text:
Massage

Massage is the rubbing or kneading of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet or a device. The purpose of massage is generally for the treatment of body stress or pain. In European countries, a person professionally trained to give massages is traditionally known as a masseur (male) or masseuse (female). In the United States, these individuals are often referred to as "massage therapists". In some provinces of Canada, they are called "registered massage therapists."

In professional settings, clients are treated while lying on a massage table, sitting in a massage chair, or lying on a mat on the floor. There are many different modalities in the massage industry, including (but not limited to): deep tissue, manual lymphatic drainage, medical, sports, structural integration, Swedish, Thai and trigger point.

Etymology
The word comes from the French massage 'friction of kneading', which, in turn, comes either from the Arabic word مَسَّ massa meaning 'to touch, feel', the Portuguese amassar 'knead', from the Latin massa meaning 'mass, dough', or the Greek verb μάσσω (massō) 'to handle, touch, to work with the hands, to knead dough'.

The ancient Greek word for massage was anatripsis and the Latin was frictio.

Ancient times
Archaeological evidence of massage has been found in many ancient civilizations including China, India, Japan, Egypt, Rome, Greece, and Mesopotamia.

BC 2330: The Tomb of Akmanthor (also known as "The Tomb of the Physician") in Saqqara, Egypt, depicts two men having work done on their feet and hands, possibly depicting a massage.

BC 2000: The word muššu'u ("massage") is written for the first time, and its use is described, in some Sumerian and Akkadian texts found at the beginning of the 21st century in ancient Mesopotamia.

BC 722–481: Huangdi Neijing is composed during the Chinese Spring and Autumn period. The Nei-jing is a compilation of medical knowledge known up to that date, and is the foundation of traditional Chinese medicine. Massage is referred to in 30 different chapters of the Nei Jing. It specifies the use of different massage techniques and how they should be used in the treatment of specific ailments, and injuries. Also known as "The Yellow Emperor's Inner Canon," the text refers to previous medical knowledge from the time of the Yellow Emperor (approx 2700 BC), misleading some into believing the text itself was written during the time of the Yellow Emperor (which would predate written history).

BC 762: In the Iliad and the Odyssey, massage with oils and aromatic substances is mentioned as a means to relax the tired limbs of warriors and as a way to help the treatment of wounds.

BC 700: Bian Que, the earliest known Chinese physician, uses massage in medical practice.

BC 500: Jīvaka Komarabhācca was an Indian physician who according to the Pāli Buddhist Canon was Shakyamuni Buddha's physician. Jivaka is sometimes credited with founding and developing a style of massage that led to the type of massage practiced in current-day Thailand. Though this claim is disputed.

BC 493: A possible biblical reference documents daily "treatments" with oil of myrrh as a part of the beauty regimen of the wives of Xerxes (Esther, 2:12).

BC 460: Hippocrates wrote "The physician must be experienced in many things, but assuredly in rubbing."

BC 300: Charaka Samhita, sometimes dated to 800 BCE, is one of the oldest of the three ancient treatises of Ayurvedic medicine, including massage. Sanskrit records indicate that massage had been practiced in India long before the beginning of recorded history.

AD 581: China establishes a department of massage therapy within the Office of Imperial Physicians.

Middle Ages
Many of Galen's manuscripts, for instance, were collected and translated by Hunayn ibn Ishaq in the 9th century. Later in the 11th-century copies were translated into Latin and again in the 15th and 16th centuries, when they helped enlighten European scholars as to the achievements of the Ancient Greeks. This renewal of the Galenic tradition during the Renaissance played a very important part in the rise of modern science.

One of the greatest Persian medics was Avicenna, also known as Ibn Sina, who lived from 980 AD to 1037 AD. His works included a comprehensive collection and systematization of the fragmentary and unorganized Greco-Roman medical literature that had been translated Arabic by that time, augmented by notes from his own experiences. One of his books, Al-Qānūn fī aṭ-Ṭibb (The Canon of Medicine) has been called the most famous single book in the history of medicine in both East and West. Avicenna excelled in the logical assessment of conditions and comparison of symptoms and took special note of analgesics and their proper use as well as other methods of relieving pain, including massage.

