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Notes: Aim:  Most acute phase pressure ulcers have necrotic tissue. Choices to treat such ulcers are controversial. The aim of this study is to help produce a guideline to treat acute phase pressure ulcers with necrosis.Methods:  Records of patients who acute phase ulcers with necrosis were retrospectively reviewed and their primary treatments and outcomes were studied. Ninety-seven ulcers of 86 patients for 3.5 year period were included. Pictures of all ulcers were taken throughout the treatment periods.Results:  Thirteen Stage II ulcers with black or yellow necrosis were treated with hydrocolloid dressings. All of them had excellent results. Forty of 76 Stage III ulcers had yellow necrosis. Hydrocolloid dressings were selected for 24 of them. Two of them became worth. Silver sulfadiazine cream was used for 5 ulcers and the results were relatively good. Fifteen of 36 ulcers with black necrosis were treated with hydrocolloid dressings. Two of them became worth. Thirteen ulcers with black necrosis were resected surgically at the beginnings of the treatments. One of them bled and became worth.Only one of eight Stage IV ulcers had yellow necrosis and it was treated with hydrocolloid dressing and result was good. Remaining five ulcers with black necrosis were resected with good results.Conclusions:  The primary choice for treating Stage II pressure ulcers with any type of necrosis is hydrocolloid dressings. We recommend hydrocolloid dressings for Stage III and IV ulcers without local symptoms of infection. Then after providing autolysis, surgical debridement should be done. If the patient is malnourished or is under poor pressure release, silver sulfadiazine cream may be recommended.

Notes: Aim:  In the present study, expression of members of the fibroblast growth factor (FGF) family and early growth response gene 1 (Egr-1), known as a transcription factor, was analyzed by reverse transcription polymerase chain reaction (RT-PCR).Methods:  After the mouse fetal small intestine was divided into single cells with collagenase-disperse, the cells were cultured. After reorganized small intestine were resected with a knife, expression of mRNAs from FGF family and Egr-1 was analyzed by RT-PCR.Results:  The wound surface was covered with epithelial cells by 24 hours after resection. Among members of the FGF family, mRNAs from FGF-1, -2, -5, and -7 were expressed. Egr-1 was expressed as early as 15 minutes after resection. Egr-1 is thought to be a transcription factor that induces the expression of FGF-2, other than factors involving wound healing, such as PDGF and TNF-a.Conclusions:  In the present study, it was determined that this structure is a potential model for studying the roles of transcription factor and growth factors expressed in association with damage and wound healing.

Notes: Aim:  Trefoil factor family (TFF) peptides are known to facilitate wound healing in gastric mucosa. However, the regulatory mechanisms of gastric TFF expression are not fully understood yet. In this study, we examined the effect of TNF-α on TFF1 and TFF2 expression in gastric epithelial cells.Methods:  MKN45 cells were used. TFF mRNA expression was analyzed by real-time quantitative RT-PCR. Promoter sequences of TFF1 gene (−956 to +36) and TFF2 gene (−912 to +24) were inserted into pGL3 vector and reporter gene assays were performed. NF-κB activity was monitored by using a NF-κB responsive element-driven reporter vector.Results:  (1) TNF-α(0.1–30 ng/ml) down-regulated TFF1 and TFF2 mRNA expression in a dose-dependent manner. (2) Reporter gene assays also confirmed the down-regulation of TFF1 and TFF2 gene transcription by TNF-α. (3) TNF-α activated NF-κB. (4) Overexpression of dominant negative IκBα prevented both TNF-α-induced NF-κB activation and TNF-α-induced down-regulation of TFF expression.Conclusions:  TNF-α down-regulates gastric TFF expression through NF-κB pathway, suggesting that TFF expression is sensitive to inflammatory stimuli.

Notes: Purpose:  Gastrointestinal (GI) damages associated with multiple organ failure is a fatal complication. The injured function of GI tract causes malnutrition and the bacterial translocation. So the functional recovery of GI tract is quite important for treating such cases. In the present study, we investigated whether basic fibroblast growth factor (bFGF) and hepatocyte growth factor (HGF) could recover the injured functions of cultured intestinal cells.Method:  Human small intestinal cells were cultured in a 10% FCS added DMEM. The cellular damages were induced by the treatment with various concentrations of cell permeable C6-ceramide (0–20 M). Growth factors (10 ng/ml bFGF or 50 ng/ml HGF) were added to the medium simultaneously or 2 days after the beginning of the ceramide treatment. After 4 days of the treatment, cell growth and apoptosis induction were investigated.Result and Conclusion:  Ceramide inhibited cell growth and induced apoptosis in a dose-dependent manner. Both growth factors significantly improved the cell growth and reduced apoptosis. These effects were also observed when the growth factor treatment was delayed 2 days after the ceramide treatment. It was found that bFGF was more significant than HGF on these protective effects. It is suggested that growth factor treatment may be a useful therapeutic option to improve GI tract dysfunction.

Notes: Introduction:  Many patients receiving heart surgery have extensive operation scars on the skin surface of the chest wall and lower leg. In some cases there are long lasting open wounds in the lower leg after vein harvesting. Some patients complain of pain and itching and we can recognize hypertrophic or extensive scars, which we have to treat.Case and result:  We treated 16 patients (11 men and 5 women) ranging in age from 47 to 86. They were receiving many drugs such as anticoagulants, thus wound healing was delayed. In these cases, we choose not to resect tissue but apply ointment to remove necrotic tissue, and prepare good granulation tissue for smooth epithelization. Then, we employ prophylactic measures against hypertrophic scar formation such as tape containing steroid, silicon gel sheets and skin tapes as well oral medicine (toranilast) for the same purpose. Because of they have had to continuously take many oral medicines, these patients often do not want to take additional oral medicine. This is one point of difference in the treatment of heart surgery patients and patients with other types of wounds.

Notes: Four off-loading devices used for the treatment of diabetic forefoot ulcers were compared: a custom-molded insole shoe, a cast MABAL shoe, a prefabricated pneumatic walking brace, and a bivalved total contact cast (BTCC). It was anticipated that all devices would significantly reduce forefoot plantar pressure compared with a control shoe. Sixteen healthy volunteers participated. Plantar pressures were evaluated using the Pedar system, while walking speed was determined using an optoelectric timer. Peak pressure (PP) of ten plantar areas and pressure–time integral for the first metatarsal area were analyzed statistically using a repeated measures analysis of variance. Forefoot pressures were significantly reduced compared with the control shoe for all devices (p〈0.001). PP was most reduced (by 65.8%) for the BTCC, and pressure–time integral was most reduced for the BTCC and cast MABAL shoe. Small but significant differences between devices in walking speed (p〈0.05) could not explain the substantial PP differences between the different devices. Although all off-loading devices resulted in a significant reduction of forefoot plantar pressure, devices differed significantly in the magnitude of pressure reduction. Further research will have to reveal the level of off-loading sufficient for effective treatment of diabetic ulcers.

Notes: Hypertrophic scarring and graft contracture are major causes of morbidity after burn injuries. It is well established that application of a split-thickness skin graft reduces scarring and contraction, and cultured epithelial autografts have a similar effect. To investigate the influence of keratinocytes on fibroblast proliferation and fibronectin synthesis, we used an in vitro separated co-culture model in which epithelial sheets were cultured above fibroblast monolayers without physical contact. We also investigated the response of fibroblasts to keratinocyte-conditioned medium (KCM) obtained from confluent and subconfluent keratinocyte monolayers. Both cultured epithelial sheets, composed of adherent fully confluent keratinocytes, and their conditioned medium, reduced fibroblast proliferation. However, KCM from subconfluent keratinocytes stimulated fibroblast proliferation at low concentrations while inhibiting it at higher concentrations, indicating that keratinocytes can produce both mitogenic and growth-inhibiting factors for fibroblasts. KCM, but not epithelial sheet co-culture, also inhibited fibroblast fibronectin synthesis. This indicates regulation of fibroblast phenotype by soluble factors released by the keratinocyte and also suggests that there is a dialogue between keratinocytes and fibroblasts with respect to fibronectin production. We conclude that this separated co-culture model is a simple way to study epithelial/mesenchymal communication particularly with respect to the role of the fibroblast in wound healing.

Notes: A central question in cell biology is how cells become senescent. After a finite number of cell divisions, normal cultured human cells enter a state of irreversible growth arrest, termed “replicative senescence.” Alternatively, oxidative stress in the form of hydrogen peroxide (H2O2) can render human dermal fibroblasts (HDFs) nonproliferative and quiescent, a phenomenon known as stress-induced premature senescence (SIPS). Although critical to the understanding of the pathophysiological basis of many diseases, there is no research to date that has simultaneously examined the interactions between age, oxidative stress, and SIPS. Therefore, the goals of this study were to examine in concert the interactions between these three factors in primary HDFs, and to test our central hypothesis that aging lowers the ability of primary HDFs to respond to oxidative stress. Our data provide, for the first time, evidence that aging dramatically reduces the capacity of primary HDFs to respond to the challenge of hydrogen peroxide. Specifically, aged HDFs showed decreased cell viability, decreased phosphorylation (activation) of pro-survival kinases (Akt and ERK 1/2), and increased entrance into a senescent state when compared with their younger counterparts. Another important conclusion of this study is that blockade of transforming growth factor-β1 had a pronounced “rescue effect” in the aged, preventing entrance of HDFs into cellular senescence.

Notes: Venous leg ulcers are common and cause considerable morbidity in the population. As healing may be slow or may never be achieved, ulcers create persistent and substantial demands on clinical resources. Great efforts have been made to accelerate tissue repair in chronic venous leg ulcers with limited success. This may at least be partly due to the limited knowledge on the microenvironment of chronic wounds. In fact, the tremendous impact of the microenvironmental conditions on the outcome of wound healing has increasingly become apparent. Oxidative stress as a consequence of an imbalance in the prooxidant-antioxidant homeostasis in chronic wounds is thought to drive a deleterious sequence of events finally resulting in the nonhealing state. The majority of reactive oxygen species are most likely released by neutrophils and macrophages and to an unknown extent from resident fibroblasts and endothelial cells. As the inflammatory phase does not resolve in chronic wounds, the load of reactive oxygen species persists over a long period of time with subsequent continuous damage and perpetuation of the inflammation. In this article, we will critically discuss recent findings that support the role of oxidative stress in the pathophysiology of nonhealing chronic venous leg ulcers.

Notes: Transdifferentiation of hepatic stellate cells into proliferative and fibrogenic myofibroblasts is a critical event in the development of liver fibrosis. The causes of HSC transdifferentiation are not well understood, although the extracellular matrix has been implicated as one possible factor. We hypothesized that HSC transdifferentiation is determined by the mechanical properties of the surrounding matrix, and that the diseased liver demonstrates an increased elastic modulus that contributes to the perpetuation of HSC transdifferentiation and the progression of fibrosis. To test this hypothesis in an in vitro system, primary rat HSC were plated on inert polyacrylamide supports of variable but precisely defined elastic modulus ranging from 100 to 12 K Pa. These were coated with different matrices (type I collagen, fibronectin, or Matrigel™) in layers thin enough not to alter the mechanical properties of the system. As determined by morphology, degree of cell spreading, and expression of α-smooth muscle actin, cells became progressively transdifferentiated as substrate stiffness (elastic modulus) increased, independent of the chemical identity of the coating matrix. The degree rather than speed of HSC transdifferentiation correlated with substrate stiffness, with cells cultured on supports of intermediate stiffness adopting stable intermediate phenotypes. These changes were independent of the addition or removal of TGF-β. This demonstrated in an in vitro system that HSC transdifferentiation is primarily a function of the physical rather than the chemical properties of the substrate. As a preliminary to determining the role of stiffness in vivo, we determined the elastic modulus of normal and progressively fibrotic rat liver. Rats were injected twice weekly with carbon tetrachloride or vehicle, and were sacrificed in groups of 7–8 (2 controls and 5–6 CCl4) at time periods ranging from four days to ten weeks after the first injection. Control rats demonstrated a G’(elastic modulus) of 460 +/− 25 Pa. The mean elastic modulus of CCl4-treated livers increased progressively, beginning at the four day point, 525 +/− 39 Pa, and reaching 1617 +/− 170 Pa at 10 weeks. These values are consistent with the values at which we saw intermediate degrees of HSC transdifferentiation in vitro, and suggest that alterations in liver stiffness are a key factor driving the progression of fibrosis.

Notes: The remodeling process in the lung of asthmatic patients results in a deposition of connective tissue and extracellular matrix components (ECM), which has been described as a subepithelial fibrosis. Fibroblasts, with the phenotypic appearance of myofibroblasts, are considered as the key source of the ECM in the fibrotic tissue. Furthermore, has the ECM molecule biglycan shown to correlate to the hyperactivity of the lung of asthmatic patients. In this study, we report the novel finding of a stretched fibroblast phenotype from bronchoalveolar lavage fluid (BALF) in 30% of the asthmatic subjects (n = 13). No fibroblasts were obtained in BALF from any of the nonasthmatic control subjects (n = 17). These BALF fibroblasts with several characteristics of a myofibroblast displayed increased migratory capacity, accompanied by an induced expression of the small GTPases RhoA and Rac1, when compared to myofibroblasts from corresponding lung biopsies. Data also shows that patients with BALF myofibroblast also have more cells in their lung tissue near to the basement membrane that stain for markers for mesechymal progenitor cells. Moreover, the BALF-myofibroblasts showed an increase in production of several types of proteoglycans like biglycan. By adding biglycan to normal fibrobalsts it is further possible to mimic the migratory type of myofibroblast found in BALF. To study differences in protein expression pattern between the two phenotypes, we used a gel-based proteomic technique in combination with MALDI-TOF mass spectrometry. BALF-myofibroblast displayed an increase in heat shock protein 20 (HSP20) and myofibroblasts from biopsies displayed an increase in chloride intracellular channel protein (CLIC) and cofilin. These proteins are all known to regulate cell migration by interacting with the actin cytoskeleton. In summery, data demonstrates that biglycan and mesenchymal progenitor cells might have an important role in the early -remodeling process in asthmatic patients and are potential future biomarkers for sub-epithelial fibrosis formation.

