Chronic wound healing by fetal cell therapy may be explained by differential gene profiling observed in fetal versus old skin cells.

Engineering of fetal tissue has a high potential for the treatment of acute and chronic wounds of the skin in humans as these cells have high expansion capacity under simple culture conditions and one organ donation can produce Master Cell Banks which can fabricate over 900 million biological bandages (9 x 12cm). In a Phase 1 clinical safety study, cases are presented for the treatment of therapy resistant leg ulcers. All eight patients, representing 13 ulcers, tolerated multiple treatments with fetal biological bandages showing no negative secondary effects and repair processes similar to that seen in 3rd degree burns. Differential gene profiling using Affymetrix gene chips (analyzing 12,500 genes) were accomplished on these banked fetal dermal skin cells compared to banked dermal skin cells of an aged donor in order to point to potential indicators of wound healing. Families of genes involved in cell adhesion and extracellular matrix, cell cycle, cellular signaling, development and immune response show significant differences in regulation between banked fetal and those from banked old skin cells: with approximately 47.0% of genes over-expressed in fetal fibroblasts. It is perhaps these differences which contribute to efficient tissue repair seen in the clinic with fetal cell therapy.

Predictors and Moderators of Clinical Outcomes in Adolescents with Severe Mental Disorders After an Assertive Community Treatment.

Previous studies have shown that stressful life events (SLEs), gender, social functioning and pretreatment severity are some of the predictors and/or moderators of treatment outcome in psychiatric care. The current study explored the effect of these predictors and moderators on the treatment outcome related to assertive community treatment (ACT) proposed to young people with severe mental disorders. 98 patients were assessed for externalizing and emotional difficulties, at admission and then at discharge of an ACT. Analyses revealed significant improvements in terms of symptomatology. In particular, regression analyses showed that pretreatment severity is a significant predictor of the outcome on emotional symptoms and is moderated by SLE on the outcome on externalizing symptoms. Furthermore, higher social functioning proved to predict better outcome on externalizing symptoms. Our results further evidence that these factors can explain inter-individual differences in outcome related to ACT. The theoretical and clinical implications of these results are discussed.

Representação social da doença mental: o olhar da família do portador de esquizofrenia

Este trabalho de investigação aborda a questão da representação social da doença mental entre familiares de pacientes diagnosticados com esquizofrenia, um aspecto necessário e fundamental para a nossa futura prática clínica. O objectivo era compreender a forma como representam a doença mental e o seu portador, e o trabalho teve como referencial vários autores que retractam a representação social da doença mental nas suas várias dimensões: significado, causas e cura da doença mental, ocupação, tomada da medicação, e futuro do portador de distúrbio psíquico. Os dados foram recolhidos mediante uma entrevista aos familiares, realizada em casa dos pacientes. Para o efeito foi desenvolvido um guião de entrevista. Foram recrutados 6 famílias dos portadores de esquizofrenia entre os utentes actuais do Hospital Agostinho Neto – “Extensão Trindade”. As entrevistas foram posteriormente transcritas e os discursos sobre as várias dimensões da representação social foram categorizados. As famílias se posicionaram caracterizando a doença mental e o seu portador segundo as representações do senso comum, pelo que concluímos que elas têm pouca informação médica e compreensão da real condição psíquica do seu familiar. O significado que a família atribuía à doença mental e à sua causa não foi influenciado pelo nível de escolaridade das famílias, mas sim corresponde aos valores culturais da sociedade cabo-verdiana. A partir desta investigação, percebemos a importância de assistir e informar os familiares que acompanham o doente mental, durante o seu tratamento.