AD 1150: Evidence of massage abortion, involving the application of pressure to the pregnant abdomen, can be found in one of the bas reliefs decorating the temple of Angkor Wat in Cambodia. It depicts a demon performing such an abortion upon a woman who has been sent to the underworld. This is the oldest known visual representation of abortion.

In Southeast Asia, massage traditions and techniques have already been entrenched in the people's diverse cultures for centuries before trade contact with Europe in the 16th century. In the Philippines, a distinct massage and healing tradition called hilot developed,  while in Thailand, the tradition of massage that developed was called nuad thai. Nuad thai was declared in 2019 as a UNESCO intangible cultural heritage.

18th and 19th centuries
AD 1776: Jean Joseph Marie Amiot and Pierre-Martial Cibot, French missionaries in China translate summaries of Huangdi Neijing, including a list of medical plants, exercises, and elaborate massage techniques, into the French language, thereby introducing Europe to the highly developed Chinese system of medicine, medical-gymnastics, and medical-massage.

AD 1776: Pehr Henrik Ling, a Swedish physical therapist and teacher of medical-gymnastics, is born. Ling has often been erroneously credited for having invented "Classic Massage", also known as "Swedish Massage", and has been called the "Father of Massage".

AD 1779: Frenchman Pierre-Martial Cibot publishes "Notice du Cong-fou des Bonzes Tao-see", also known as "The Cong-Fou of the Tao-Tse", a French language summary of medical techniques used by Taoist priests. According to English historian of China Joseph Needham, Cibot's work "was intended to present the physicists and physicians of Europe with a sketch of a system of medical gymnastics which they might like to adopt—or if they found it at fault they might be stimulated to invent something better. This work has long been regarded as of cardinal importance in the history of physiotherapy because it almost certainly influenced the Swedish founder of the modern phase of the art, Pehr Hendrik Ling. Cibot had studied at least one Chinese book but also got much from a Christian neophyte who had become expert in the subject before his conversion."

AD 1813: The Royal Gymnastic Central Institute for the training of gymnastic instructors was opened in Stockholm, Sweden, with Pehr Henrik Ling appointed as principal. Ling developed what he called the "Swedish Movement Cure". Ling died in 1839, having previously named his pupils as the repositories of his teaching. Ling and his assistants left a little proper written account of their methods.

AD 1868: Dutch massage practitioner Johan Georg Mezger applies French terms to name five basic massage techniques, and coins the phrase "Swedish massage system". These techniques are still known by their French names (effleurage (long, gliding strokes), petrissage (lifting and kneading the muscles), friction (firm, deep, circular rubbing movements), tapotement (brisk tapping or percussive movements) and vibration (rapidly shaking or vibrating specific muscles)).

China
As of 2005, with the city of Shanghai alone there were an estimated 1,300–2,000 foot massage centers, with more than 3,000 in Shenzhen. It was also estimated that there were nearly 30,000 massage workers in Shanghai and over 40,000 in Shenzhen. The average rate of pay for a worker in the massage industry in China is over 10,000 yuan per month, making them a well-paying job in China's service sector.

United States
Massage started to become popular in the United States in the middle part of the 19th century and was introduced by two New York physicians, George and Charles Taylor, based on Pehr Henrik Ling's techniques developed in Sweden.

During the 1930s and 1940s massage's influence decreased as a result of medical advancements of the time, while in the 1970s massage's influence grew once again with a notable rise among athletes. Until the 1970s, nurses used massage to reduce pain and aid sleep. Popular books and videos, such as Massage for Relaxation, helped introduce massage to popular culture outside of a health setting. The massage therapy industry is continuously increasing. In 2009, U.S. consumers spent between $4 and $6 billion on visits to massage therapists. In 2015, research estimates that massage therapy was a $12.1 billion industry.