Notes: Common Achilles tendon ruptures are usually not fixed by absorbable sutures due to limitations in their strength properties. Modern technology has made it possible to develop bioabsorbable sutures with prolonged strength retention. To evaluate histologically tissue reactions and biodegradation of poly-L/D-lactide (PLDLA) sutures implanted in Achilles tendon of rabbits. Fifteen rabbits were operated on and killed within a time schedule of 2, 6 and 12 weeks, with five rabbits in per period. PLDLA monofilament sutures (Tampere University of Technology, Tampere, Finland) were implanted inside the rabbit medial gastrocnemius tendon for biocompatibility testing. Polyglyconate (4.0) monofilament sutures (Maxon®, Cyanamid of Great Britain Ltd., Gosport, UK) with the same diameter were implanted in the contralateral tendon. The histology was studied in hard-resin embedded samples and the thickness of the encapsule membrane was determined histomorphometrically.PLDLA have significantly smaller capsule formation around each fiber in tendon than Maxon® sutures. The mean capsule thicknesses around PLDLA sutures was 5.26, 11.66, and 10.63 after 2, 6, and 12 weeks respectively. The mean capsule thicknesses around Maxon® sutures was 13.22, 80.97, and 17.59 after 2, 6, and 12 weeks, respectively. In conclusion, by 12 weeks the PLDLA sutures implanted intratendineously formed thinner fibrous capsule than Maxon® sutures of same diameter. The suture materials were not degraded by 12 weeks.Acknowledgments:  Research funds from the Technology Development Center in Finland (TEKES, Biowaffle Project 40274/03 and MFM Project 424/31/04), the European Commission (EU Spare Parts Project QLK6-CT-2000-00487), the Academy of Finland (Project 73948) and the Ministry of Education (Graduate School of Biomaterials and Tissue Engineering) are greatly appreciated.

Notes: Considering that nitric oxide (NO) plays an important role on cutaneous wound repair, but its effects have not been defined, an inhibitor of NO synthesis (LNAME) was used. Control group received free water and LNAME group received LNAME (20 mg/kg/day) in drinking water. A full-thickness excisional wound was performed (0d), and the animals were sacrificed 7, 14, and 21 days later. Wound contraction was evaluated by lesion surface measurement at 0d, 7d, 14d, and 21d. The blood pressure of all rats was measured in the beginning and at the each time point of the experiment with a plethysmography method. The wound and normal skin surrounding was formol fixed and paraffin embedded. To evaluate the vessels, an immunohistochemistry for α-smooth muscle actin was done and stereological parameters were estimated in superficial and deep dermis. At 7d, 14d, and 21d the blood pressure of LNAME group was higher compared with control group (p 〈 0.001 for all). The wound contraction of LNAME group was slower compared with control group at 14d and 21d (p = 0.004 for both). In superficial dermis, vessels were more dilated in control group compared with LNAME group at 14d and 21d (p = 0.02; p 〈 0.0001, respectively) and longer in control group compared with LNAME group at 7d and 14d (p = 0.043; p = 0.002, respectively). Deep dermal vessels were more prominent and dilated in control group compared with LNAME group at 21d (p = 0.003; p = 0.0007, respectively), but at 7d, vessels were more dilated in LNAME group compared with control group (p = 0.015). In deep dermis, vessels were longer in control group compared with LNAME group at 14d and 21d (p = 0.002; p = 0.046, respectively). Our results show that nitric oxide inhibition affects the wound contraction and the vascularization pattern, mainly in the later phases of skin wound repair.

Notes: Liver myofibroblasts are the key cells of liver fibrogenesis. Recent data show that the serine proteinase thrombin is involved in fibrogenesis through a mitogenic effect on myofibroblasts. The aim of this study was to evaluate the effects of thrombin on the migration of human liver myofibroblasts; another major parameter in fibrogenesis.In a Boyden chamber assay, thrombin dose-dependently (10−10–10−7 M) decreased spontaneous myofibroblast migration down to 49 ± 1% of control values (p = 5.10−10) without affecting cell adhesion or viability. Thrombin effect was blocked by its specific catalytic inhibitor hirudin and could be reproduced by using the proteinase-activated receptor-1 (PAR-1) agonist SFLLRNP. Thrombin also completely inhibited migration when induced by the chemotactic agent platelet-derived growth factor-BB. We then investigated the signaling mechanisms involved. The COX-2 inhibitor NS398 dose-dependently (2.5–10 μM) blunted the inhibitory effect of thrombin on spontaneous migration. However, NS398 did not reverse the inhibitory effect of thrombin on PDGF-BB-induced migration. Phosphatidylinositol 3-kinase (PI3-K) is a major determinant of chemotaxis induced by PDGF. Whereas thrombin did not itself induce PI3-K activity, as shown by the lack of detectable phosphorylation of Akt-1, it inhibited PDGF-BB-induced Akt-1 phosphorylation. This effect was dependent of the Rho/ROCK pathway since it was abolished in the presence of the ROCK inhibitor Y-27632.In summary, thrombin, acting via a proteinase-activated receptor, inhibits human liver myofibroblasts migration. Inhibition of basal migration is dependent on COX-2, while inhibition of PDGF-BB-induced migration involves decreased PI3-K activation via a Rho/ROCK mechanism. We suggest that thrombin could thus stabilize activated myofibroblasts on the site of active fibrogenesis.

Notes: ICR-derived glomerulonephritis (ICGN) mouse is a hereditary model animal for nephrotic syndrome with chronic renal tubulointerstitial fibrosis. In fibrotic disorder, myofibroblastic differentiation plays crucial roles in pathogenesis and is dominantly regulated by the transforming growth factor-beta1 (TGF-β1) signaling system. To reveal the relationships between the pathogenic mechanism of the renal fibrosis and TGF-β1 signaling in ICGN mice, we examined the expression and localization of TGF-β1 signal transducer proteins, TGF-β receptor (TGFR)-I, TGFR-II, Smad2/3 and Smad4, in kidney sections and in primarily cultured renal tubulointerstitial fibroblasts (TIFs). In kidneys of ICGN mice, many TIFs were differentiated to myofibroblastic cells, confirmed as alpha-smooth muscle actin (αSMA)-positive cells, and though no significant increase in production and activation of TGF-β1 were observed in ICGN-TIFs as compared with control ICR-TIFs. The rate of αSMA positive cells in ICGN-TIFs increased during cell culture but not in those of ICR-TIFs. In vitro transcriptional reporter assay for TGF-β1 and Western blotting for TGF-β1 signal transducers revealed that no notable differences in the expression levels of TGFR-I, TGFR-II or Smad2/3 were seen between ICR- and ICGN-TIFs. However, augmented cytoplasmic Smad4 in ICGN-TIFs was observed, and it may cause hypersensitivity against TGF-β1. These results indicate that abnormal cytoplasmic augmentation of Smad4 induces acceleration of TGF-β1 signaling and fibrogenic myofibroblastic differentiation in the renal tubulointerstitial cells of ICGN mice.

Notes: Mechanical stress is a crucial factor for modulating fibroblasts into differentiated myofibroblasts, which are characterized by expression of α-smooth muscle actin (α-SMA). Incorporation of α-SMA into stress fibers generates high contractile activity and drives the formation of “supermature” focal adhesions (FA) that are considerably longer (6–30 μm) compared with “classical” FAs (2–6 μm) of α-SMA-negative fibroblasts. We here show that in turn, supermature FAs control myofibroblast differentiation by communicating the level of extracellular matrix stress to the cytoskeleton. Culture on compliant silicone substrates reduces the size of supermature FAs to that of classical FAs and leads to a concomitant decrease of α-SMA expression. Incorporation of α-SMA into stress fibers requires the formation of FAs longer than 6 μm as demonstrated by plating myofibroblasts on arrays of adhesive islets with dimensions ranging from 1.5 × 2–20 μm and spacing between 2–6 μm, which are created on rigid culture surfaces by means of microcontact printing (μCP). Stretching 6 μm islets on flexible silicone membranes to 8 μm length induces stress fiber formation of α-SMA-EGFP transfected fibroblasts; this was not achieved by applying the same stretch (30%) to cells initially grown on 4 μm islets. By analyzing local deformations created in deformable micropatterned substrates by paxillin-EGFP transfected myofibroblasts, we determined a linear relationship between the size of supermature FAs and local force exertion; hence we determined the minimal tension at individual supermature FAs required for α-SMA recruitment.

Notes: The normal ripening of the human cervix is characterized by rapid degradation of the extracellular matrix, where fibroblasts play an important role. To accomplish this, the fibroblasts undergo phenotypic changes, generally characterized by decreased synthesis of ECM molecules and increased production of degrading enzymes. The hypothesis of this study is that fibroblasts from cervices at different stages of remodeling are of different phenotypes. Fibroblasts were obtained from nonpregnant women, women after 36 weeks of pregnancy and women directly after partus (postpartal) and kept for at least three–four passages to obtain stable conditions prior experiments were performed. The cells were immunostained for differentiation markers, screened for cytokine and MMP expression and production, followed by a global proteomic search. In accordance with in vivo data, a decrease of α-smooth muscle actin and 4-prolyl-hydroxylase was noted by immunohistochemical staining with time of pregnancy. The fibroblasts established from postpartal donors had a three- to fourfold increase of interleukin 6 (IL-6). The production of the chemotactic interleukin 8 (IL-6) was increased even further, five- to sixfold, in postpartal fibroblast cultures. This correlates well to the events in vivo, where IL-6 and Il-8 is produced in high amounts by cervical fibroblast. In addition also the secretion metalloproteinase 1 and 3 are increased threefold in postpartal cultures, which is in agreement with in vivo events. Intermediate amounts of interleukins and metalloproteinases are produced in culture obtained after 36 weeks of pregnancy. A global proteomic approach resulted in regulated proteins involved in Ca-signaling, cytoskeletal mobility and apoptosis. Taken together these data suggest that remodeling of cervix is achieved by a transient activation or recruitment or differentiation of active fibroblasts usually found in inflammatory conditions, characterized by increased MMP and cytokine expression.

Notes: We describe here a new animal model designed to assess the impact of ischemia on wound healing. Among eight patterns of arterial lesion, resection of the external iliac artery down to the femoral artery at the level of the knee was chosen as the reference model, and was performed on the left limb in 24 Wistar rats. The right limb was sham operated and was used as a control. Skin wounds measuring 1.2 × 0.8 cm were created bilaterally on the dorsal aspect of the foot. Blood flow, measured by laser Doppler flowmetry, decreased by over 90% in the ischemic limb after arterial lesion. A significant delay in wound closure was observed with a measurable decrease in wound contraction. Quantification of myofibroblasts by means of α-smooth muscle actin staining showed a significant delay in the appearance and a decrease in the number of myofibroblasts. These findings suggest that decreased wound contraction plays an important role in delayed ischemic wound healing, probably due to reduced myofibroblast development and activity. The model we have developed may also be useful for further investigating other mechanisms of wound healing, for testing pharmaceutical agents and for the study of the impact of pathological conditions such as hypertension or diabetes mellitus.

Notes: Fibroblast to myofibroblast modulation is characterized by expression of α-smooth muscle actin (α-SMA) and represents a crucial step in granulation tissue contraction during wound healing. We have recently demonstrated that myofibroblasts develop cadherin-type cell-cell adherens junctions (AJs), which join stress fibers over the cell membrane. Cadherin expression changes from N-cadherin to OB-cadherin upon TGF-β induced myofibroblast differentiation in culture and coincides with the enlargement of AJs. We here show that myofibroblast AJs exhibit a higher mechanical resistance compared with that of α-SMA-negative fibroblasts by measuring the binding strength between two cells. (1) By separating two suspended cells placed in contact with laser tweezers, we revealed two types of Ca2+-dependent adhesion bonds with different strength. The first bond exhibited a breaking force of 5.5 ± 1.5 nN and existed in both, fibroblasts and myofibroblasts. The strength of the second bond differed between the two cells, breaking at 18.2 ± 0.8 nN in fibroblasts and at 23.0 ± 1.5 nN in myofibroblasts. Measuring the adhesion force between two plated cells by atomic force microscopy after short contact grossly confirmed these observations. Since no cyoskeletal reinforcement was involved in these experimental conditions, we suggest that these differences represent the different cadherins involved in (myo)fibroblast adhesion. (2) Subjecting suspended cells that were attached to plated cells to hydrodynamic forces in a flow chamber demonstrated ∼18% higher adhesion of myofibroblasts over fibroblasts at shear forces of 4 Nm−2. This higher adhesion was reduced to the level of fibroblast attachment by a peptide that inhibits α-SMA-mediated contraction, indicating AJ reinforcement by α-SMA-positive stress fibers. To conclude, high cell-cell adhesion of myofibroblasts appears to be determined by their specific cadherin pattern and by α-SMA-mediated mechanical reinforcement of AJs.

