Functional Genomics Unique to Week 20 Post Wounding in the Deep Cone/Fat Dome of the Duroc/Yorkshire Porcine Model of Fibroproliferative Scarring

Background: Hypertrophic scar was first described over 100 years ago; PubMed has more than 1,000 references on the topic. Nevertheless prevention and treatment remains poor, because 1) there has been no validated animal model; 2) human scar tissue, which is impossible to obtain in a controlled manner, has been the only source for study; 3) tissues typically have been homogenized, mixing cell populations; and 4) gene-by-gene studies are incomplete.Methodology/Principal Findings: We have assembled a system that overcomes these barriers and permits the study of genome-wide gene expression in microanatomical locations, in shallow and deep partial-thickness wounds, and pigmented and non-pigmented skin, using the Duroc( pigmented fibroproliferative)/Yorkshire( non-pigmented non-fibroproliferative) porcine model. We used this system to obtain the differential transcriptome at 1, 2, 3, 12 and 20 weeks post wounding. It is not clear when fibroproliferation begins, but it is fully developed in humans and the Duroc breed at 20 weeks. Therefore we obtained the derivative functional genomics unique to 20 weeks post wounding. We also obtained long-term, forty-six week follow-up with the model.Conclusions/Significance: 1) the scars are still thick at forty-six weeks post wounding further validating the model. 2) the differential transcriptome provides new insights into the fibroproliferative process as several genes thought fundamental to fibroproliferation are absent and others differentially expressed are newly implicated. 3) the findings in the derivative functional genomics support old concepts, which further validates the model, and suggests new avenues for reductionist exploration. in the future, these findings will be searched for directed networks likely involved in cutaneous fibroproliferation. These clues may lead to a better understanding of the systems biology of cutaneous fibroproliferation, and ultimately prevention and treatment of hypertrophic scarring.The National Institute on Disability and Rehabilitation ResearchThe National Institutes of HealthThe Washington State Council of Fire Fighters Burn FoundationThe Northwest Burn FoundationUniv Washington, Dept Surg, Div Plast Surg, Seattle, WA 98195 USAIowa State Univ, Dept Anim Sci, Ames, IA USAUniv Washington, Dept Biostat, Seattle, WA 98195 USAMahidol Univ, Ramathibodi Hosp, Dept Surg, Bangkok 10700, ThailandUniv Washington, Dept Environm & Occupat Hlth Sci, Seattle, WA 98195 USAUniversidade Federal de São Paulo, Div Plast Surg, Dept Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Div Plast Surg, Dept Surg, São Paulo, BrazilThe National Institute on Disability and Rehabilitation Research: H133G050022The National Institutes of Health: 1R21GM074673The National Institutes of Health: 5U54GM062119-09Web of Scienc

Plasma and neutrophil fatty acid composition in advanced cancer patients and response to fish oil supplementation

Metabolic demand and altered supply of essential nutrients is poorly characterised in patients with advanced cancer. A possible imbalance or deficiency of essential fatty acids is suggested by reported beneficial effects of fish oil supplementation. To assess fatty acid status (composition of plasma and neutrophil phospholipids) in advanced cancer patients before and after 14 days of supplementation (12±1 g day−1) with fish (eicosapentaenoic acid, and docosahexaenoic acid) or placebo (olive) oil. Blood was drawn from cancer patients experiencing weight loss of >5% body weight (n=23). Fatty acid composition of plasma phospholipids and the major phospholipid classes of isolated neutrophils were determined using gas liquid chromatography. At baseline, patients with advanced cancer exhibited low levels (<30% of normal values) of plasma phospholipids and constituent fatty acids and elevated 20 : 4 n-6 content in neutrophil phospholipids. High n-6/n-3 fatty acid ratios in neutrophil and plasma phospholipids were inversely related to body mass index. Fish oil supplementation raised eicosapentaenoic acid and docosahexaenoic acid content in plasma but not neutrophil phospholipids. 20 : 4 n-6 content was reduced in neutrophil PI following supplementation with fish oil. Change in body weight during the supplementation period related directly to increases in eicosapentaenoic acid in plasma. Advanced cancer patients have alterations in lipid metabolism potentially due to nutritional status and/or chemotherapy. Potential obstacles in fatty acid utilisation must be addressed in future trials aiming to improve outcomes using nutritional intervention with fish oils

Estudos sobre transtornos de personalidade Antissocial e Borderline Estudios sobre trastornos de personalidad Anti-social y Borderline Studies of personality disorders Antisocial and Borderline