All but five states require massage therapists to be licensed, and licensure requires the applicant to receive training at an accredited school, and to pass a comprehensive exam. Those states that require licensure also typically require continuing education in massage techniques and in ethics.

United Kingdom
The service of massage or "physiological shampooing" was advertised in The Times from as early as 1880. Adverts claimed it as a cure for obesity amongst other chronic ailments.

Sports, business and organizations
Massage developed alongside athletics in both Ancient China and Ancient Greece. Taoist priests developed massage in concert with their Kung Fu gymnastic movements, while Ancient Greek Olympians used a specific type of trainer ("aleiptes") who would rub their muscles with oil. Pehr Ling's introduction to massage also came about directly as a result of his study of gymnastic movements.

The 1984 Summer Olympics in Los Angeles was the first time that massage therapy was televised as it was being performed on the athletes. And then, during the 1996 Summer Olympics in Atlanta massage therapy was finally offered as a core medical service to the US Olympic Team. Massage has been employed by businesses and organizations such as the U.S. Department of Justice, Boeing and Reebok. Athletes such as Michael Jordan and LeBron James have personal massage therapists that at times even travel with them.

Acupressure
Acupressure [from Latin acus "needle" (see acuity) + pressure (n.) ] is a technique similar in principle to acupuncture. It is based on the concept of life energy which flows through "meridians" in the body. In treatment, physical pressure is applied to acupuncture points with the aim of clearing blockages in those meridians. Pressure may be applied by fingers, palm, elbow, toes or with various devices.

Some medical studies have suggested that acupressure may be effective at helping manage nausea and vomiting, for helping lower back pain, tension headaches, stomach ache, among other things, although such studies have been found to have a high likelihood of bias.

Ashiatsu
In ashiatsu, the practitioner uses their feet to deliver treatment. The name comes from the Japanese, ashi for foot and atsu for pressure. This technique typically uses the heel, sesamoid, arch, and/or whole plantar surface of foot, and offers large compression, tension and shear forces with less pressure than an elbow and is ideal for large muscles, such as in thigh, or for long-duration upper trapezius compressions. Other manual therapy techniques using the feet to provide treatment include Keralite, Barefoot Lomilomi, and Chavutti Thirumal.

Ayurvedic massage
Ayurvedic massage is known as Abhyangam in Sanskrit. According to the Ayurvedic Classics Abhayngam is an important dincharya (Daily Regimen) that is needed for maintaining a healthy lifestyle. The massage technique used during Ayurvedic Massage aims to stimulate the lymphatic system. Practitioners claim that the benefits of regular Ayurvedic massage include pain relief, reduction of fatigue, improved immune system and improved longevity.

Burmese massage

"Known in Myanmar as Yoe Yar Nhake Nal Chin, meaning 'traditional massage', Burmese massage has its ancient origins from Thai, Chinese and Indian medicine. Currently, Burmese massage also includes the use of local natural ingredients such as Thanaka which helps to promote smooth skin and prevents sunburn."

Burmese massage is a full body massage technique that starts from head to toes, drawing on acupuncture, reflexology and kneading. Signature massage strokes include acupressure using the elbows, quick gentle knocking of acupressure points, and slow kneading of tight muscles. The massage aims to improve blood circulation and quality of sleep, while at the same time help to promote better skin quality.

Biomechanical stimulation (BMS) massage
Biomechanical stimulation (BMS) is a term generally used for localised biomechanical oscillation methods, whereby local muscle groups are stimulated directly or via the associated tendons by means of special hand held mechanical vibration devices. Biomechanical oscillation therapy and training is offered in a variety of areas such as competitive sports, fitness, rehabilitation, medicine, prevention, beauty and used to improve performance of the muscles and to improve coordination and balance. It is often used in myofascial trigger point therapy to invoke reciprocal inhibition within the musculoskeletal system. Beneficial effects from this type of stimulation have been found to exist.

Biodynamic massage
Biodynamic massage was created by Gerda Boyesen as part of Biodynamic Psychotherapy. It uses a combination of hands-on work and "energy work" and also uses a stethoscope to hear the peristalsis.