Notes: Fibrocytes are a unique leukocyte subpopulation implicated in wound healing. They are derived from peripheral blood mononuclear cells, display fibroblast-like properties, and synthesize extracellular matrix macromolecules. This study investigated whether fibrocytes are present in healing burn wounds and whether the number of fibrocytes in tissue correlates with the degree of burn injury and the development of hypertrophic scar. Proteins extracted from cultured fibrocytes and nonadherent lymphocytes were found to be similar using two-dimensional gel electrophoresis and quite distinct from those obtained from fibroblasts. However, one protein, identified as leukocyte-specific protein 1 using mass spectrometric peptide mapping, was found in significantly larger amounts in fibrocytes than in lymphocytes but was undetectable in fibroblasts. Double immunostaining with antibodies to leukocyte-specific protein-1 and to the N-terminal propeptide of type I collagen was performed on cryosections of hypertrophic scar, mature scar, and normal skin. Fibrocytes were seen in scar tissue as dual-labeled spindle-shaped cells but were absent from normal skin. Moreover, the number of fibrocytes was higher in hypertrophic than in mature scar tissue. We conclude that fibrocytes, which have been reported to be antigen-presenting cells, are recruited to wounds following extensive burn injury and could potentially upregulate the inflammatory response and synthesize collagen and other matrix macromolecules, thus contributing to the development of hypertrophic scarring.

Notes: Dermal fibroblasts actively contribute to wound healing by migrating to the wound, synthesizing extracellular matrices, and generating mechanical forces within the wound to initiate wound contraction. Fibroblast-seeded collagen gels provide an in vitro model to study wound contraction. The authors are evaluating the role of the adrenergic signaling system in cutaneous wound repair and recently found that β2-adrenergic receptor (β2-AR) activation markedly decreases keratinocyte migration, an essential step in wound reepithelialization. Because the β2-ARs are also expressed on dermal fibroblasts, a study was initiated to determine the effects of β-adrenergic agonists on dermal fibroblast-mediated collagen gel contraction. A β-agonist (isoproterenol) delayed gel contraction in a dose-dependent manner. A β2-AR specific antagonist (ICI 118,551) prevented the delay, indicating that the β2-AR alone mediated the delay. The active cyclic adenosine monophosphate (cAMP) analog also delayed collagen gel contraction, whereas an inactive cAMP analog partially prevented the delay, suggesting that the mechanism for β-AR agonist–mediated delay was partly cAMP-dependent. Identifying and characterizing agents that modulate wound contraction improves understanding of the wound healing process and could result in novel therapeutic strategies for preventing unwanted wound contraction in burn and trauma patients.

Notes: Lucilia sericata larvae, or greenbottle fly maggots, placed within chronic wounds have been observed to remove necrotic tissue and infection. They are also believed to actively promote granulation tissue formation. Interactions between fibroblasts and the surrounding extracellular matrix play a crucial role in tissue formation, influencing fibroblast proliferation, migration, and tissue remodeling. For example, the strength of cell adhesion to surfaces coated with extracellular matrix influences cell motility. L. sericata larval excretory/secretory products having previously been shown to modify fibroblast adhesion to collagen and particularly fibronectin, it was hypothesized that these products would alter fibroblast migration. This was investigated using a two-dimensional in vitro wound assay, time-lapse digital photography, enzyme class-specific substrates and inhibitors, and gel electrophoresis. Results showed that L. sericata excretory/secretory products promoted fibroblast migration upon a fibronectin-coated surface. This was related to the degradation of fibronectin by serine proteinases within maggot excretion/secretions. The presence of a metalloproteinase activity may also have played a role. Thus, a possible mechanism by which maggots enhance tissue formation within wounds may be via the promotion of fibroblast motility, providing for a wider distribution of viable fibroblasts.

Notes: Cell-to–cell interactions between human mesenchymal stem cells and potential adjacent cells such as endothelial cells, dermal fibroblasts, and epidermal keratinocytes was investigated. A modified dual Boyden chamber assay using 8-µm pores revealed a more powerful chemotactic cell migration of human mesenchymal stem cells toward human epidermal keratinocytes than other cells, such as umbilical artery endothelial cells and dermal fibroblasts, during 16 hours of incubation (336.2 ± 52.33, 36.0 ± 11.20, and 62.7 ± 18.16, cells/field, respectively, p 〈 0.01; comparison between endothelial cells and keratinocytes, and fibroblasts and keratinocytes). Scanning electron microscopy showed human mesenchymal stem cell migration through the pores, with endothelial cells, fibroblasts, or keratinocytes in the lower chambers. Mesenchymal stem cell ultrastructural changes occurred, including a larger euchromatin nucleus, when the cells were placed in medium containing 10 percent fetal bovine serum, whereas basic fibroblast growth factor maintained the immature cell morphology for 4 days. Monolayer coculture also showed human mesenchymal stem cell changes in ultrastructural morphology in the vicinity of the epidermal keratinocytes. These data suggest that human mesenchymal stem cells may interact with human epidermal keratinocytes to accelerate wound healing and coverage.

Notes: Introduction:  Diabetic Foot Ulcers (DFU) continue to present a formidable challenge in terms of morbidity and healthcare costs. Increasing evidence ascertains the important role of Matrix Metallo-Proteinases (MMPs) and their tissue inhibitors TIMPS in wound healing. Imbalance of MMPs in the DFU microenvironment has been associated with poor wound healing. Current research is directed toward therapeutic agents that could redress the imbalance of MMPs / TIMPs. Polyhydrated Ionogens (PHIs) formulation is based on metallic ions and citric acid. PHI application aims to positively restore MMP ratios within chronic wounds. This initial multicenter pilot study aimed to investigate the efficacy of the PHI formulation in achieving stable wound closure in recalcitrant DFUs.Methods:  Twenty-nine patients with therapy resistant DFUs of at least 2 cm2 and 3 months duration were treated with PHI formulation in an acetate carrier dressing. Wound debridement, digital imaging, and wound perimeter tracing were performed weekly. Serum samples and punch biopsies were taken from random ulcers for quantitative MMP/TIMP analysis at three time points to assess feasibility of this method. Patient satisfaction was assessed with a questionnaire.Results:  Stable wound closure with high patient satisfaction was achieved in 15 (75%) DFUs. MMP/TIMP ratios within different healing phases were delineated.Discussion:  This pilot study’s encouraging results prompt us to further investigate the PHI efficacy in DFU treatment in a Web-based, multicenter, randomized controlled trial.

Notes: Purpose:  Gene therapy provides a useful method to enhance wound healing, but it has not been attempted in healing of wounds in flexor tendons in the hands, which inherently lack sufficient intrinsic healing capacity. To explore the potential of application of gene therapy to tendon wound healing, we genetically modified tenocytes with the platelet-derived growth factor-B (PDGF-B) and the vascular endothelial growth factor (VEGF) gene and investigated the expression of the genes for collagen production in an in vitro model of the proliferating tenocytes.Method:  Tenocytes were obtained from cultures of rat intrasynovial tendons and randomly distributed to 34 dishes. The tenocytes in dishes in two experimental groups (n = 9, each group) were treated for 12 hours with the plasmid containing the PDGF-B cDNA or the VEGF cDNA and were then cultured for 5 days; tenocytes in the other eight dished received sham vector and the tenocytes in the control dishes (n = 8) did not receive the exogenous gene. Efficiency of the gene transfer was evaluated by detection of the presence of the transgene in the tenocytes by reverse transcription polymerase chain reactions (RT-PCR). Levels of expression of type I and III collagen, and TGF-β genes were determined by quantitative analysis of the products of RT-PCR.Results:  Expression of the type I collagen gene was significantly increased by transfer of the exogenous PFDGF gene to the tenocytes (p 〈 0.001). Transfer of the PDGF-B gene did not affect the expression of TGF-β and the type III collagen genes significantly. Expression of TGF-β gene increased significantly in the cells treated with exogenous VEGF cDNA (p = 0.039). Expression of type I and III collagen genes by tenocytes was minimally affected by transfer of the VEGF gene to the tenocytes and was significantly weaker than that stimulated by PDGF-B gene therapy (p = 0.001). Efficient gene transfer was confirmed by the presence of the PDGF-B gene or the VEGF gene in the tenocytes receiving the transferred genes.Conclusions:  Transfer of exogenous PDGF-B gene significantly enhances expression of the type I collagen gene of the tenocytes. Transfer of exogenous VEGF gene has very limited effects on promotion of collagen production in the proliferating tenocytes. In contrast, transfer of the VEGF gene significantly increases expression of the TGF-β gene. This study suggests that transfer of the PDGF-B gene may offer a novel way of effectively promoting healing of intrasynovial flexor tendons. VEGF gene therapy is not as beneficial as PDGF-B gene therapy to tendon healing and may increase activities of TGF-β that are associated with adhesion formations.

Notes: Tissue ischemia is a common occurrence in many disease processes including chronic wounds, stroke, solid tumors, and myocardial infarction. The application of gene delivery for healing of wounds has demonstrated increasing therapeutic promises in animal models. Adenoviral vectors have been successfully used for gene delivery to the ischemic wound. However, these vectors typically demonstrate short, transient transgene expression while eliciting significant cytotoxic immune response. Adeno-associated viral vectors (AAV) do not have those limitations; however, scant information is available about their transfection efficiency under low-oxygen tension. The goal of this study was to compare AAV vector with adenoviral vector in terms of relative efficiency of gene delivery and cytotoxic immune response in ischemic wounds. Reporter constructs Ad5-LacZ and AAV-LacZ (108 pfu/wound) were injected onto the dermis of rabbit ear prior to creation of ischemic wounds. Wounds were harvested at postoperative day 10. Frozen sections of the wounds were fixed in cold acetone and stained with an in situ β-gal staining kit. Intense expression of β-gal was observed with both vectors; however, transduction rates with AAV vector was approximately 10-fold lower than Adenovirus. Unlike Adenovirus, no noticeable inflammatory cell infiltration was observed with AAV injection. Even when the dosage of AAV was increased to 109 pfu/wound inflammatory cell infiltration remained negligible. Thus our data indicates that both AAV and adenoviral vectors are suitable to use in gene-therapy experiments in ischemic tissues. The particular advantage of AAV is the ability to transfect with higher doses while at lower dose maximal transfection rate seems to be more with Adenovirus.

Notes: Fibroblasts in chronic wounds, and in skin in which ulcers develop, have been reported to show characteristics of senescence, presumably induced by conditions predisposing to chronic wounds or the wound environment. In monolayer culture, secretion of IL-8 declines to zero as the cells approach senescence (at about generations 50–55 in the cells tested). In three-dimensional scaffold-based tissue culture, fibroblasts, at about 30–35 population doublings, upregulate the IL-8 gene by comparison with monolayer cultures and secrete large amounts of IL-8 (30–50 ng/106 cells/day). However, it is inferred that a decline in secretion, similar to that seen in monolayer also occurs in three-dimensional culture and in the senescent fibroblasts of chronic wounds. This will result in decreased influx and activation of neutrophils. The hypothesis is proposed that chronic wounds arise because fibroblasts, following injury to ulcer-prone skin, do not recruit and activate neutrophils sufficiently to prevent bacterial colonization. As the result of the persistent presence of live bacteria, inflammatory cells or keratinocytes in a wound site may be expected to trigger mechanisms to inhibit keratinocyte migration and reepithelialization, leading to chronic ulceration.

Notes: Delayed healing can result for a number of reasons; however, one important factor in the wound healing process is the role of bacteria. An imbalance in the wound bioburden may lead to infection, and thereby severely delay healing. Thus to ensure healing progresses in a timely manner, it is necessary to maintain a healthy microbial balance and prevent any impending infection.Dermal cells such as fibroblasts and keratinocytes generate numerous chemokines and growth factors that regulate the immune response and the phases of healing. While topical antiseptics and antimicrobials can kill bacteria and are therefore used to help manage infection in wounds, they may also be cytotoxic to these important cell types. Cytotoxicity is acceptable when overt clinical infection is present, due to a greater need for bacterial balance. However, clinical signs of infection in chronic wounds may not be present, making it difficult to correctly determine diagnosis and appropriate use of these antimicrobial products. In these cases, a product which addresses both the antibacterial action of topical antiseptics/antimicrobials and their impact on key healing factors, (i.e., cytotoxicity to host cells), could help reduce the incidence of wound infection without impacting the rate of healing.In this study we investigated the effect of silver-ORC and an ORC/collagen matrix containing silver-ORC on human dermal fibroblast proliferation. The antimicrobial properties of the dressing was also investigated, in in vitro studies using common bacterial wound pathogens.While other silver-releasing dressings address the bioburden of nonhealing wounds, their in vitro cytotoxicity suggests that the rate of healing may not be optimal if the presence of infection is questionable. In contrast this in vitro work suggests the ORC/collagen matrix containing silver-ORC is not cytotoxic, but is still capable of controlling wound pathogens, suggesting it may be used on a broad spectrum of wounds independent of their bacterial bioburden.

Notes: Removal of necrotic tissue is essential for wound-bed preparation for the treatment of chronic wounds. Enzymatic debridement appears to be most useful in the removal of eschar when surgical techniques cannot be utilized. The purpose of this study is to determine the efficacy of papain–urea chlorophyllin ointment compared to moist wound care using an infected, acute, porcine full thickness wound model. Twenty full thickness wounds were created on the dorsum of domestic pigs. Following hemostasis, the wounds were contaminated with wound-isolated bacteria then treated with test articles and dressed with moisture-retentive dressing. All the wounds were evaluated 1, 4, 8, 11, 14,18, and 21 days postsurgery for epithelialization and biopsies were obtained for microscopic evaluation. The results showed no adverse effect in reepithelialization in acute wounds when using papain–urea chlorophyllin "ointment compared to moist wound care, TEWL measurements also showed no adverse affects from the treatment. Microscopic examination reveals an increase in the number of keratinocytes present in the epidermis of the treated pigs as well as an increase in the depth of rete pegs. New blood vessel formation was increased at all examined time points in the papain–urea chlorophyllin ointment treated pigs, which was verified with CD31 and von Willebrand Factor staining. VEGF was increased after 1 week in the wound fluid from treated wounds compared to moist control. While the reepithelialization rate does not appear to be inhibited by papain–urea-chlorophyllin combination in acute wounds, the healing appears to be more complete based on the number of keratinocytes present in the epidermis and the extensive rete peg formation. The wounds also appear to have enhanced vascularization which is vital in supplying nutrients to the newly healed wound.