OBJETIVO: Este estudo objetivou revisar, na literatura, os critérios diagnósticos e as intervenções nos transtornos de personalidade do tipo Antissocial e Borderline. MÉTODOS: Uma pesquisa manual foi realizada no acervo bibliográfico particular do autor, selecionando-se 12 referências; outra pesquisa sistematizada foi desenvolvida no período de 1990 a 2008, no mês de janeiro de 2009, na Biblioteca Virtual em Saúde, selecionando-se 23 artigos. RESULTADOS: Os achados indicaram duas abordagens - uma que classifica como doença, mas que necessita de revisão dos critérios diagnósticos e avaliação e a segunda, que classifica como problemas morais. CONCLUSÃO: Independente da abordagem é necessário que o enfermeiro aprimore seu conhecimento e compreenda a dificuldade desse sujeito ao relacionar-se adequadamente com outras pessoas; assim, é de fundamental importância que os membros da equipe de saúde analisem seus sentimentos, atitudes e reações em relação ao comportamento do cliente, uma vez que a relação com esta clientela é considerada uma das mais complexas em saúde mental.<br>OBJETIVO: Este estudio tuvo por objetivo revisar, en la literatura, los criterios diagnósticos y las intervenciones en los trastornos de personalidad del tipo Anti-social y Borderline. MÉTODOS: Se trata de una investigación manual que fue realizada en el acervo bibliográfico particular del autor, seleccionando 12 referencias; otra investigación sistematizada fue desarrollada en el período de 1990 a 2008, en el mes de enero de 2009, en la Biblioteca Virtual en Salud, seleccionándose 23 artículos. RESULTADOS: Los hallazgos indicaron dos abordajes - uno que los clasifica como enfermedad, pero que necesita de revisión de los criterios diagnósticos y de evaluación, y la segunda, que los clasifica como problemas morales. CONCLUSIÓN: Independientemente del abordaje es necesario que el enfermero perfeccione su conocimiento y comprenda la dificultad de ese sujeto para relacionarse adecuadamente con otras personas; así, es de fundamental importancia que los miembros del equipo de salud analicen sus sentimientos, actitudes e reacciones en relación al comportamiento del cliente, una vez que la relación con esta clientela es considerada una de las más complejas en salud mental.<br>OBJECTIVE: This study had the objective of reviewing, in the literature, the diagnostic criteria and the intervention in personality disorders, Antisocial and Borderline types. METHODS: A manual research was performed in the author's private collection of books, selecting 12 references; other research has been systematically developed in the period 1990-2008, in January 2009, in the Virtual Health Library, selecting 23 papers. RESULTS: Our findings indicated two approaches - one that classifies as an illness, but that needs to review the diagnostic criteria and evaluation, and the second, that classifies them as moral problems. CONCLUSION: Regardless the type of approach, is necessary that nurses enhance their knowledge and understand the difficulty of this subject to relate properly with others; thus, it is crucial that members of the healthcare team examine their feelings, attitudes and reactions related to the client's behavior, since the relationship with this type of customer is considered one of the most complex in the mental health field

Pseudomonas aeruginosa multiresistente em unidade de cuidados intensivos: desafios que procedem? Pseudomonas aeruginosa multiresistente en una unidad de cuidados intensivos: desafíos que proceden? Multi-resistant pseudomonas aeruginosa among patients from an intensive care unit: persistent challenge?

OBJETIVOS: Avaliar a ocorrência de infecção hospitalar por Pseudomonas aeruginosa multiresistente em pacientes hospitalizados em uma unidade de cuidados intensivos. MÉTODO: estudo retrospectivo realizado de outubro de 2003 a setembro de 2004 em um hospital de emergências. RESULTADOS: Totalizou-se 68 portadores de bactérias multiresistentes sendo 10 (14,7%) de P. aeruginosa. Destes, 8 pacientes eram do sexo masculino, as médias de idade e de internação foram respectivamente de 57 anos a média de idade, 43,7 a média de dias de internação e 7 pacientes morreram. Isolaram-se 8 cepas no sangue, cinco na urina, duas em cateteres venosos e uma no líquor, das quais sete sensíveis somente a polimixina e três ao imipenem. CONCLUSÃO: O perfil microbiológico deve ser avaliado periodicamente visto que é específico de uma unidade ou instituição, e demanda ações correlatas.<br>OBJETIVOS: Evaluar la ocurrencia de infección hospitalaria por Pseudomonas aeruginosa multiresistente en pacientes hospitalizados en una unidad de cuidados intensivos. MÉTODO: estudio retrospectivo realizado de octubre del 2003 a setiembre del 2004 en un hospital de emergencias. RESULTADOS: Se tuvo un total de 68 portadores de bacterias multiresistentes de las cuales 10 (14,7%) de P. aeruginosa. De éstos, 8 pacientes eran del sexo masculino, los promedios de edad y de internamiento fueron respectivamente de 57 años y 43,7 de días de internamiento y 7 pacientes murieron. Se aislaron 8 cepas en la sangre, cinco en la orina, dos en catéteres venosos y una en el licor, de ellas siete eran sensibles sólo a la polimixina y tres al imipenem. CONCLUSIÓN: El perfil microbiológico debe ser evaluado periódicamente dado que es específico de una unidad o institución, y demanda acciones correlatas.<br>OBJECTIVES: To evaluate the occurrence of multi-resistant Pseudomonas Aeruginosa infection among patients from an Intensive Care Unit. METHODS: This retrospective study was conducted in an Emergency Hospital. Data were collected from October 2003 to September 2004. RESULTS: Sixty-eight patients were infected with multi-resistant bacteria. Ten of these patients (14.7%) were infected with Pseudomonas Aeruginosa. Among these with Pseudomonas Aeruginosa, 8 patients were male and they had a mean age of 57 years and a mean of hospitalization of 43.7 days. Strains of Pseudomonas Aeruginosa were isolated in blood (n =8), in urine (n = 5), in venous catheter port (n = 2), and in cerebrospinal fluid (n =1). Seven of these strains were sensitive to Polymyxin B and 3 strains were sensitive to Imipenem. CONCLUSIONS: Since patients' microbiological profile is specific to a unit or institution, it should be assessed periodically and addressed with specific interventions

Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies

Excessive scars form as a result of aberrations of physiologic wound healing and may arise following any insult to the deep dermis. By causing pain, pruritus and contractures, excessive scarring significantly affects the patient’s quality of life, both physically and psychologically. Multiple studies on hypertrophic scar and keloid formation have been conducted for decades and have led to a plethora of therapeutic strategies to prevent or attenuate excessive scar formation. However, most therapeutic approaches remain clinically unsatisfactory, most likely owing to poor understanding of the complex mechanisms underlying the processes of scarring and wound contraction. In this review we summarize the current understanding of the pathophysiology underlying keloid and hypertrophic scar formation and discuss established treatments and novel therapeutic strategies