Craniosacral therapy
Craniosacral therapy (CST) is a pseudoscience that aims to improve fluid movement and cranial bone motion by applying light touch to the skull, face, spine, and pelvis.

Erotic massage
A type of massage that is done in an erotic way via the use of massage techniques by a person on another person's erogenous zones to achieve or enhance their sexual excitation or arousal and to achieve orgasm.

It was also once used for medical purposes as well as for the treatment of "female hysteria" and "womb disease".

Nuru massage is a Japanese form of erotic massage.

Hammam ("Turkish bath") massage
In the traditional Hammam, massage involves not just vigorous muscle kneading, but also joint cracking, "not so much a tender working of the flesh as a pummelling, a cracking of joints, a twisting of limbs..." An 18th-century traveler reported: "...one of the attendants begins to press and handle the tops of the shoulders, the muscles of the arm, and successively the whole body; first gently, then by degrees increasing the pressure, till he comes to handle pretty roughly, but without giving pain. This is repeated at short intervals till the skin is perfectly softened. The attendant then taking hold of the bather's fingers, with a dexterous jerk makes each joint crack successively; after which, laying him flat on his back, and bringing the arms across the breast, the shoulder joints are made to crack in like manner."

Lomilomi and indigenous massage of Oceania
Lomilomi is the traditional massage of Hawaii. As an indigenous practice, it varies by island and by family. The word lomilomi also is used for massage in Samoa and East Futuna. In Samoa, it is also known as lolomi and milimili. In East Futuna, it is also called milimili, fakasolosolo, amoamo, lusilusi, kinikini, fai’ua. The Māori call it romiromi and mirimiri. In Tonga massage is fotofota, tolotolo, and amoamo. In Tahiti it is rumirumi. On Nanumea in Tuvalu, massage is known as popo, pressure application is kukumi, and heat application is tutu. Massage has also been documented in Tikopia in the Solomon Islands, in Rarotonga, in Pukapuka and in Western Samoa.

Lymphatic drainage
Manual lymphatic drainage is a technique used to gently work and stimulate the lymphatic system, to assist in reduction of localized swelling. The lymphatic system is a network of slow moving vessels in the body that carries cellular waste toward the liver, to be filtered and removed. Lymph also carries lymphocytes and other immune system agents. Manual lymphatic drainage claims to improve waste removal and immune function.

Medical massage
Medical massage is a controversial term in the massage profession. Many use it to describe a specific technique. Others use it to describe a general category of massage and many methods such as deep tissue massage, myofascial release and trigger-point therapy, as well as osteopathic techniques, cranial-sacral techniques and many more can be used to work with various medical conditions.

Massage used in the medical field includes decongestive therapy used for lymphedema which can be used in conjunction with the treatment of breast cancer. Light massage is also used in pain management and palliative care. Carotid sinus massage is used to diagnose carotid sinus syncope and is sometimes useful for differentiating supraventricular tachycardia (SVT) from ventricular tachycardia. It, like the valsalva maneuver, is a therapy for SVT. However, it is less effective than management of SVT with medications.

A 2004 systematic review found single applications of massage therapy "reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level," while "multiple applications reduced delayed assessment of pain," and found improvements in anxiety and depression similar to effects of psychotherapy. A subsequent systematic review published in 2008 found that there is little evidence supporting the use of massage therapy for depression in high quality studies from randomized controlled trials.

Myofascial release
Myofascial release refers to the manual massage technique that claims to release adhered fascia and muscles with the goal of eliminating pain, increasing range of motion and equilibrioception. Myofascial release usually involves applying shear compression or tension in various directions, cross fiber friction or by skin rolling.

Reflexology
Reflexology, also known as "zone therapy", is an alternative medicine involving application of pressure to the feet and hands with specific thumb, finger, and hand techniques without the use of oil or lotion. It is based on a pseudoscientific belief in a system of zones and reflex areas that purportedly reflect an image of the body on the feet and hands, with the premise that such work effects a physical change to the body.