Notes: We previously showed that Calreticulin (CRT), a chaperone of the endoplasmic reticulum, has profound effects on the process of wound healing by increasing both epithelial migration and granulation tissue formation in models of impaired porcine and murine repair. In the present study, using the scratch plate assay as an in vitro model of wound repair, we show that CRT (10−6–10−9 M) induces cell migration/wound closure in human keratinocytes and fibroblasts that is equivalent to EGF (positive control). Furthermore, by an MTS proliferation assay, CRT stimulated cellular proliferation of human keratinocytes (2-fold), fibroblasts (100-fold), and vascular endothelial cells (1.2-fold). Markedly increased cellular proliferation was confirmed by anti-ki67 immunostaining (IHC) which was confined to basal keratinocytes in the CRT-(5 mg/ml) treated porcine and murine wounds during reepithelialization and in numerous cells of the granulation tissue. Also, CRT increased dermal depth and granulation tissue formation between days 6–14 following injury (p 〈 0.05). The effect of CRT on the dermal layer was qualitatively different than PDGF or PBS as there was a remarkably higher number of dermal cells that reconstituted the CRT-treated pig wounds, a more organized pattern of collagen organization by picrosirrius red staining, and greater fibronectin and TGF-β3 by IHC. CRT also increased tensile strength in a rat incisional wound model (p 〈 0.005 @ 21 days). By Mac-138 IHC of porcine wounds, we observed an increase in macrophages in the wound bed compared to PDGF (p 〈 0.013). Since the uptake of apoptotic cells by phagocytes is a CRT-dependent process, this finding suggests a potential role for CRT as a bacteriocidal and/or debriding agent. Unlike PDGF, CRT positively affects both the epithelial and dermal aspects of repair. Our studies suggest that CRT accelerates and improves the rate and quality of wound repair by affecting many cells involved in the repair process.

Notes: The paradigms of surgical wound closure are direct repair, grafts, and flaps. The core subject of plastic surgery, these distinct modalities are a sophisticated art that can reliably close any healthy wound. The caveat is that ordinary surgery implicitly depends on competent wound healing. With pathological wounds, those due to vascular, hematological, immunopathic, and other ulcerogenic diseases, these modalities may not work. The operation is threatened if wound healing is retarded, and incisions and donor sites are subject to morbidity from active disease. Disease and risks may limit potential donor tissues, sustain inflammation and lysis, restrict circulation, or make the patient too ill for elaborate procedures.Integra® collagen-chondroitin matrix has ideal properties for managing chronic pathological wounds: a high-grade artificial skin; survives disease and conditions where grafts die; performs the coverage duties of flaps without donor sites; minimizes nursing care; suppresses inflammation, wound healing, and scar; induces embryonic dermatogenesis. Risk free to the recipient, it is safe where disease and altered anatomy make conventional closure impossible or unsafe. Its indications, use, results, and conceptual basis make it a distinct fourth paradigm of surgical wound closure: in situ tissue engineering. Understanding when a flap should but cannot be used is to understand when Integra should be used.Study:  Using a consistent set of indications and management scheme, Integra was used for chronic pathological wounds in 111 patients (158 individual ulcers, 166 instances of exposed anatomical structures, diverse diagnoses). Success rate was 92% of patients healed; 90% of open structures healed. Inpatient services were nearly eliminated.Integra is not an alternative to conventional repair, grafts, and flaps. As a method of tissue engineering, it is a new and equal paradigm of care with its own indications and contraindications, and a superior safety and success profile. Repair, grafts, and flaps, which require wound healing competency, are best suited for healthy and acute wounds. For many chronic and pathological wounds, in situ matrix-guided histogenesis is the best method, and surgeons must begin working this into their practices.

Notes: The potential to lower destructively high levels of elastase found in chronic wounds with oleic acid-treated cotton wound dressings was assessed and compared with two types of oleic acid-treated occlusive wound dressings. The ability of albumin to bind oleic acid and transfer elastase inhibitory activity from the dressing material to elastase in solution was examined. Cotton, hydrogel, and hydrocolloid wound dressings were treated with oleic acid and tested for their ability to lower elastase activity. Oleic acid–treated cotton gauzes, hydrogels, and hydrocolloid dressings were found to release oleic acid in the presence of albumin in sufficient quantities to inhibit elastase activity. The order of elastase lowering activity with the three oleic acid-formulated wound dressings was cotton gauze 〉 hydrogel 〉 hydrocolloid. Elastase inhibition by oleic acid displaced from gauze followed a dose response profile. In contrast Cathepsin G, when displaced by albumin, was inhibited within a narrow range of oleic acid formulations. The effect of albumin levels representative of the chronic wound on displacement of oleic acid was determined. Solubilization of cotton bound oleic acid by albumin was found to be most effective at 4% albumin. However, there was sufficient solubilization of oleic acid at the 2% albumin levels found in chronic wound fluid to achieve a significant elastase-lowering effect. Albumin promoted solubilization of oleic acid from cotton with a solubility threshold of 27 mg/g cotton gauze. Equivalent lowering of elastase activity was found with 1%, 2%, and 4% albumin concentrations with oleic acid on cotton at 128 mg oleic acid/gram of cotton.

Notes: Introduction:  Currently freeze-dried, gamma-sterilized, or glycerol-preserved amniotic membranes are widely used. However, it is not clear whether this devitalized state is the optimal application form. Therefore within this study the ideal condition for midterm storage of human amniotic membranes was assessed to ensure the availability of vital amniotic membranes, in particular for burn wounds.Methods and Materials:  For this purpose mothers were serologically tested and term placentae were collected and washed. After the amniotic membrane was peeled off and further washed, biopsies were taken for microbiological testing and various storage experiments (different media and temperatures).〈list style="custom"〉• cell culture medium, 37 °C• glycerol, 4 °C• 10% DMSO, −80 °CViability of fresh and stored amniotic membranes was determined with the MTT-based EZ4U- Assay (Biomedica, Vienna, Austria).Results and Discussion:  Best results were obtained while storing the membranes in cell culture medium at 37 °C, whereas storage in glycerol at 4 °C resulted in cell death within the first 4 days.To our knowledge this is the first study investigating the viability of amniotic membrane under different storage conditions. The influence on wound healing is currently under investigation.

Notes: Sepsis remains the single most important cause for multiple organ failure and death following burn injury for which no effective treatment is currently available. Burn injury is associated with immunosuppression which promotes sepsis. Studies from our laboratory have demonstrated that levels of the antimicrobial peptide (AMP), human β-defensin-2, was significantly decreased in burned skin epithelia, absent in burn blister fluid and poorly expressed in lung during inhalation injury.We hypothesize that 1) deficient antimicrobial peptides in burn wound promote progressive colonization of pathogens in burn wounds and 2) replacing active peptide components will restore the antimicrobial activity in burn wounds. We have synthesized several cationic steroid antimicrobials (CSAs) which mimic naturally occurring AMPs functionally. In vitro experiments using one of these synthetic drugs with locally isolated common burn pathogen P. aeruginosa and S aureus demonstrate MIC values of 2.0 ± 0.3 μg/ml and 0.4 ± 0.1 μg/ml, respectively, indicating effectiveness of these compounds against burn pathogens. These drugs were tested for cytotoxicity on cultured human keratinocytes using MTT cell viability assay. Results indicate that these drugs are nontoxic to cultured keratinocytes at the level required for bacterial killing. Since theses drugs are membrane active compounds it will be hard for bacteria to develop resistance and there is a great potential to be developed for clinical treatment.

Notes: Background:  Acinetobacter baumannii has recently emerged as an important hospital-acquired pathogen, especially in surgery, burn, and intensive care units. Due to its ability to develop resistance to antimicrobials, wound infection with A. baumannii is difficult to treat, and can lead to septicemia and even death. Use of appropriate topical antimicrobial agents in these circumstances could be one of the first steps in prevention of A. baumannii wound infection.Objectives:  In this study, we will discuss the in vitro effects of seven common topical antimicrobial creams and dressings on A. baumannii.Methods:  A. Baumannii ATCC# 6919 was subjected to sensitivity tests against mupirocin, silver sulfadiazine, mafenide acetate, a double antibiotic combination of polymyxin and bacitracin, a triple antibiotic combination of Neomycin, bacitracin and polymyxin, and two silver-containing dressings. Zones of inhibition were measured after 24 hours incubation period.Results and Conclusion:  Of the evaluated antimicrobial agents, mafenide acetate was the most efficacious followed by mupirocin, triple and double antibiotic combinations in decreasing order. The silver-containing dressings yielded a lesser zone of inhibition as compared to the previously mentioned, and no zone of inhibition was observed using silver sulfadiazine. Further in vivo studies on the effect of antimicrobial agents against A. Baumannii are necessary to substantiate these findings and determine the potential clinical relevance of these therapies.

Notes: Often chronic wounds have an increased bacterial burden that can impair healing without the classical clinical signs of infection. Silver dressings may provide an alternative topical method to control bacterial burden.The primary aim of this study was to evaluate the effect of 2–4 weeks therapy with the Silver Containing Hydrofiber® dressing on quantitative bacterial burden and clinical improvement in chronic wounds not healing at the expected rate.This was a single centre, four-armed study which included a total of 30 patients with diabetic foot ulcers, leg ulcers, pressure ulcers and miscellaneous wounds that did not fit into any of the above categories. Patients had a baseline quantitative bacterial biopsy and this was repeated at weeks 2 to 4. The wound size was recorded along with a semi quantitative estimate of exudate and the periwound temperatures. Repeat measurements were performed at the follow-up visits and the decrease in wound size calculated. The underlying cause of the ulceration was be treated and corrected. This was followed by application of silver containing hydrofiber® dressing. There was a significant delay in healing of the leg ulcers associated with increased bacterial burden in the quantitative biopsy bacterial burden results at week 0 and healing at week 2. (p = 0.01). Other subgroups had a similar association that did not reach statistical significance. The presence of an increased exudate in the leg ulcers at week two was associated with delayed healing at week 4 (p = 0.05). There was also a significant increase in skin surface temperature of the surrounding skin with an increased quantitative bacterial biopsy of the deep wound compartment for venous, diabetic neurotrophic foot ulcers and pressure ulcers with p values of 0.05, 0.01 and 0.01 respectively. There was no significant decrease in exudate or increased healing of the wounds with the application of the silver hydrofiber dressing in this difficult to heal population. The population studied in this case series had increased bacterial burden in the deep compartment as measured with increased exudate and or an increased temperature of the periwound skin. These patients have an increased bacterial burden in the deep wound compartment that does not respond to topical ionized silver in the dressing studied.

Notes: Despite recent advances in wound care, chronic infected ulcers still remain a huge challenge to the modern society. Nitric oxide has been identified as a mediator for important biological processes such as vasodilation, antimicrobial, and wound repair. The aim of the present study was to explore the antimicrobial properties of exogenous nitric oxide gas (gNO) as well as its effect on skin cells in vitro. To test this, a specialized gNO chamber was designed to expose S. aureus and P. aeruginosa in saline continuously to 200 ppm gNO or air. A colony count was obtained following gNO treatment. Furthermore, fibroblast-populated collagen gel, keratinocytes, and endothelial cells were cultured in DMEM, KSFM, and M199, respectively. Endothelial migration was tested by a 3D Matrigel tubule formation assay. Fibroblast matrix production and keratinocyte differentiation were monitored by mRNA expression of procollagen type I, interstitial collagenase, and involucrin. All cells were exposed to 200 ppm gNO for 8 hours a day for 3 consecutive days. A MTT assay was used to observe cell proliferation. The results revealed 100% bacterial kill following 4 hour exposure to 200 ppm gNO. Interestingly this dose did not exhibit any significant toxic effect on fibroblast, keratinocyte, and endothelial proliferation. Dermal fibroblasts migration out of the collagen gel was not affected by gNO treatment when compared to the control. The keratinocytes in both groups were able to express involucrin, an indicator of cell’s ability to differentiate. The migration and tube formation by endothelial cells within the matrigel was not compromised following gNO treatment. In conclusion, the present study provided evidence for potential application of gNO for reducing bacterial burden in chronic infected wounds without compromising re-epithilialization, proliferation, and angiogenesis in the wound healing process.Acknowledgment:  This study was funded by PulmoNOx Medical Inc.

Notes: Skin substitutes are slowly finding a position in the treatment of burns, scar reconstructions and chronic wounds. Some of the substitutes consist of extracellular matrix replacement material only, such as Integra and Alloderm; some include allogeneic cells (Dermagraft, Appligraf). The ideal skin substitute has not been developed yet, since none of the presently available products can ultimately prevent scar formation.Study of the role of autologous fibroblasts in the healing process might give further insight into the scarring process and eventually lead to improved skin substitutes.We compared wound reepithelialization of experimental wounds treated with proliferating keratinocytes and a dermal substitute with either dermal fibroblasts, adipose tissue derived fibroblasts or no fibroblasts. We also investigated the rate of keratinocyte migration of human skin equivalents cultured in vitro in the presence of dermal or adipose tissue derived fibroblasts.We reached successful wound closure in 8 days with transfer of proliferating keratinocytes on a dermal substitute seeded with dermal fibroblasts. However, the wounds treated with substitutes which contained adipose tissue derived fibroblasts or no fibroblasts at all were not closed even after 21 days.Keratinocytes seeded onto collagen lattices populated with either dermal or fat-derived fibroblasts showed similar findings: a retarded migration and/or proliferation of keratinocytes on the collagen lattices with fat-derived fibroblasts. The collagen lattices populated with fat-derived fibroblasts also showed a marked contraction, up till 50% of the original area.In both models, more alpha-smooth muscle actin positive cells were found in the fibroblast population from adipose origin.We conclude that epidermal regeneration is negatively influenced by the presence of fat-derived fibroblasts in a dermal matrix; possibly, myofibroblasts play a role in this.

