Stromal progenitor cell therapy corrects the wound-healing defect in the ischemic rabbit ear model of chronic wound repair

Chronic wounds create a formidable clinical problem resulting in considerable morbidity and healthcare expenditure. The etiology for wound healing impairment appears to be multifactorial; however, ischemia is a common factor in most types of chronic wounds. Ideal therapy for such wounds would be to correct deficiencies in growth factors and matrix components and provide cellular precursors required for timely wound closure. We hypothesized that stromal progenitor cell (SPC) therapy could correct the ischemic wound-healing defect through both direct and indirect mechanisms. To test this hypothesis, we used the ischemic rabbit ear model of chronic wound healing. We found that treatment of the wounds with SPCs was able to reverse the ischemic wound-healing impairment, with improved granulation tissue formation and reepithelialization compared with vehicle or bone marrow mononuclear cell controls. In vitro, SPCs were found to produce factors involved in angiogenesis and reepithelialization, and extracellular matrix components, providing evidence for both direct and indirect mechanisms for the observed correction of the healing impairment in these wounds. Treatment of ischemic wounds with SPCs can dramatically improve wound healing and provides a rationale for further studies focused on SPCs as a potential cellular therapy in impaired wound healing.     

End-of-life Models and Emergency Department Care

Many people die in emergency departments (EDs) across the United States from sudden illnesses or injuries, an exacerbation of a chronic disease, or a terminal illness. Frequently, patients and families come to the ED seeking lifesaving or life-prolonging treatment. In addition, the ED is a place of transition-patients usually are transferred to an inpatient unit, transferred to another hospital, or discharged home. Rarely are patients supposed to remain in the ED. Currently, there is an increasing amount of literature related to end-of-life care. However, these end-of-life care models are based on chronic disease trajectories and have difficulty accommodating sudden-death trajectories common in the ED. There is very little information about end-of-life care in the ED. This article explores ED culture and characteristics, and examines the applicability of current end-of-life care models.     

227. Der gestielte Peronaeus-Insellappen als Alternative zum freien Gewebetransfer am distalen Unterschenkel und Fuß

Zusammenfassung Der distal gestielte Peronaeus-Insellappen, erstmals 1984 von Yoshimura publiziert, ist ein fasciocutaner Lappen, der über einen Hautast der A. peronea ernährt wird. Die A. peronea weist distal, ca 5 cm oberhalb des Sprunggelenkes, einen Ramus perforans zur A. tibialis anterior auf und über einen Ramus communicans besteht eine Verbindung zur A. tibialis posterior. Unterbindet man die A. peronea proximal der Abgangsstele der Hautarterie, so kommt es über die distalen Anastomosen zur retrograden Durchblutung. Der distal gestielte Peronaeuslappen besitzt einen großen Schwenkbereich bis hin zum Fußrücken. Die Durchgängigkeit der drei Unterschenkelarterien ist die Voraussetzung für die Durchführbarkeit. Die Indikation ergibt sich bei oberflächlichen Knochen- und Hautdefekten im distalen Unterschenkeldrittel, der Malleolengabel, der Ferse und des Fußrückens.     

Early Designs for the Occlusal Anatomy of Posterior Denture Teeth: Part III

Part III of this series of articles, like Part II, reviews the pioneering efforts in the 19th century to improve the quality of artificial teeth. The focus of this article, unlike that of Part II, is specifically modifications in the design of the occlusal anatomy of the 19th century denture teeth, along with the theories of mandibular movement that inspired those modifications. This article concludes the introductory phase of this project, which seeks to unravel the confusing history of the development of (posterior) denture teeth.