Effects of macrophage-activating lipopeptide-2 (MALP-2) on the vascularisation of implanted polyurethane scaffolds seeded with microvascular fragments.

The seeding of scaffolds with adipose tissue-derived microvascular fragments represents a promising strategy to establish a sufficient blood supply in tissue constructs. Herein, we analysed whether a single application of macrophage-activating lipopeptide-2 (MALP-2) at the implantation site further improves the early vascularisation of such microvessel-seeded constructs. Microvascular fragments were isolated from epididymal fat pads of C57BL/6 mice. The fragments were seeded on polyurethane scaffolds, which were implanted into mouse dorsal skinfold chambers exposed to MALP-2 or vehicle (control). The inflammatory host tissue response and the vascularisation of the scaffolds were analysed using intravital fluorescence microscopy, histology and immunohistochemistry. We found that the numbers of microvascular adherent leukocytes were significantly increased in MALP-2-treated chambers during the first 3 days after scaffold implantation when compared to controls. This temporary inflammation resulted in an improved vascularisation of the host tissue surrounding the implants, as indicated by a higher density of CD31-positive microvessels at day 14. However, the MALP-2-exposed scaffolds themselves presented with a lower functional microvessel density in their centre. In addition, in vitro analyses revealed that MALP-2 promotes apoptotic cell death of endothelial and perivascular cells in isolated microvascular fragments. Hence, despite the beneficial pro-angiogenic properties of MALP-2 at the implantation site, the herein evaluated approach may not be recommended to improve the vascularisation capacity of microvascular fragments in tissue engineering applications.

Adipose tissue-derived microvascular fragments from aged donors exhibit an impaired vascularisation capacity.

Adipose tissue-derived microvascular fragments are promising vascularisation units for applications in the field of tissue engineering. Elderly patients are the major future target population of such applications due to an increasing human life expectancy. Therefore, we herein investigated the effect of aging on the fragments' vascularisation capacity. Microvascular fragments were isolated from epididymal fat pads of adult (8 months) and aged (16 months) C57BL/6 donor mice. These fragments were seeded onto porous polyurethane scaffolds, which were implanted into dorsal skinfold chambers to study their vascularisation using intravital fluorescence microscopy, histology and immunohistochemistry. Scaffolds seeded with fragments from aged donors exhibited a significantly lower functional microvessel density and intravascular blood flow velocity. This was associated with an impaired vessel maturation, as indicated by vessel wall irregularities, constantly elevated diameters and a lower fraction of CD31/α-smooth muscle actin double positive microvessels in the implants' border and centre zones. Additional in vitro analyses revealed that microvascular fragments from adult and aged donors do not differ in their stem cell content as well as in their release of angiogenic growth factors, survival and proliferative activity under hypoxic conditions. However, fragments from aged donors exhibit a significantly lower number of matrix metalloproteinase -9-positive perivascular cells. Taken together, these findings demonstrate that aging is a crucial determinant for the vascularisation capacity of isolated microvascular fragments.

The blessing of giving: the importance of reciprocity to self-health care.

This qualitative study of reciprocity and self-health care demonstrated the importance of reciprocity in the lives of 20 elderly participants. Self-health care included actions centering around nutrition, exercise, health care monitoring, and psychospiritual activities. The importance of giving to others and the difficulty in accepting help should their functional capacity diminish create concern among our participants. Nursing interventions based on understanding reciprocity and helping caregivers create opportunities for the older person to reciprocate, despite limited physical resources, are discussed.

The relationship of reciprocity to self health care in older women.

According to Social Exchange Theory, reciprocity in relationships is essential to functioning within the social context and is an important component in well-being as people age. Because of a potential relationship to meaning in life and hence to self health behaviors this study addressed: (1) Does reciprocity relate to self health care and (2) does reciprocity contribute to the explanation of self health care within a model including functional status, satisfaction with social support, and sense of meaning in life? Data were collected from 69 community dwelling women aged 65 to 99. Analysis indicated general health perception, support provided to others and sense of meaning in life were significant predictors of self health care.

Keeping a watchful eye. Receipt of preventive service screening recommendations by women in long-term care facilities.

This study explored the extent to which women in long-term care facilities received preventive screening services. Physical examination screening of women residents exceeded the 40% recommendation of Healthy People 2000 with the exception of clinical breast examination and Pap smears. Laboratory and screening procedures--cholesterol, thyroid, and tuberculin testing--fell short of recommendations. Nurses in long-term care have an opportunity to enhance residents' quality of life by ensuring consistent use of preventive screening services.