Notes: It has been known for several decades that early gestational human fetuses will regenerate cutaneous wounds resulting in a scarless repair. In postnatal humans, myofibroblasts are known to play a central role in wound healing and in the pathology of fibrosis. The role of the profibrotic growth factor TGF-β1 in human fetal fibroblasts remains unclear, with recent data now showing that TGF-β1 is present in fetal wounds but for shorter periods. We have therefore examined the effects of TGF-β1 on fibroblasts isolated from early human fetuses (〈14week EGA). We have identified that stimulation with 5 ng/ml TGF-β1 induces a significant proportion of human fetal fibroblasts to differentiate into myofibroblasts (approximately 40%), as identified by staining of α-smooth muscle actin (n = 5). Interestingly, this response was earlier (peaking at day 2–3) and more transitory (over by day 4–5) than that seen with postnatal dermal fibroblasts (peaking at day 6–8 and dropping at day 10). We examined the effects of blocking various intracellular pathways involved in TGF-β1 signalling. The early and transitory myofibroblast induction seen in fetal cells is blocked by an inhibitor of p-JNK (n = 4; p =〈 0.05). In contrast, the later and more prolonged induction of myofibroblasts seen in postnatal cells was not affected by inhibition of p-JNK. Despite the fact that fetal fibroblasts do indeed differentiate into myofibroblasts they were further shown to exhibit differential behavior to postnatal myofibroblasts with respect to TGF-β1 stimulation of collagen expression, producing significantly less soluble collagen (approximately 50%, n = 4) after 24 or 48 hours of treatment with TGF-β1 in serum-free media. These results appear to indicate a role for TGF-β1 during cutaneous wound healing in the early fetus and show that the response of fetal cells to this important profibrotic cytokine is rapid and more controlled, being short lived. It is possible that a prolonged response to this cytokine may lead to the overblown nature of postnatal wound healing, resulting in fibrosis.

Notes: Cellular contraction, defined as the force cells exhibit on the extracellular matrix, plays a significant role in dermal tissue. To study the contractility of cells in vitro, we have developed a new patented device named GlaSbox®“Growing Lattice Study Box”. It consists of a cell chamber composed with 8 rectangular wells (26 × 33 mM) in which lattices develop. Two opposite silicon beams hang down into each well. The lattice is attached to this sensor through a grid directly etched on the lower part of the beams. A strain gauge is deposited at the beam surface, and connected to form a Wheastone bridge. The strain gauges signal output is amplified then converted and collected by a computer which includes an acquisition card and a specific program giving directly the forces in real time. The significant advantages of the GlaSbox® are:〈list style="custom"〉– the absence of any interface between the collagen lattice and the beams which maintain it stretched,– its ability to test eight lattices simultaneously,– the low volumes of cells and collagen required.To demonstrate the applicability of this system, contractile forces of human fibroblasts from different skin conditions were measured such as chronic venous leg ulcers and striae distensae. These fibroblasts were found to produce an average force of 1.10−8 N/cell and have greater contractile capacity than normal fibroblasts (Viennet et al., J Wound Care 2004, in press). The GlaSbox® is a useful tool to study the contractility of dermis equivalent composed of various fibroblast lines and, the effect of different active principles or even growth factors (e.g., TGF-β) on cellular contraction. In addition, it can be used to examine the relationship between cellular contraction, cell proliferation, and collagen production, which is important for the understanding of the mechanism of scar tissue formation.

Notes: A petrogenetic grid in the model system CaO–FeO–MgO–Al2O3–SiO2–H2O is presented, illustrating the phase relationships among the minerals grunerite, hornblende, garnet, clinopyroxene, chlorite, olivine, anorthite, zoisite and aluminosilicates, with quartz and H2O in excess. The grid was calculated with the computer software thermocalc, using an upgraded version of the internally consistent thermodynamic dataset HP98 and non-ideal mixing activity models for all solid solutions. From this grid, quantitative phase diagrams (P–T pseudosections) are derived and employed to infer a P–T path for grunerite–garnet-bearing amphibolites from the Endora Klippe, part of the Venetia Klippen Complex within the Central Zone of the Limpopo Belt. Agreement between calculated and observed mineral assemblages and garnet zonation indicates that this part of the Central Zone underwent a prograde temperature and pressure increase from c. 540 °C/4.5 kbar to 650 °C/6.5 kbar, followed by a post-peak metamorphic pressure decrease. The inferred P–T path supports a geotectonic model suggesting that the area surrounding the Venetia kimberlite pipes represents the amphibolite-facies roof zone of migmatitic gneisses and granulites that occur widely within the Central Zone. In addition, the P–T path conforms to an interpretation that the Proterozoic evolution of the Central Zone was controlled by horizontal tectonics, causing stacking and differential heating at c. 2.0 Ga.

Notes: A review and reinterpretation of previous experimental data on the deformation of partially melted crustal rocks reveals that the relationship of aggregate strength to melt fraction is non-linear, even if plotted on a linear ordinate and abscissa. At melt fractions, Φ 〈 0.07, the dependence of aggregate strength on Φ is significantly greater than at Φ 〉 0.07. This melt fraction (Φ = 0.07) marks the transition from a significant increase in the proportion of melt-bearing grain boundaries up to this point to a minor increase thereafter. Therefore, we suggest that it is the increase of melt-interconnectivity that causes the dramatic strength drop between the solidus and a melt fraction of 0.07. We term this drop the ‘melt connectivity transition’ (MCT). A second, less-pronounced strength drop occurs at higher melt fractions and corresponds to the breakdown of the solid (crystal) framework. This is the ‘solid-to-liquid transition’ (SLT), corresponding to the well known ‘rheologically critical melt percentage’. Although the strength drop at the SLT is about four orders of magnitude, the absolute value of this drop is small compared with the absolute strength of the unmelted aggregate, rendering the SLT invisible in a linear aggregate strength v. melt-fraction diagram. On the other hand, the more important MCT has been overlooked in previous work because experimental data usually are plotted in logarithmic strength v. melt-fraction diagrams, obscuring large strength drops at high absolute strength values. We propose that crustal-scale localization of deformation effectively coincides with the onset of melting, pre-empting attainment of the SLT in most geological settings. The SLT may be restricted to controlling flow localization within magmatic bodies, especially where melt accumulates.

Notes: Contact metamorphism caused by the Glenmore plug in Ardnamurchan, a magma conduit active for 1 month, resulted in partial melting, with melt now preserved as glass. The pristine nature of much of the aureole provides a natural laboratory in which to investigate the distribution of melt. A simple thermal model, based on the first appearance of melt on quartz–feldspar grain boundaries, the first appearance of quartz paramorphs after tridymite and a plausible magma intrusion temperature, provides a time-scale for melting. The onset of melting on quartz–feldspar grain boundaries was initially rapid, with an almost constant further increase in melt rim thickness at an average rate of 0.5–1.0 × 10−9 cm s−1. This rate was most probably controlled by the distribution of limited amounts of H2O on the grain boundaries and in the melt rims.The melt in the inner parts of the aureole formed an interconnected grain-boundary scale network, and there is evidence for only limited melt movement and segregation. Layer-parallel segregations and cross-cutting veins occur within 0.6 m of the contact, where the melt volume exceeded 40%. The coincidence of the first appearance of these signs of the segregation of melt in parts of the aureole that attained the temperature at which melting in the Qtz–Ab–Or system could occur, suggests that internally generated overpressure consequent to fluid-absent melting was instrumental in the onset of melt movement.

Notes: New eclogite localities and new 40Ar/39Ar ages within the Western Gneiss Region of Norway define three discrete ultrahigh-pressure (UHP) domains that are separated by distinctly lower pressure, eclogite facies rocks. The sizes of the UHP domains range from c. 2500 to 100 km2; if the UHP culminations are part of a continuous sheet at depth, the Western Gneiss Region UHP terrane has minimum dimensions of c. 165 × 50 × 5 km. 40Ar/39Ar mica and K-feldspar ages show that this outcrop pattern is the result of gentle regional-scale folding younger than 380 Ma, and possibly 335 Ma. The UHP and intervening high-pressure (HP) domains are composed of eclogite-bearing orthogneiss basement overlain by eclogite-bearing allochthons. The allochthons are dominated by garnet amphibolite and pelitic schist with minor quartzite, carbonate, calc-silicate, peridotite, and eclogite. Sm/Nd core and rim ages of 992 and 894 Ma from a 15-cm garnet indicate local preservation of Precambrian metamorphism within the allochthons. Metapelites within the allochthons indicate near-isothermal decompression following (U)HP metamorphism: they record upper amphibolite facies recrystallization at 12–17 kbar and c. 750 °C during exhumation from mantle depths, followed by a low-pressure sillimanite + cordierite overprint at c. 5 kbar and c. 750 °C. New 40Ar/39Ar hornblende ages of 402 Ma document that this decompression from eclogite-facies conditions at 410–405 Ma to mid-crustal depths occurred in a few million years. The short timescale and consistently high temperatures imply adiabatic exhumation of a UHP body with minimum dimensions of 20–30 km. 40Ar/39Ar muscovite ages of 397–380 Ma show that this extreme heat advection was followed by rapid cooling (c. 30 °C Myr−1), perhaps because of continued tectonic unroofing.

Notes: High-grade gneisses (amphibolite–granulite facies) of the Namche Barwa and Gyala Peri massifs, in the eastern Himalayan syntaxis, have been unroofed from metamorphic depths in the late Tertiary–Recent. Rapid exhumation (2–5 mm year−1) has resulted in a pronounced shallow conductive thermal anomaly beneath the massifs and the intervening Tsangpo gorge. The position of the 300 °C isotherm has been estimated from fluid inclusions using CO2–H2O immiscibility phase equilibria to be between 2.5 and 6.2 km depth below surface. Hence, the near-surface average thermal gradient exceeds 50 °C km−1 beneath valleys, although the thermal gradient is relatively lower beneath the high mountains. The original metamorphic fluid in the gneisses was 〉90% CO2. This fluid was displaced by incursion of brines from overlying marine sedimentary rocks that have since been largely removed by erosion. Brines can exceed 60 wt% dissolved salts, and include Ca, Na, K and Fe chlorides. These brines were remobilized during the earliest stages of uplift at 〉500 °C. During exhumation, incursion of abundant topography-driven surface waters resulted in widespread fracture-controlled hydrothermal activity and brine dilution down to the brittle–ductile transition. Boiling water was particularly common at shallow levels (〈2.5 km) beneath the Yarlung Tsangpo valley, and numerous hot springs occur at the surface in this valley. Dry steam is not a major feature of the hydrothermal system in the eastern syntaxis (in contrast to the western syntaxis at Nanga Parbat), but some dry steam fluids may have developed locally.

Notes: Abstract  Objective: To identify the relationship of work stress and family stress to the health of women in Korea. Design: Cross-sectional study. Sample: Three hundred and thirty-one married women working in 14 manufacturing companies in Korea. Methods: Subjects responded to a questionnaire that included items on work stress, family stress, social support, and general characteristics. Perceived health status (PHS) was assessed with the Short Form-36. Results: There was a significant positive relationship between social support and PHS, but significant negative relationships were found between PHS and work stress as well as family stress. Hierarchical multiple regression analysis explained the health status of married working women by four categories: personal, work related, family related, and social support, and accounted for 45.4% of the variance. When family-related factors were added to the model, the power of explanation was increased by 17.9% compared with the explained variance. Family stress was a major variable not only for explaining the variance but also for correlating with health status. Conclusions: Both work stress and family stress should be considered together when addressing the health of working women in the industrial sector in Korea.

Notes: Abstract  Objectives: Inactive nurses' interest in volunteering for emergency preparedness was examined. Methods: A mail survey was sent to the entire Vermont Board of Nursing list of in-state inactive and lapsed registered nurses (n = 3,682). A high rate of undeliverable surveys (60%) was found and 611 surveys were returned for a 20% response rate. Results: Twenty-seven percent of the respondents were interested in volunteering. Those interested in participating in volunteer work as part of a national homeland security effort were significantly more likely to (a) be younger in age (p 〈 0.0001); (b) identify themselves as “being a nurse” (p = 0.001); (c) be employed versus retired (p = 0.002); and (d) be currently volunteers (p = 0.001). Conclusions: Because 33% of the nation's nurses are over age 50, inactive nurses offer a potentially large pool of volunteers for emergency preparedness training and response in the years to come.

Notes: Abstract  Objective : To assess the views of service users towards sexual health nursing outreach clinics situated in youth clubs. The clinics were established in economically deprived areas to meet the needs of young people aged 13–18 yrs who are reluctant to attend mainstream services. Design: Descriptive cross-sectional study. Sample and measurements: 250 questionnaires collecting data on service use and service users’ views of the clinics were distributed to a 25% sample of clinic users. In addition, 20 semi-structured interviews were conducted with service users. Results: 166 questionnaires were returned (66% response rate). The service was equally popular with males and females who often attended to meet friends but subsequently sought sexual health advice. Interviews found that young people appreciated the non-judgmental aspect of the clinics, although some reported concerns about confidentiality when the clinics were busy. Some respondents indicated that the clinics gave them confidence to discuss sexual health matters with others, but often the clinics provided advice for young people who had no one else to talk to. Conclusions: The clinics seem popular with young people, and situating services within an area young people access to socialize appears to be an effective way to target them with sexual health advice.