A integração do portador de transtorno mental na família

O presente estudo visa reflectir sobre a percepção do portador de transtorno mental sobre a sua integração na família, identificando e analisando vários factores que podem exercer um papel determinante na sua integração. Neste sentido, buscamos problematizar a integração do portador de transtorno mental, tendo em vista o funcionamento da família e as suas condições socioeconómicas, a relação que mantém com os serviços cuidadores, bem como as políticas públicas implementadas, com o objectivo de debelar o problema de transtorno mental. A nossa pesquisa foi realizada no Hospital Trindade, situada na cidade da Praia, extensão do Hospital Agostinho Neto e que tem acolhido e tratado sobretudo os portadores de transtorno mental. Para a colecta de dados, realizamos entrevistas a quinze portadores de transtorno mental e às respectivas famílias, onde focamos os aspectos cruciais para o nosso intento: na entrevista aos pacientes, realçamos a forma como convivem com os outros, com especial atenção para a relação familiar, já que pretendemos elucidar a forma como percebem a sua integração na família; na entrevista aos familiares, sublinhamos também a forma como vêm a relação com o seu portador de transtorno mental, mas quisemos dar um enfoque especial à forma como a família percebe os vários apoios, quer das diferentes instituições, quer do Estado, na medida em que sozinha, tendo em vista uma grande sobrecarga – frise-se os aspectos emocionais e socioeconómicos – não poderá tratar do seu familiar portador de transtorno mental. Assim, a partir dos aspectos supracitados, inferimos que, não obstante os preconceitos socialmente arraigados, apesar de o Estado estar aquém do seu papel, seja na implementação de políticas públicas direccionadas ao portador de transtorno mental, seja no apoio às famílias, e, ainda, apesar de não haver uma verdadeira inclusão da família, no processo de tratamento, os portadores de transtorno mental, em geral, querem estar no seu próprio seio familiar, o que nos leva a pensar que é o espaço onde, de facto, se sentem bem.

Poly-N-acetyl glucosamine fibers are synergistic with vacuum-assisted closure in augmenting the healing response of diabetic mice.

BACKGROUND: Vacuum-assisted closure (VAC) has become the preferred modality to treat many complex wounds but could be further improved by methods that minimize bleeding and facilitate wound epithelialization. Short fiber poly-N-acetyl glucosamine nanofibers (sNAG) are effective hemostatic agents that activate platelets and facilitate wound epithelialization. We hypothesized that sNAG used in combination with the VAC device could be synergistic in promoting wound healing while minimizing the risk of bleeding. METHODS: Membranes consisting entirely of sNAG nanofibers were applied immediately to dorsal excisional wounds of db/db mice followed by application of the VAC device. Wound healing kinetics, angiogenesis, and wound-related growth factor expression were measured. RESULTS: The application of sNAG membranes to wounds 24 hours before application of the VAC device was associated with a significant activation of wounds (expression of PDGF, TGFβ, EGF), superior granulation tissue formation rich in Collagen I as well as superior wound epithelialization (8.6% ± 0.3% vs. 1.8% ± 1.1% of initial wound size) and wound contraction. CONCLUSIONS: The application of sNAG fiber-containing membranes before the application of the polyurethane foam interface of VAC devices leads to superior healing in db/db mice and represents a promising wound healing adjunct that can also reduce the risk of bleeding complications.

Governor's Task Force on Dependent Adults with Mental Retardation Final Report, 2009

On February 17, 2009, Governor Culver signed Executive Order No. 11 to create a Task Force on Dependent Adults with Mental Retardation. The executive order charges the Task Force with the responsibility of recommending steps to strengthen and improve state laws and regulations on the care and treatment of dependent adults with mental retardation. The Final Report includes recommendations that establish or improve systems of coordination between government entities. The report includes a series of proposals from the Department of Human Services (DHS) that redesign the adult abuse assessment process that are necessary for long-term reform. Included in them is a proposal to enhance a community’s capacity to provide a safety net of services, as well as formal and informal supports for vulnerable adults through partnerships among multiple local stakeholders.