[Pain after sympathectomy]. / Douleurs après sympathectomies.

Surgical sympathectomies and chemical sympatholyses bring about a true sympathetic deafferentation. This leads to central retrograde degenerescence reactions of the pre-ganglionic neurons, to a reduction of the muscular tone and to a secondary neurovascular disorder at the edge of the sympathetic denervation zone. In a limited number of cases, a radiculalgia-like functional painful syndrome may develop. There are variations in the degree of seriousness and evolution, but the outcome is always spontaneously favourable. Forty seven cases of radiculalgias are reported; the onset is sudden, most often at night, and the untoward effects gradually wear off with the recovery of some degree of peripheral vasomotor tone. Although classical antalgic therapies do not seem to affect the spontaneous evolution of this syndrome, the use of membrane stabilizers such as nifedipine does however induce an immediate functional improvement of the neurovascular disorders. This leads to a dramatic sedation of the pain, provided calcium inhibitors were not administered prior to the sympathectomy.

[Local intravenous treatment of algodystrophy of the hand: buflomedil versus guanethidine, long term follow-up]. / Traitements locaux intra-veineux des algodystrophies de la main: buflomédil versus guanéthidine, suivi à long terme.

This report compares the results obtained after treatment of reflex sympathetic dystrophies (algodystrophies) of the hand by pharmacological segmental blocks with buflomedil (51 cases) versus guanethidine (30 cases). The results were similar for all the different stages of algodystrophies treated: 65% satisfactory to excellent results with buflomedil, versus 63% with guanethidine. The sooner the algodystrophy is treated after its onset, the better the results. On TPBS, when the technique is effective, both hemovelocity and blood pool return to normal, along with the improvement in the patient's condition. Early and delayed bone fixations evolve independently of the treatment. These techniques should always be associated with active, mild physiotherapy, and in some cases with dynamic splints in order to prevent the development of functional sequelae in the form or capsulo-aponeurotic retraction.

[Thoracolumbar or sacral epidural administration of clonidine in deafferentation pain: possibilities, limits and long-term follow-up]. / Clonidine par voie épidurale thoraco-lombaire ou sacrée dans les douleurs de déafférentation: possibilités, limites et suivi à long terme.

Clonidine was administered by epidural injections with per os relay and long term therapeutic follow-up to 38 patients with deafferentation neurological sequellar pain either fully or partly intractable to classical pain treatments. In such types of pain, this technique provides hypoalgesia which can be enhanced by the administration of serotoninergic anti-depressants or low dose tricyclics. However, side effects may occur. After some time, a tolerance develops with a lesser antalgic efficiency, as well as rare cases of withdrawal syndromes when the treatment is suddenly discontinued.

The patient's approach to wellness.

The patient's own approach to wellness is receiving increasing attention as the potential for self-responsibility in assuming wellness behaviors is recognized as one, if not the most, significant factor determining health status. Shifts in patterns of illness and potential for illness intervention are acknowledged as central in moving the focus from illness to wellness. Recognition of the deleterious impact of lifestyle and existing behaviors has raised awareness of the need to promote change in wellness behaviors and mechanisms. The scope and quality of information becoming available related to health promotion is bewildering and often contradictory. Information becomes available daily on nutrition, exercise, stress and relaxation, relatedness and support systems, and consciousness and spirituality . Desires and motivations are complex, combining a wish to perpetuate an affluent lifestyle with recognition that depletion of resources and environmental contaminations are risks to the well-being of individuals and society. Nurses, as well as other health care providers, are concerned with health promotion. We need to view our arena realistically and with full cognizance of balancing reasonable caution in scrutinizing new information with openness to ideas that will expand both the potential for wellness and our potential to contribute to health promotion. We practice in a quagmire of uncertainty, unsubstantiated truths, and demands for assurances and answers. We are asked to provide quality care and to perform responsibly in a cost-effective manner. We are pressured for pragmatics . We need to recognize our urge to capitulate to demands. Since historically we are a caring, responsive practice, we can be trapped into "false assurance." While recognizing appropriate limitations in providing assurances, it is possible to offer assistance in ferreting out information and understanding the degree of confidence with which it can be viewed and to support increasing autonomy. Educational programs can be used in conjunction with relationship skills in enhancing health care, the recipient's adoption of wellness behaviors that promote health.