Notes: Abstract  Optimal home self-management in young children with asthma includes accurate symptom identification followed by timely and appropriate treatment. The objective of this study was to evaluate a home-based asthma educational intervention targeting symptom identification for parents of children with asthma. Two hundred twenty-one children with asthma were enrolled into an ongoing home-based clinical trial and randomized into either a standard asthma education (SAE) or a symptom/nebulizer education intervention (SNEI). Data included home visit records and parent's self-report on questionnaires. Symptom identification and self-management skills significantly improved from preintervention to postintervention for parents in both groups with the exception of checking medications for expiration dates and the frequency of cleaning nebulizer device and equipment. However, significantly more parents of children in the SNEI group reported treating cough symptoms as compared with the SAE group (p = 0.05). Of concern is that only 38% of all parents reported having an asthma action plan in the home. A targeted home-based asthma education intervention can be effective for improving symptom identification and appropriate use of medications in children with asthma. Home asthma educational programs should address accurate symptom identification and a demonstration of asthma medication delivery devices.

Notes: Abstract  The aim of this study was to investigate the relationships between self-reported nocturnal sleep quality and napping patterns in elderly persons with insomnia and to compare the nocturnal sleep quality between napping and non-napping groups. Convenience sampling was used to recruit 60 community-dwelling elderly residents of Taichung City, Taiwan (age range 60–83 years, mean 67.1 years) who reported insomnia. All participants scored greater than 5 on the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Napping prevalence, frequency, and duration were assessed by participant interview. Self-reported sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction were measured with the PSQI. Sixty-four percentage of participants (n = 38) reported napping. There were no age, gender, and ethnicity differences on napping patterns. Global sleep quality, sleep efficiency, and sleep disturbance were significantly associated with prevalence of napping (r = 0.24–0.26, p 〈 0.05). A significant correlation was also found between global sleep quality and nap duration (r = 0.31, p 〈 0.05). Elders in the napping group reported better global sleep quality (t = 2.2, p 〈 0.05) and sleep efficiency (t = 2.1, p 〈 0.05) than those in the non-napping group. The findings suggest that there is no need for health care providers to restrict elderly insomniacs’ daytime napping.

Notes: EDITOR's NOTE  The following reprint of the unsigned editorial for the April 1952 issue of Public Health Nursing describes the historical needs and the continuing development of school health nursing from the early to mid-20th century. Twenty-first century schools continue to deal with some of the same issues such as hunger, poor nutrition, and the adverse effects of overly burdensome work schedules on adolescent health and mental well-being. The goal, so optimistically anticipated by the editors of Public Health Nursing in 1952, of continuous, well-coordinated health supervision from birth to maturity continues to elude us. Of course, school nurses and other health personnel address problems not openly discussed in the 1950s—substance abuse, violence, sexually transmitted diseases, and teen pregnancy. The theme of this historical editorial is the power of advocacy—and the responsibility public health nurses have to use our talents to improve child health.

Notes: Abstract  Objective : To assess contraceptive behavior and whether pre-birth psychosocial factors could predict consistency in contraceptive use among adolescent mothers at six-month postpartum. Design: Prospective study. Sample: 104 Taiwanese adolescent mothers. Measurements: Participants completed a contraception questionnaire in their third trimester and a postpartum contraception questionnaire at six-month postpartum. Results: Prior to giving birth, the adolescent mothers most commonly answered that condom use (39.8%) was the contraceptive method they planned to use after delivery. It was also more commonly reported in the postpartum to be the method they actually were using (54.3%). Stepwise logistic regression analysis further showed that a more positive contraceptive attitude (odds ratio = 1.104) and a higher self-efficacy (odds ratio = 1.068) in contraceptive use in the pre-birth period increased the probability that a participant would report that she always used contraceptives in the postpartum period. Nevertheless, a higher score in the pre-birth period in the area of subjective contraceptive norms (odds ratio = 0.978) decreased this probability. The final regression model could correctly classify 81.7% of the participants. Conclusions: Health care professionals should provide adolescent mothers with the information they need to improve their attitude and self-efficacy toward contraception before they enter the postpartum period.

Notes: Abstract  Objective : Explore use, cost, and satisfaction with the quality and effectiveness of complementary therapy among older rural adults. Design: Descriptive survey. Sample: A random sample of 325 older adults from rural communities throughout Montana and North Dakota. Measurements: Participants were interviewed by telephone. Results: Only 57 participants (17.5%) had used complementary providers and most sought this care for chronic problems, heard about providers through word-of-mouth information, and were satisfied with the care. A total of 35.7%(116) used self-directed complementary practices and most used these practices for health promotion, heard about them through informal sources, and found them to be at least somewhat helpful. Of the 325 participants, 45.2%(147) used some form of complementary care, e.g., providers, self-directed practices, or both. Participants used as much complementary care as is found in national studies. Most spent relatively little out-of-pocket for complementary care. Conclusions: Understanding the health care choices that older rural residents make, including complementary health care, is paramount for a comprehensive approach to meeting their health care needs.

Notes: Abstract  Given inconclusive findings regarding racial/ethnic differences in risk for intimate partner violence (IPV), this study will estimate annual prevalence and severity of IPV and associated risk factors of homicide among a multiethnic population of English- and Spanish-speaking African American, White, and Hispanic women receiving public primary health care. A personal interview survey was conducted using three measurement instruments including a brief two-question screen. The sample consisted of 7,443 women, aged 18–44 years, receiving care at urban, primary health care clinics in southern Texas. White women disclosed abuse at a rate of 8.9%, followed by African American women at 6.0% and Hispanic women at 5.3%. More abuse was reported by White and African American women compared to Hispanic women. Use of a brief two-question screen provides racial/ethnic specific surveillance data for patient care programming and can track progress toward decreasing violence against women.

Notes: Abstract  Despite progress in meeting Healthy People 2010 goals, African American (AA) men and women have higher mortality and morbidity rates as compared with Caucasian Americans. These may be attributed to lifestyle behaviors; however, this is a complex, multifactorial problem. The purpose of this study was to examine gender differences among AA lifestyle behaviors. A descriptive comparative design was used. The sample consisted of 223 AAs residing in southeastern United States. The health-promoting lifestyle profile (HPLP) was used to measure health-promoting behaviors. Independent t-test analysis revealed no statistically significant gender differences for total HPLP scores, t(220) = −1.49, p = 0.14. When controlling for income, education, and marital status, no significant interactions were seen with gender on HPLP. Independent t-test analyses revealed statistically significant differences for interpersonal relationship support, t(221) = −1.97, p = 0.05, health responsibility, t(214) = −2.46, p = 0.02, and nutrition t(219) = −3.27, p 〈 0.01, with women scoring higher than men. Although gender differences in AAs are evident for specific health-promoting lifestyle behaviors, these differences become less dominant when education and marital status were used as covariates.

Notes:   Facilitating a distance-based public health/community health nursing practicum for RN to BSN students posed challenges and opportunities. Challenges included time involved in arranging the practicum, relationship building with agencies and staff, communicating with students, and the need for flexible practicum scheduling. Exposure to practice models from across the nation allowed students to compare and contrast these public health nursing models. Programs planning to offer this type of course should consider faculty workload particularly during the semester prior to teaching the practicum.

Notes: Abstract  Deaf persons' access to health-related information is limited by barriers to spoken or written language: they cannot overhear information; they have limited access to television, radio, and other channels for public information; and the average reading level of Deaf adults is at a 3rd to 4th grade level. However, literature searches revealed no published reports of community analysis focusing specifically on health education priorities for Deaf communities. A seven-step community analysis was conducted to learn the health education priorities in Arizona Deaf communities and to inform development of culturally relevant health education interventions in Deaf communities. The word “Deaf rdquo; is capitalized to reflect the cultural perspective of the Deaf community. A 14-member Deaf Health Committee collected data using multimethods that included review of state census data, review of national health priorities, key informant interviews, discussions with key community groups, a mail survey (n = 20), and semistructured interviews conducted in sign language with 111 Deaf adults. The community diagnosis with highest priority for health education was vulnerability to cardiovascular disease (CVD). Following completion of the community analysis, a heart-health education intervention (The Deaf Heart Health Intervention) was developed using a train-the-trainer, community health worker model. If this model proves to be effective in addressing vulnerability to CVD, then a similar protocol could be employed to address other health concerns identified in the Deaf community analysis.

Notes: Abstract  There is an increasing number of children placed in foster care due to abuse and neglect. Parents of these children often have difficult drug abuse problems leading to the removal of their children. The cost of caring for these children is staggering, reaching an estimated $24 billion. One program in Northern California that has been created to assist parents is dependency drug court. This research utilized qualitative and quantitative data to identify the perceived needs of women who have graduated from this dependency drug court (n = 50) and what they think the public health nurse (PHN) could do to intervene in the difficult process of going through dependency drug court and reunifying with their children. Two main themes emerged from select interviews with former drug court recipients who were functioning as “mentor moms” (n = 4). Common barriers contributed to stress during recovery, and specific strategies promoted reunification and program success. Among strategies recommended by the mentor moms was a suggestion for PHNs to bridge the information gap through regular reports on the development and health of their children during the time they reside in foster care.

Notes: Abstract  Advanced practice nurses and nurse researchers with experience in clinical settings may encounter challenges in the initial development and implementation of community-based projects. Participatory action research methodology, a user-friendly framework for community-based research activities, provides a way for researchers and community members to work together to define a problem, take action, and evaluate their work. This article attempts to bridge the theory-implementation gap by describing background steps that researchers can use when conceptualizing and initiating a research project with community partners. Suggestions for initial steps and the planning and review cycles are presented, along with examples from the literature.

Notes: The depth distribution of submersed aquatic vegetation (SAV) was studied in Lake Pontchartrain, Louisiana, to develop a model to predict changes in SAV abundance from changes in environmental quality. We conducted annual line-intercept surveys from 1997 through 2001 and monitored monthly photosynthetically active radiation at four sites with different shoreface slopes. The following relationships between SAV distribution and environmental factors were used as model parameters: (1) water clarity controls SAV colonization depth; (2) fluctuation in annual mean water level and wave mixing determines SAV minimum colonization depth; and (3) site differences in SAV areal coverage under the comparable water quality conditions are due to shoreface slope differences. These parameters expressed as mathematical components of the model are as follows: mean water clarity determines SAV colonization depth (Zmax= 2.3/Kd); mean water level and wave mixing controls SAV minimum depth (Zmin= 0.3 m); and shoreface slope angle (θ) determines the distance from Zmin to Zmax. The equation developed for the potential SAV habitat (PSAV) model is PSAV = (2.3 − 0.3 ×Kd)/(sinθ×Kd). The model was validated by comparing empirical values from the dataset to values predicted by the model. Although the model was developed to predict the PSAV in Lake Pontchartrain, it can be applied to other coastal habitats if local SAV light requirements are substituted for Lake Pontchartrain values. This model is a useful tool in selecting potential restoration sites and in predicting the extent of SAV habitat gain after restoration.

Notes: Assessing the community-level consequences of ecological restoration treatments is essential to guide future restoration efforts. We compared the vegetation composition and species richness of restored sites that received a range of restoration treatments and those of unrestored sites that experienced varying levels of disturbance. Our study was conducted in the industrially degraded landscape surrounding Sudbury, Ontario, Canada. The Great Lakes–St. Lawrence Forest once present in this area was degraded through logging, mining, and smelting activities beginning in the late 1800s until restoration of the most visibly degraded areas began in 1974. Restoration treatments ranged from simple abiotic enhancements to complex, multistage revegetation treatments using native and non-native species, which included fertilizing, spreading of ground dolomitic limestone, understory seeding, and tree planting. Canonical correspondence analysis was used to determine which restoration treatments explained differences in the community structure among sites. We found that native understory vascular species richness was similar in restored sites that received more complex restoration treatments and unrestored sites that were mildly disturbed; however, the role of planted trees and non-native species in the restored communities remains unclear. Understory vascular seeding played a key role in determining community composition of vascular understory and overstory communities, but the time since restoration commenced was a more important factor for nonvascular communities because they received no direct biotic enhancements. The use of non-native species in the vascular seed mix seems to be slowly encouraging the colonization of native species, but non-natives continue to dominate restored sites 25 years after restoration began.

Notes: Grasslands dominated by exotic annual grasses have replaced native perennial vegetation types in vast areas of California. Prescribed spring fires can cause a temporary replacement of exotic annual grasses by native and non-native forbs, but generally do not lead to recovery of native perennials, especially where these have been entirely displaced for many years. Successful reintroduction of perennial species after fire depends on establishment in the postfire environment. We studied the effects of vegetation changes after an April fire on competition for soil moisture, a key factor in exotic annual grass dominance. As an alternative to fire, solarization effectively kills seeds of most plant species but with a high labor investment per area. We compared the burn to solarization in a study of establishment and growth of seeds and transplants of the native perennial grass Purple needlegrass (Nassella pulchra) and coastal sage species California sagebrush (Artemisia californica). After the fire, initial seed bank and seedling densities and regular percent cover and soil moisture (0–20 cm) data were collected in burned and unburned areas. Burned areas had 96% fewer viable seeds of the dominant annual grass, Ripgut brome (Bromus diandrus), leading to replacement by forbs from the seed bank, especially non-native Black mustard (Brassica nigra). In the early growing season, B. diandrus dominating unburned areas consistently depleted soil moisture to a greater extent between rains than forbs in burned areas. However, B. diandrus senesced early, leaving more moisture available in unburned areas after late-season rains. Nassella pulchra and A. californica established better on plots treated with fire and/or solarization than on untreated plots. We conclude that both spring burns and solarization can produce conditions where native perennials can establish in annual grasslands. However, the relative contribution of these treatments to restoration appears to depend on the native species being reintroduced, and the long-term success of these initial restoration experiments remains to be determined.