Shiatsu
Shiatsu (指圧) (shi meaning finger and atsu meaning pressure) is a form of Japanese bodywork based on concepts in traditional Chinese medicine such as qi meridians. It consists of finger, palm pressure, stretches, and other massage techniques. There is no convincing data available to suggest that shiatsu is an effective treatment for any medical condition.

Sports massage
Sports massage is the use of specific massage therapy techniques in an athletic context to improve recovery time, enhance performance and reduce the risk of injury. This is accomplished using techniques that stimulate the flow of blood and lymph to and from muscles. Sports massage is often delivered before or after physical activity depending on the subject's needs, preferences and goals.

Structural Integration
Structural Integration's aim is to unwind the strain patterns in the body's myofascial system, restoring it to its natural balance, alignment, length and ease. This is accomplished by hands-on manipulation, coupled with movement re-education. There are about 15 schools of Structural Integration as recognized by the International Association of Structural Integration, including the Dr. Ida Rolf Institute (with the brand Rolfing), Hellerwork, Guild for Structural Integration, Aston Patterning, Soma, and Kinesis Myofascial Integration.

Swedish massage
The most widely recognized and commonly used category of massage is Swedish massage. The Swedish massage techniques vary from light to vigorous. Swedish massage uses five styles of strokes. The five basic strokes are effleurage (sliding or gliding), petrissage (kneading), tapotement (rhythmic tapping), friction (cross fiber or with the fibers) and vibration/shaking.

The development of Swedish massage is often inaccurately credited to Per Henrik Ling, though the Dutch practitioner Johann Georg Mezger applied the French terms to name the basic strokes. The term "Swedish massage" is actually only recognized in English- and Dutch-speaking countries, and in Hungary. Elsewhere the style is referred to as "classic massage".

Clinical studies have found that Swedish massage can reduce chronic pain, fatigue, joint stiffness and improve function in patients with osteoarthritis of the knee.

Thai massage

Known in Thailand as Nuat phaen boran, meaning "ancient/traditional massage", traditional Thai massage is generally based on a combination of Indian and Chinese traditions of medicine.

Thai massage combines both physical and energetic aspects. It is a deep, full-body massage progressing from the feet up, and focusing on sen or energy lines throughout the body, with the aim of clearing blockages in these lines, and thus stimulating the flow of blood and lymph throughout the body. It draws on yoga, acupressure and reflexology.

Thai massage is a popular massage therapy that is used for the management of conditions such as musculoskeletal pain and fatigue. Thai massage involves a number of stretching movements that improve body flexibility, joint movement and also improve blood circulation throughout the body. In one study scientists found that Thai massage showed comparable efficacy as the painkiller ibuprofen in the reduction of joint pain caused by osteoarthritis (OA) of the knee.

Traditional Chinese massage
Massage of Chinese Medicine is known as An Mo (按摩, pressing and rubbing) or Qigong Massage and is the foundation of Japan's Anma. Categories include Pu Tong An Mo (general massage), Tui Na An Mo (pushing and grasping massage), Dian Xue An Mo (cavity pressing massage), and Qi An Mo (energy massage). Tui na (推拿) focuses on pushing, stretching, and kneading muscles, and Zhi Ya (指壓) focuses on pinching and pressing at acupressure points. Technique such as friction and vibration are used as well.

Trigger point therapy
Sometimes confused with pressure point massage, this involves deactivating trigger points that may cause local pain or refer pain and other sensations, such as headaches, in other parts of the body. Manual pressure, vibration, injection, or other treatment is applied to these points to relieve myofascial pain. Trigger points were first discovered and mapped by Janet G. Travell (President Kennedy's physician) and David Simons. Trigger points have been photomicrographed and measured electrically and in 2007 a paper was presented showing images of Trigger Points using MRI. These points relate to dysfunction in the myoneural junction, also called neuromuscular junction (NMJ), in muscle, and therefore this technique is different from reflexology acupressure and pressure point massage.

