings in each country, there being considerable variation due to overall treatment costs.

[base] name=Red Hat Linux $releasever - $basearch - Base baseurl= http://mirror.dulug.duke.edu/pub/yum-repository/redhat/$releasever/$basearch/ gpgcheck=1 The [main] configuration block shown in Listing 1-48 contains the global variables used by Yum. You can read about those in the yum.conf man page. The [base] configuration defines a repository to check for updated packages. I have added the option gpgcheck=1 to this repository to make Yum check for valid GPG signatures. You need to add this option to the definitions of all repositories defined to Yum if you want them to use GPG signature checking. To install a package with Yum, use the install option, as follows, replacing the packagename variable with the name of the particular package to be installed: puppy# yum install packagename To upgrade all available packages with Yum, use the upgrade option. puppy# yum upgrade You can see the additional options available with Yum in its man page.

To date, there is only a small pilot study showing the clinical use of DermaxTM in the public domain Karim et al (2002) studied the impact of using DermaxTM on four non-healing chronic wounds over six weeks They found an increase in broblast activity and a decline in the levels of MMP2 Further clinical trials are in progress and the results are required before the value of this product can be clearly determined..