Notes: This study assesses the risks in ecological restoration arising from transplanting into soil containing glyphosate residues. Four Australian restoration species were grown for 60 days in nonadsorbing media treated continuously with glyphosate to establish threshold concentrations for damage. Visual signs of injury were observed in three species, and severe effects on root growth in all species, at solution concentrations as low as 18 mg/L. Only the perennial grass Themeda sp. died at this concentration, with other species surviving at concentrations in the range 36–360 mg/L, beyond which all plants died. Fourteen days exposure followed by removal of glyphosate from root media produced similar effects. Field and glasshouse experiments with the relatively tolerant tree species Angophora costata showed that application rates in the range 10–50 L/ha of herbicide product (360 g/L) would be needed to sustain damage to young plants transplanted into soil typical of local restoration sites. The volume of spray delivered using a hand-operated sprayer varied between operators by 5- and 10-fold to complete the same tasks, at the high end presenting a potential risk to the most tolerant species under field conditions, even when spray concentrations follow label instructions. For all but the most sensitive species, the risk of glyphosate residues in ecological restoration should be minimized by training operators of unregulated applicators to deliver controlled volumes of herbicide when spot spraying prior to transplanting.

Notes: Restoring habitat structure that existed before active and inadvertent fire suppression is thought to be critical to maintaining populations of some rare plants in fire-suppressed habitats. Nevertheless, the impacts of habitat restoration on most endangered plants are poorly understood. Current theory predicts and empirical studies have shown that the reduction of shade or competition (frequently a goal of many habitat restoration projects in degraded fire-dependent ecosystems) benefits plants adapted to nutrient-poor soils by increasing the benefit-to-cost ratio of adaptations for enhanced nutrient capture. Here, I examined how experimental reduction of neighboring plants in a wet longleaf pine community dominated in the ground cover by shrubs and stump sprouts influenced the growth, the reproduction, the carnivorous effort, and the benefits of carnivory in a U.S. federally endangered species, Sarracenia rubra ssp. alabamensis. Two years of data showed no significant effects of neighbor reduction or prey exclusion on any of several indicators of plant performance, nor was there any evidence of a hypothesized morphological trade-off between shade avoidance and prey capture. These results were unexpected. Inadequate replication and atypical precipitation patterns were ruled out as possible explanations. The population studied here (unlike that of a different, but morphologically similar, species growing in a fire-maintained pine grass–sedge savanna) did not exhibit the ability to respond to variation in competition from neighboring plants.

Notes: In Ohio and elsewhere, recent grassland plantings in the federal Conservation Reserve Program (CRP) have become much more extensive than native prairie remnants. The seed source for CRP grasslands in Ohio often comes from as far away as Missouri or Texas, which may be undesirable from the standpoint of conservation genetics. The goal of this study was to examine the potential for gene flow from large, recently introduced populations of Big bluestem (Andropogon gerardii, Poaceae) to small local populations of this outcrossing perennial species. We examined the potential for cross-pollination between three local populations and three introduced CRP populations by comparing flowering phenologies. Flowering times overlapped extensively, indicating that cross-pollination is possible where local and introduced genotypes co-occur. To compare genetic variation in local and CRP populations, we analyzed variation at 68 RAPD loci in six populations of each type. Somewhat surprisingly, we found no significant differences in the genetic diversity or composition between the two groups (local vs. CRP). In summary, we found that local and introduced populations of Big bluestem have the potential to interbreed, based on their flowering periods, but further research is needed to determine whether local genotypes harbor unique genetic variation that could be jeopardized by hybridization with introduced genotypes.

Notes: Coastal protection remains a global priority. Protection and maintenance of shoreline integrity is often a goal of many coastal protection programs. Typically, shorelines are protected by armoring them with hard, non-native, and nonsustainable materials such as limestone. This study investigated the potential shoreline protection role of created, three-dimensional Eastern oyster (Crassostrea virginica) shell reefs fringing eroding marsh shorelines in Louisiana. Experimental reefs (25 × 1.0 × 0.7 m; intertidal) were created in June 2002 at both high and low wave energy shorelines. Six 25-m study sites (three cultched and three control noncultched) were established at each shoreline in June 2002, for a total of 12 sites. Shoreline retreat was reduced in cultched low-energy shorelines as compared to the control low-energy shorelines (analysis of variance; p 〈 0.001) but was not significantly different between cultched and noncultched sites in high-energy environments. Spat set increased from 0.5 ± 0.1 spat/shell in July 2002 to a peak of 9.5 ± 0.4 spat/shell in October 2002. On average, oyster spat grew at a rate of 0.05 mm/day through the duration of the study. Recruitment and growth rates of oyster spat suggested potential reef sustainability over time. Small fringing reefs may be a useful tool in protecting shorelines in low-energy environments. However, their usefulness may be limited in high-energy environments.

Notes: The Araucaria forest is Brazil's highly threatened subtropical forest ecosystem that has been disappearing in recent decades. Restoration programs involving this forest type are scarce, and there is a lack of scientific information on how ecological processes such as competition, facilitation, and seed dispersal influence natural forest restoration. This work aims to investigate how use of perches to attract seed dispersers and the influence of pioneer vegetation and soil fertilization could affect the colonization of woody species in a degraded area. An experiment was conducted in an abandoned field where the natural establishment of seeds and seedlings of woody species was monitored under factorial combinations of the following treatments: (1) pioneer vegetation (presence and absence); (2) soil fertility (addition of NPK and control); and (3) perches (presence and absence). Seed and seedling abundance, seed and seedling species richness, and seedling mortality were recorded monthly during 12 months. Seed abundance and species richness were significantly greater in places with perches than in control plots. These results were consistent over the year and more pronounced when the surrounding forest produced a higher amount of fruit. Species richness and abundance of seedlings were significantly greater in places with perches than in control plots, and in places with vegetation than without. Soil fertility did not influence seedling establishment. Facilitation and seed dispersal are important factors affecting the colonization of woody species in this subtropical area. Nutrient availability neither regulates the facilitation process nor influences species replacement during the early stages of Araucaria forest succession.

Notes: We investigate the scenario in which some amount of higher quality habitat is destroyed and is then replaced by some undetermined amount of lower quality habitat. We examined how much low-quality habitat would need to be created to maintain the equilibrium population abundance in the entire geographic area. Using a source–sink model, we find that (1) the number of hectares of created habitat per hectare of destroyed habitat must equal the ratio of the high-quality habitat's productivity to the low-quality habitat's productivity, however, (2) if the created habitat is a sink, then there is a threshold fraction of destroyed high-quality habitat below which the initial population abundance cannot be maintained through the creation of habitat. We illustrate these results using data on Red-winged Blackbirds (Agelaius phoeniceus) in two different regions where high-quality habitat is being replaced by or converted into lower quality habitat.

Notes: Introduced grasses have displaced Hawaiian Pili grass (Heteropogon contortus) in most dry, leeward habitats of the Hawaiian Islands. The purpose of this study was to assess the feasibility of restoring an indigenous Heteropogon grassland at the Puukohola Heiau National Historic Site, where introduced Buffel grass (Cenchrus ciliaris) is now dominant. Heteropogon seeds (50 seedlings/m2) were added to replicate plots within a Cenchrus grassland. Some plots were subjected to one-time herbicide or hand-pulling treatments to remove established Cenchrus. Because Hawaiians historically used fire to promote Heteropogon grasslands, the plots were burned biennially. Plots were also subjected to two levels of water supplementation. Heteropogon establishment was monitored over 2 and 4 years in the higher- and lower-water plots, respectively. In treatments containing established Cenchrus, Heteropogon establishment was consistently poor (〈10% cover). But in the burned plots where established Cenchrus had been removed, as many as 31 Heteropogon seedlings per square meter were recorded, and Heteropogon became the dominant cover, averaging 34% absolute cover (81% relative cover) after 4 years in the lower-water plot and 34% absolute cover (60% relative cover) after 2 years in the higher-water plot. Few Cenchrus grass seedlings survived, possibly due to insufficient water. Water supplementation promoted growth of other alien grasses from the seed bank (Digitaria insularis and Eragrostis spp.); however, these grasses quickly declined after supplemental watering was terminated. Although initial suppression of Cenchrus was required, Heteropogon expanded quickly when seeds and fire were reintroduced, demonstrating that a Heteropogon-dominated grassland can be reestablished in 2–4 years.

Notes: Human activities have degraded riparian systems in numerous ways, including homogenization of the floodplain landscape and minimization of extreme flows. We analyzed the effects of changes in these and other factors for extinction–colonization dynamics of a threatened Bank Swallow population along the upper Sacramento River, California, U.S.A. We monitored Bank Swallow distributions along a 160-km stretch of the river from 1986–1992 and 1996–2003 and tested whether site extinctions and colonizations corresponded with changes in maximum river discharge, surrounding land cover, estimated colony size, temperature, and precipitation. Colonization probabilities increased with maximum discharge. Extinction probabilities decreased with proximity to the nearest grassland, decreased with colony size, and increased with maximum discharge. To explore the implications for restoration, we incorporated the statistically estimated effects of distance to grassland and maximum discharge into simple metapopulation models. Under current conditions, the Bank Swallow metapopulation appears to be in continued decline, although stable or increasing numbers cannot be ruled out with the existing data. Maximum likelihood parameters from these regression models suggest that the Sacramento River metapopulation could be restored to 45 colonies through moderate amounts of grassland restoration, large increases in discharge, or direct restoration of nesting habitat by removing approximately 10% of existing bank protection (riprap) from suitable areas. Our results highlight the importance of grassland restoration, mixed benefits of restoring high spring discharge, and the importance of within-colony dynamics as areas for future research.

Notes: Spatial heterogeneity of resources can influence plant community composition and diversity in natural communities. We manipulated soil depth (two levels) and nutrient availability (three levels) to create four heterogeneity treatments (no heterogeneity, depth heterogeneity, nutrient heterogeneity, and depth + nutrient heterogeneity) replicated in an agricultural field seeded to native prairie species. Our objective was to determine whether resource heterogeneity influences species diversity and the trajectory of community development during grassland restoration. The treatments significantly increased heterogeneity of available inorganic nitrogen (N), soil water content, and light penetration. Plant diversity was indirectly related to resource heterogeneity through positive relationships with variability in productivity and cover established by the belowground manipulations. Diversity was inversely correlated with the average cover of the dominant grass, Switchgrass (Panicum virgatum), which increased over time in all heterogeneity treatments and resulted in community convergence among the heterogeneity treatments over time. The success of this cultivar across the wide range of resource availability was attributed to net photosynthesis rates equivalent to or higher than those of the native prairie plants in the presence of lower foliar N content. Our results suggest that resource heterogeneity alone may not increase diversity in restorations where a dominant species can successfully establish across the range of resource availability. This is consistent with theory regarding the role of ecological filters on community assembly in that the establishment of one species best adapted for the physical and biological conditions can play an inordinately important role in determining community structure.

Notes: A pilot experiment designed to test the effect of cattle, small mammals, and elevation on the success of reforestation of an endemic dwarf pine species in northeastern Mexico was implemented. Pinus culminicola (Andresen et Beaman) grows only in four high peaks in the Sierra Madre Oriental and is under pressure from grazing, wildfires, and human activities such as mining, road development for timber extraction, and telecommunication and aerial navigation devices. We planted and monitored 2-year-old seedlings at three elevations within the natural distribution range of this species at Cerro El Potosí in Nuevo León, Mexico. At each elevation three treatments were established: (1) seedlings protected from cattle plus small mammals, (2) seedlings protected from cattle, and (3) seedlings with free access to cattle and small mammals. Seedling survival was approximately 50% in (1) after 4 years, but there were no surviving seedlings with free access to cattle. Elevation in general did not account for variation in survival. Seedling growth was poor during the 4 years, which implies that seedlings remain susceptible to grazing and trampling by cattle and small mammals. The implications for a large-scale restoration program are discussed.

Notes: Salvaging from premining areas and translocation of succulent plants has been investigated for the revegetation of gypsiferous mine spoil in an arid region of South Africa. Given that facilitation effects are thought to outweigh competition effects in harsh environments, we hypothesized that the survival of translocated succulents would be higher when planted in multispecies clumps than alone and that the growth rate (measured as stem extension) and fruit-set would be greater for plants in clumps than for those planted alone. Two leaf-succulent species (Aridaria noctiflora ssp. noctiflora and Drosanthemum deciduum) and one stem-succulent species (Psilocaulon dinteri) were salvaged from the area destined for mining and translocated onto the mine spoil. These plants were planted either in a multispecies clump of the three species together or alone. One year after translocation, 67% of the plants survived. It was also found that the succulents used in these experiments survived in higher numbers when planted alone. Due to the similar root morphology of D. deciduum and P. dinteri, they competed for resources instead of facilitating each other's establishment. The results were variable for each of the species used, and neither growth nor seed-set was improved by clumping. These findings would also possibly vary from year to year with different abiotic conditions.

Notes: Human-induced erosion regularly delivers massive quantities of fine sediments into streams and rivers forming large static bodies of sediment known as sand slugs, which smother in-stream habitat, alter community structure, and decrease biodiversity. Sand slugs are widespread in parts of southeastern Australia as well as in many other parts of the world, and there is now considerable interest in restoring such affected streams. The reintroduction of large timber is widely suggested as a strategy for restoring habitat complexity, but this has rarely been tested in sand slug–affected streams. We examined the response of fish populations to wood addition to two streams in southeastern Australia that have been impacted by sand slugs. Manipulated sites (three per treatment) had either one or four timber structures added, and these sites were compared with (three) unmanipulated (control) sites before and after the manipulation occurred. Despite a supraseasonal drought during the study, we observed short-term increases in the abundance of Mountain galaxias (Galaxias olidus) at the four-structure sites, while both the four-structure and the one-structure treatments appeared to buffer against drought-induced declines in two other species, River blackfish (Gadopsis marmoratus) and Southern pygmy perch (Nannoperca australis), relative to controls. However, drought eventually caused the complete loss of surface water from these streams and the loss of fish from both manipulated and unmanipulated sites. Thus, although the study supports the use of timber structures as a means of increasing local fish abundances, these beneficial effects were, in these streams, contingent upon permanency of flow. Because sedimentation has depleted the number of permanent refuge pools in these creeks, recovery rates of the fauna (i.e., resilience) are likely to be slow. We therefore conclude that in streams subjected to frequent disturbance, restoring refugia may be as, if not more, important as restoring what we term residential habitat.