Enfermagem e reinserção da pessoa portadora de doença mental institucionalizada na família

Com este trabalho científico pretendeu-se examinar o contributo da enfermagem na reinserção da pessoa portadora da doença mental institucionalizada na família. É um estudo exploratório descritivo de natureza qualitativa, direccionada às famílias das ppdm institucionalizadas no Centro de Apoio de Doentes Mentais de São Vicente. Neste sentido, participaram do estudo 5 famílias das respectivas ppdm institucionalizadas e o estudo decorreu nos domicílios das respectivas famílias. As informações foram colhidas através de uma entrevista semiestruturada e os dados tratados com base na análise de conteúdo. Os resultados apontam que existem um leque de factores que dificultam a reinserção, nomeadamente a carência da informação por parte dos familiares da ppdm e a consequente falta de envolvimento da família no seu tratamento, o impacto da sobrecarga de diversa ordem e a necessidade de um trabalho por parte dos cuidadores de saúde no sentido de auxiliarem e apoiarem estas famílias, com maior proximidade e de forma holística. Este trabalho trouxe um contributo a nível teórico no sentido de promover futuros trabalhos ligados a esta problemática e a necessidade de investir em trabalhos mais direccionadas às comunidades, sendo um ponto que precisa de ser trabalhado. Em termos práticos a pesquisa veio expor a necessidade de uma intervenção multidisciplinar em prol da reinserção da pessoa portadora da doença mental institucionalizada na família, tanto no sentido de promover a socialização e reduzir as consequências de uma institucionalização prolongada. Conclui-se, finalmente que existe uma necessidade de um trabalho de Enfermagem em Saúde Mental e Psiquiatria mais virada as famílias em suas próprias comunidades/residências, tanto de promoção a saúde e de prevenção em todos os níveis.

Nitric oxide mediates the blood pressure response to mental stress in humans.

OBJECTIVE: Nitric oxide (NO) regulates arterial pressure by modulating peripheral vascular tone and sympathetic vasoconstrictor outflow. NO synthesis is impaired in several major cardiovascular disease states. Loss of NO-induced vasodilator tone and restraint on sympathetic outflow could result in exaggerated pressor responses to mental stress. METHODS: We, therefore, compared the sympathetic (muscle sympathetic nerve activity) and haemodynamic responses to mental stress performed during saline infusion and systemic inhibition of NO-synthase by NG-monomethyl-L-arginine (L-NMMA) infusion. RESULTS: The major finding was that mental stress which during saline infusion increased sympathetic nerve activity by ~50 percent and mean arterial pressure by ~15 percent had no detectable sympathoexcitatory and pressor effect during L-NMMA infusion. These findings were not related to a generalised impairment of the haemodynamic and/or sympathetic responsiveness by L-NMMA, since the pressor and sympathetic nerve responses to immersion of the hand in ice water were preserved during L-NMMA infusion. CONCLUSION: Mental stress causes pressor and sympathoexcitatory effects in humans that are mediated by NO. These findings are consistent with the new concept that, in contrast to what has been generally assumed, under some circumstances, NO has a blood pressure raising action in vivo.

Department of Human Services: Cherokee Mental Health Institute, FY 2007

These Facts sheets have been developed to provide a multitude of information about executive branch agencies/departments on a single sheet of paper. The Facts provides general information, contact information, workforce data, leave & benefits information, and affirmative action data. This is the most recent update of information for the fiscal year 2007.

Department of Human Services: Cherokee Mental Health Institute, FY 2008

These Facts sheets have been developed to provide a multitude of information about executive branch agencies/departments on a single sheet of paper. The Facts provides general information, contact information, workforce data, leave & benefits information, and affirmative action data. This is the most recent update of information for the fiscal year 2007.

Deletion of delta-opioid receptor in mice alters skin differentiation and delays wound healing.

In addition to their well-known antinociceptive action, opioids can modulate non-neuronal functions, such as immune activity and physiology of different cell types. Several findings suggest that the delta-opioid receptor (DOR) and its endogenous ligands (enkephalins) are important players in cell differentiation and proliferation. Here we show the expression of DOR in mouse skin and human skin cultured fibroblasts and keratinocytes using RT-PCR. In DOR knock-out (KO) mice, a phenotype of thinner epidermis and higher expression of cell differentiation marker cytokeratin 10 (CK 10) were observed compared with wild type (WT). Using a burn wound model, significant wound healing delay (about 2 days) and severe epidermal hypertrophy were shown at the wound margin of DOR KO mice. This wound healing delay was further investigated by immunohistochemistry using markers for proliferation, differentiation, re-epithelialization, and dermal repair (CK 6, CK 10, and collagen IV). The levels of all these markers were increased in wounds of KO mice compared with WT. During the wound healing, the epidermal thickness in KO mice augments faster and exceeds that of the WT by day 3. These results suggest an essential role of DOR in skin differentiation, proliferation, and migration, factors that are important for wound healing.

