Normoxic wound fluid contains high levels of vascular endothelial growth factor

OBJECTIVE: To examine the temporal integration of vascular endothelial growth factor (VEGF), which has been shown to be present in wound fluid, with the putatively related processes of wound fluid oxygen content, wound angiogenesis, and granulation tissue formation. SUMMARY BACKGROUND DATA: During cutaneous wound repair, new tissue formation starts with reepithelialization and is followed by granulation tissue formation, including neutrophil and macrophage accumulation, fibroblast ingrowth, matrix deposition, and angiogenesis. Because angiogenesis and increased vascular permeability are characteristic features of wound healing, VEGF may play an important role in tissue repair. METHODS: A ventral hernia, surgically created in the abdominal wall of female swine, was repaired using silicone sheeting and skin closure. Over time, a fluid-filled wound compartment formed, bounded by subcutaneous tissue and omentum. Ultrasonography was performed serially to examine the anatomy and dimensions of the subcutaneous tissue and wound compartment. Serial wound fluid samples, obtained by percutaneous aspiration, were analyzed for PO2, PCO2, pH, and growth factor concentrations. RESULTS: Three independent assays demonstrate that VEGF protein is present at substantially elevated levels in a wound fluid associated with the formation of abdominal granulation tissue. However, the wound fluid is not hypoxic at any time. Serial sampling reveals that transforming growth factor beta-1 protein appears in the wound fluid before VEGF. CONCLUSIONS: The results suggest that VEGF is a prominent regulator of wound angiogenesis and vessel permeability. A factor other than hypoxia, perhaps the earlier appearance of another growth factor, transforming growth factor beta-1, may positively regulate VEGF appearance in the wound fluid.     

Fetal antecedents of infant temperament

This study established the emergence of stable individual differences in neurobehavioral functioning prior to birth and examined their relation to subsequent infant temperament. Fetal heart rate and movement were recorded longitudinally for 31 fetuses at 6 gestational ages beginning at 20 weeks' gestation. Maternally reported temperament data were collected at 3 and 6 months. Moderate stability in all measures except reactivity was apparent at some time before birth. By 36 weeks, fetal neurobehavior accounted for between 22% and 60% of the variance in prediction of temperament scores. In general, more active fetuses were more difficult, unpredictable, unadaptable, and active infants. Higher fetal heart rate was associated with lower emotional tone, activity level, and predictability. We conclude that features of fetal neurobehavior provide the basis for individual differences in reactivity and regulation in infancy.     

Microsurgical replantation of the main segments of the extremities

Computerizing an organization's policies and guidelines is difficult but rewarding. The assessment, planning, implementation, and evaluation of converting all paper policies and procedures into a computerized system are outlined, with particular focus on organizing guidelines according to the Joint Commission on Accreditation of Healthcare Organization's (JCAHO) functional standards.