Notes: Numerous tree species can establish by vegetative means in the tropics. Many are used in agriculture as living fences and in alley cropping and could also be used in a restorational setting. However, little is known about their establishment ability. This study evaluated the establishment ability and cover development of multiple species in three separate field trials in northern Honduras. First, 11 species were evaluated for their ability to establish in a common garden experiment. Second, of the former species, Bursera simaruba and Gliricidia sepium were evaluated for 2 years for their ability to establish vegetatively and develop cover at three deforested sites. Lastly, a study examined whether greater initial stake height and diameter at breast height increased the establishment success and crown development of G. sepium stakes. First, five species, Erythrina berteroana, Erythrina fusca, Jatropha curcas, G. sepium, and B. simaruba, had high establishment success. Others showed promise but may have been planted in the wrong season. Second, establishment for G. sepium was nearly 100% at all sites, whereas B. simaruba ranged from 30–50%. Gliricidia sepium stakes developed more rapidly and attained greater cover than B. simaruba. Dry season planting may increase the establishment success of both species. Lastly, greater initial stake height and diameter at breast height each resulted in greater crown development for G. sepium. The use of living fence species as a restorational tool has been overlooked. Aside from the advantages of planting tree species vegetatively, species can act as seed recruitment foci by attracting seed dispersers and provide shade to improve microclimatic conditions for seedling establishment. The technique described is simple and could have broad application throughout tropical regions.

Notes: We studied the effects of limestone sand additions in Bear and Rock runs, two chronically and episodically acidified streams in southwestern Pennsylvania, U.S.A. Linn Run, a nearby episodically acidified stream, served as a reference stream. Our objectives were to evaluate the effects of doubling recommended limestone sand amounts on water quality and macroinvertebrates on Bear and Rock runs and to assess substrate changes resulting from limestone sand inundation. Approximately 23 and 6 tonnes of limestone sand were added annually to the headwaters of Bear and Rock runs, respectively, from 1999 to 2001. In 2002, amounts were doubled. Macroinvertebrate communities were assessed from 1999 to 2003 at points above and below the sand additions on Bear Run and Rock Run. Small, plastic substrate samplers were used to assess sand substrate effects. Doubling annual limestone sand amounts resulted in significantly improved pH and acid-neutralizing capacity; however, total dissolved aluminum increased significantly downstream (α≤ 0.05). Macroinvertebrate density and diversity were not significantly affected, but an increase in acid-sensitive taxa was observed at a site 3,500 m downstream. Substrate sampler data indicated a significant negative relationship between amount of sand deposited and density of macroinvertebrates. The mixed water quality and benthic macroinvertebrate results were reasonably consistent with earlier work and call into question the use of limestone sand in the restoration of chronically and episodically acidified waters.

Notes: Ecosystem restoration in highly complex, human-dominated estuaries rests on a strong conceptual foundation of sustainability, ecosystems, and adaptive management of human-induced environmental impacts. Successful application involves evaluating uncertainty, incorporating place-based information, and engaging diverse constituencies in the planning process. That means integration of technical knowledge with an understanding of the “cultural milieu” inherent in all estuaries, that is, the intensity of human activity and impacts plus socioeconomic factors relevant to restoration goals. Operational definitions of what constitutes acceptable ecosystem conditions and current baselines are critical yet rest in large measure on cultural values and socioeconomic considerations. Resources for long-term monitoring and research to assess performance and ecosystem condition are paramount. Unprecedented population growth promises additional stressors on estuarine environments worldwide, making maintenance of present conditions difficult. The art of good, practical ecosystem restoration as a management tool at multiple geographic scales promises to play a crucial role in sustainability goals.

Notes: Restoration of wet prairie in the central midwestern United States should include Prairie cordgrass (Spartina pectinata), but historic densities of this once dominant species are not easily achieved. Spartina pectinata was transplanted into a former agricultural field in three planting strategies: 20 small plugs, 4 medium-sized plugs, and a single large plug, with each treatment area totaling 0.6 m2. Plugs were sampled annually for 3 years to determine which planting strategy produced highest survival, area, stem density (per unit vegetated area), and height of S. pectinata It was also determined whether these factors varied with microtopography, and the resulting differences in flooding, within the restoration site. Stem density and height of restored S. pectinata were also compared to reference S. pectinata communities, including both pristine populations and the source of transplants. Because soil particle size and soil nitrogen content can influence S. pectinata stem density and height, these soil characteristics were also tested in restored and reference sites. Three years after planting, S. pectinata survived in all planted plots regardless of planting strategy or microtopography, with an overall survival rate of 89.8% at the end of the study. The small plug treatment produced the greatest area after 3 years (3.99 m2), compared with the final area of medium (1.18 m2) and large plug treatments (0.79 m2). Stem density of small and medium plugs decreased dramatically during the sampling period, whereas density of large plugs increased. Height did not vary among planting strategies, and microtopography did not affect area, stem density, or height. Reference populations of S. pectinata had greater stem density and height than the transplanted plugs in the restoration, and these differences cannot be attributed to soil particle size or soil nitrogen. This study indicates that more than 3 years is needed to create area, density, or height of S. pectinata similar to established wet prairie populations. Planting many small plugs yields the greatest area of S. pectinata, and including some large plugs may add dense physical structure to wet prairie restoration.

Notes: Beach nourishment creates many opportunities for resource development and use, but it also creates new issues regarding cumulative, long-term losses in borrow areas and appropriate human actions in fill areas. Nourished beaches should be considered as more than consumptive resources built for shore protection and recreation. Assessments of nourishment projects in the United States are used to identify research needed to address impacts on species and habitats in borrow areas and restoration of natural subenvironments in nourished areas. Achieving these goals involves changes in stakeholder attitudes about the meaning of beach nourishment and development of research initiatives to demonstrate the scientific, technologic, and economic feasibility of methods that are more compatible with maintaining or restoring natural landforms and habitats. Suggestions are made for expanding the spatial and temporal scales of investigation, evaluating alternative beach and sediment types, identifying new uses for fill, evaluating alternative technologies and practices, implementing adaptive management strategies, assessing stakeholder attitudes and capabilities, overcoming cost constraints, and conducting interdisciplinary studies.

Notes: To bridge the gaps between restoration as a science and as a practice, restoration ecology has to broaden its scope toward transdisciplinarity in close cooperation with landscape ecologists and other holistic environmentally oriented scientists, professionals, practitioners, and stakeholders. For restoration, the ongoing transdisciplinary scientific revolution has opened new insights to cope with the complex bio-hydro- and human-ecological network relations. The Total Human Ecosystem (THE), integrating humans with all other organisms and their total environment at the highest level of the global hierarchy, should become the unifying holistic paradigm for all synthetic “eco-disciplines.” These should link ecological knowledge, wisdom, and ethics with their scientific and professional expertise from the natural and social sciences and the humanities. As the tangible matrix for all organisms, including humans, our industrial Total Human Landscape is the concrete spatial and functional system of the THE. It forms a closely interlaced network of solar energy–powered natural and seminatural biosphere landscapes and fossil energy–powered urban and agro-industrial technosphere landscapes. The self-organizing and self-creative restoration capacities of biosphere landscapes are driven by mutually amplifying auto- and cross-catalytic feedback loops, but the rapidly expanding technosphere landscapes are driven by destabilizing “run-away” feedback loops. To prevent a global breakdown and to ensure the sustainable future for both humankind and nature, these positive feedbacks have to be counteracted by restraining, cultural feedbacks of environmental planning and management, conservation, and restoration. As the theme of this special issue alludes to, this template should become an integral part of an urgently needed sustainability revolution, to which the transdisciplinary landscape restoration could contribute its important share.

Notes: Metabotropic γ-aminobutyric acidB (GABAB) receptors for the major inhibitory transmitter GABA, together with metabotropic glutamate (mGLuRs) receptors, the extracellular calcium-sensing receptors (CaSRs), some V2R pheromone receptors and T1R taste receptors, belong to the family of 3 G-protein-coupled receptors (GPCRs). GABAB receptors are known to control neuronal excitability and modulate synaptic neurotransmission, playing a very important role in many physiological activities. These receptors are widely expressed and distributed in the nervous system and have been implicated in a variety of neurodegenerative and pathophysiological disorders including epilepsy, spasticity, chronic pain, depression, schizophrenia and drug addiction. To form a functional receptor entity, GABAB receptors must exist as a heterodimer consisting of GABAB1 and GABAB2 receptor subtypes with two 7-transmembrane proteins, and these subunits arise from distinct genes. The GABAB1 subunit binds the endogenous ligand within its extracellular N-terminus, whilst the GABAB2 subunit is not only essential for the correct trafficking of the GABAB1 subunit to the cell surface, but is also responsible for the interaction of the receptor with its cognate G-protein. Allosteric modulation has recently been recognized as an alternative pharmacological approach to gain selectivity in drug action. It is now generally accepted that modulators acting at the allosteric sites provide a novel perspective for the development of subtype-selective agents acting at GPCRs. These agents interact with allosteric binding sites quite separate from the highly conserved agonist binding region. In this review, we present a new class of phenylalkylamines, based on the lead compound fendiline, that are potent positive potentiators of GABAB receptor-mediated function and discuss their putative clinical applications. It is proposed that these new modulators may have therapeutic value in GABAB receptor pharmacology and are capable of selectively modifying GABAB receptor function. The allosteric modulators are offering an attractive and novel means to identify new leads, that are devoid of side effects associated with GABAB receptor agonists, and may, therefore, represent a major advance in the drug discovery process.

Notes: KTX 0101 is the sodium salt of the physiological ketone, D-β-hydroxybutyrate (βOHB). This neuroprotectant, which has recently successfully completed clinical Phase IA evaluation, is being developed as an intravenous infusion fluid to prevent the cognitive deficits caused by ischemic foci in the brain during cardiopulmonary bypass (CPB) surgery. KTX 0101 maintains cellular viability under conditions of physiological stress by acting as a “superfuel” for efficient ATP production in the brain and peripheral tissues. Unlike glucose, this ketone does not require phosphorylation before entering the TCA cycle, thereby sparing vital ATP stores. Although no reliable models of CPB-induced ischemia exist, KTX 0101 is powerfully cytoprotectant under the more severe ischemic conditions of global and focal cerebral ischemia, cardiac ischemia and lung hemorrhage. Neuroprotection has been demonstrated by reductions in infarct volume, edema, markers of apoptosis and functional impairment. One significant difference between KTX 0101 and other potential neuroprotectants in development is that βOHB is a component of human metabolic physiology which exploits the body's own neuroprotective mechanisms. KTX 0101 also protects hippocampal organotypic cultures against early and delayed cell death in an in vitro model of status epilepticus, indicating that acute KTX 0101 intervention in this condition could help prevent the development of epileptiform foci, a key mechanism in the etiology of intractable epilepsy. In models of chronic neurodegenerative disorders, KTX 0101 protects neurons against damage caused by dopaminergic neurotoxins and by the fragment of β-amyloid, Aβ1–42, implying possible therapeutic applications for ketogenic strategies in treating Parkinson's and Alzheimer's diseases. Major obstacles to the use of KTX 0101 for long term therapy in chronic disorders, e.g., Parkinson's and Alzheimer's diseases, are the sodium loading problem and the need to administer it in relatively large amounts because of its rapid mitochondrial metabolism. These issues are being addressed by designing and synthesizing orally bioavailable multimers of βOHB with improved pharmacokinetics.

Notes: Piracetam, a derivative of the neurotransmitter γ-aminobutyric acid (GABA), has a variety of physiological effects that may result, at least in part, from the restoration of cell membrane fluidity. At a neuronal level, piracetam modulates neurotransmission in a range of transmitter systems (including cholinergic and glutamatergic), has neuroprotective and anticonvulsant properties, and improves neuroplasticity. At a vascular level, it appears to reduce erythrocyte adhesion to vascular endothelium, hinder vasospasm, and facilitate microcirculation. This diverse range of physiological effects is consistent with its use in a range of clinical indications. Its efficacy is documented in cognitive disorders and dementia, vertigo, cortical myoclonus, dyslexia, and sickle cell anemia. While high doses are sometimes necessary, piracetam is well tolerated.

Notes: Neuronal death in Parkinson's disease (PD) may originate from the reciprocal interactions of a restricted number of conditions, such as mitochondrial defects, oxidative stress and protein mishandling, which would favor a state of apoptotic cell death in the nigrostriatal pathway. The search for pharmacological treatments able to counteract the nigrostriatal degeneration, possibly by interfering with these phenomena, has recently raised considerable interest in rasagiline [R(+)-N-propargyl-1-aminoindan], a potent, selective, and irreversible inhibitor of monoamine oxidase B (MAO-B). Rasagiline, like selegiline, is a propargylamine, but is ∼10 times more potent. Unlike selegiline, rasagiline is not metabolized to amphetamine and/or methamphetamine and is devoid of sympathomimetic activity. Numerous experimental studies, conducted both in vitro and in vivo, have shown that rasagiline possesses significant protective properties on neuronal populations. The pro-survival effects of the drug appear to be linked to its propargyl moiety, rather than to the inhibitory effect on MAO-B. Rasagiline's major metabolite, aminoindan — which possesses intrinsic neuroprotective activity — may also contribute to the beneficial effects of the parent compound.Rasagiline has been recently evaluated in early PD patients, with results that are consistent with slowing the progression of the disease. Therefore, the neuroprotective activity shown by the drug under experimental conditions may be reflected in the clinic, thus providing new perspectives for the treatment of PD.