Recurrent human herpes simplex lesions are infiltrated by macrophages and CD4 and CD8 lymphocytes, which secrete cytokines and chemokines. Vesicle fluid was examined by ELISA for the presence of cytokines and beta (C-C) chemokines. On the first day of the lesion, high concentrations of interleukin (IL)-1beta, and IL-6, moderate concentrations of IL-1alpha and IL-10, and low concentrations of IL-12 and beta chemokines were found; levels of macrophage inflammatory protein (MIP)-1beta were significantly higher than levels of MIP-1alpha and RANTES. At day 3, the concentrations of IL-1beta, IL-6, and MIP-1beta were lower, whereas the levels of IL-10, IL-12, and MIP-1alpha remained similar, and the level of tumor necrosis factor-alpha was now detectable. Herpes simplex virus infection of keratinocytes in vitro stimulated production of beta chemokines followed by IL-12 and then IL-10, IL-1alpha, IL-1beta, and IL-6, indicating a potential role for these events in early recruitment, activation, and interferon-gamma production of CD4 cells in herpetic lesions.
High-protein nutrition bars can be formulated so they remain soft during storage by selecting proteins and sugars that are compatible with each other. Otherwise, the protein and sugar will separate from each other which can then lead to hardening.
Expectations for evidence-based healthcare are growing, yet the most difficult step in the process, implementation, is often left to busy nursing leaders who may be unprepared for the challenge. Selecting from the long list of implementation strategies and knowing when to apply them are a bit of an "art," matching clinician needs and organizational context. This article describes an application-oriented resource that nursing leaders can use to plan evidence-based practice implementation in complex healthcare systems.
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