Overview of the State Mental Health Institutes, August 24th, 2009

Iowa’s four Mental Health Institutes (MHIs), located in Cherokee, Clarinda, Independence and Mount Pleasant, provide critical access to quality acute psychiatric care for Iowa’s adults and children needing mental health treatment, and provide specialized mental health related services. The specialized services include substance abuse treatment, dual diagnosis treatment for persons with mental illness and substance addiction, psychiatric medical institution for children (PMIC), and long-term psychiatric care for the elderly (geropsychiatric).

Peroxisome proliferator-activated receptor (PPAR)-beta as a target for wound healing drugs: what is possible?

Peroxisome proliferator-activated receptor (PPAR) dysfunction has been implicated in the manifestation of many diseases and illnesses, ranging from obesity to cancer. Herein, we discuss the role of PPARbeta, one of the three PPAR isotypes, during wound healing. While PPARbeta expression is undetectable in unchallenged and healthy adult interfollicular mouse skin, it is robustly re-activated in stress situations, such as upon phorbol ester treatment, hair plucking and cutaneous wounding. The inflammatory reaction associated with a skin injury activates the keratinocytes at the edges of the wound. This activation involves PPARbeta, whose expression and activity as transcription factor are up-regulated by pro-inflammatory signals. The re-activation of PPARbeta influences three important properties of the activated keratinocytes that are vital for rapid wound closure, namely, survival, migration and differentiation. The anti-apoptotic and, thus, survival role of PPARbeta is mediated by the up-regulation of expression of integrin-linked kinase and 3-phosphoinositide-dependent kinase-1. Both kinases are required for the full activation of the Akt1 survival cascade. Therefore, the up-regulation of PPARbeta, early after injury, appears to be important to maintain a sufficient number of viable keratinocytes at the wound edge. At a later stage of wound repair, the stimulation of keratinocyte migration and differentiation by PPARbeta is also likely to be important for the formation of a new epidermis at the wounded area. Consistent with these observations, the entire wound healing process is delayed in PPARbeta +/- mice and wound closure is retarded by 2-3 days. The multiple roles of PPARbeta in the complex keratinocyte response after injury and during skin repair certainly justify a further exploration of its potential as a target for wound healing drugs.

Selective expression of a dominant-negative form of peroxisome proliferator-activated receptor in keratinocytes leads to impaired epidermal healing.

Many nuclear hormone receptors are involved in the regulation of skin homeostasis. However, their role in the epithelial compartment of the skin in stress situations, such as skin healing, has not been addressed yet. The healing of a skin wound after an injury involves three major cell types: immune cells, which are recruited to the wound bed; dermal fibroblasts; and epidermal and hair follicle keratinocytes. Our previous studies have revealed important but nonredundant roles of PPARalpha and beta/delta in the reparation of the skin after a mechanical injury in the adult mouse. However, the mesenchymal or epithelial cellular compartment in which PPARalpha and beta/delta play a role could not be determined in the null mice used, which have a germ line PPAR gene invalidation. In the present work, the role of PPARalpha was studied in keratinocytes, using transgenic mice that express a PPARalpha mutant with dominant-negative (dn) activity specifically in keratinocytes. This dn PPARalpha lacks the last 13 C terminus amino acids, binds to a PPARalpha agonist, but is unable to release the nuclear receptor corepressor and to recruit the coactivator p300. When selectively expressed in keratinocytes of transgenic mice, dn PPARalphaDelta13 causes a delay in the healing of skin wounds, accompanied by an exacerbated inflammation. This phenotype, which is similar to that observed in PPARalpha null mice, strongly suggests that during skin healing, PPARalpha is required in keratinocytes rather than in other cell types.