Tui na
Tui na is a Chinese manual therapy technique that includes many different types of strokes, aimed to improve the flow of chi through the meridians.

Watsu
Watsu, developed by Harold Dull at Harbin Hot Springs, California, is a type of aquatic bodywork performed in near-body-temperature water, and characterized by continuous support by the practitioner and gentle movement, including rocking, stretching of limbs, and massage. The technique combines hydrotherapy floating and immersion with shiatsu and other massage techniques. Watsu is used as a form of aquatic therapy for deep relaxation and other therapeutic intent. Related forms include Waterdance, Healing Dance, and Jahara technique.

Massage tables and chairs
Specialized massage tables and chairs are used to position recipients during massages. A typical commercial massage table has an easily cleaned, heavily padded surface, and horseshoe-shaped head support that allows the client to breathe easily while lying face down and can be stationary or portable, while home versions are often lighter weight or designed to fold away easily. An orthopedic pillow or bolster can be used to correct body positioning.

Ergonomic chairs serve a similar function as a massage table. Chairs may be either stationary or portable models. Massage chairs are easier to transport than massage tables, and recipients do not need to disrobe to receive a chair massage. Due to these two factors, chair massage is often performed in settings such as corporate offices, outdoor festivals, shopping malls, and other public locations.

Warm-water therapy pools
Temperature-controlled warm-water therapy pools are used to perform aquatic bodywork. For example, Watsu requires a warm-water therapy pool that is approximately chest-deep (depending on the height of the therapist) and temperature-controlled to about 35 °C (95 °F).

Dry-water massage tables
A dry-water massage table uses jets of water to perform the massage of the patient's muscles. These tables differ from a Vichy shower in that the client usually stays dry. Two common types are one in which the client lies on a waterbed-like mattress which contains warm water and jets of water and air bubbles and one in which the client lies on a foam pad and is covered by a plastic sheet and is then sprayed by jets of warm water, similar to a Vichy shower. The first type is sometimes seen available for use in shopping centers for a small fee.

Vichy showers
A Vichy shower is a form of hydrotherapy that uses a series of shower nozzles that spray large quantities of water over the client while they lie in a shallow wet bed, similar to a massage table, but with drainage for the water. The nozzles may usually be adjusted for height, direction, and temperature to suit the patient's needs.

Cremes, lotions, gels, and oils
Many different types of massage cremes, lotions, gels, and oils are used to lubricate and moisturize the skin and reduce the friction between skin (hands of technician and client).

Massage tools
These instruments or devices are sometimes used during massages. Some tools are for use by individuals, others by the therapist.

Tools used by massage therapists
Instrument-assisted soft-tissue massage can deploy stainless-steel devices to manipulate tissue in a way that augments hands-on work.

A body rock is a serpentine-shaped tool, usually carved out of stone. It is used to amplify the therapist's strength and focus pressure on certain areas. It can be used directly on the skin with a lubricant such as oil or corn starch or directly over clothing.

Bamboo and rosewood tools are also commonly used. They originate from practices in southeast Asia, Thailand, Cambodia, and Burma. Some of them may be heated, oiled, or wrapped in cloth.

Cupping massage is often carried out using plastic cups and a manual hand-pump to create the vacuum. The vacuum draws the soft tissue perpendicular to the skin, providing a tensile force, which can be left in one site or moved along the tissue during the massage.

Tools used by both individuals and massagers
Hand-held battery-operated massaging and vibrating instruments are available, including devices for massaging the scalp following a haircut.

Vibrating massage pads come in a range of sizes, some with the option of heating.

Vibrating massage chairs can provide an alternative for therapy at home.

There is a widespread market in erotic massage instruments, including electric dildos and vibrators such as the massage wand.

Medical and therapeutic use
The main professionals that provide therapeutic massage are massage therapists, athletic trainers, physical therapists and practitioners of many traditional Chinese and other eastern medicines. Massage practitioners work in a variety of medical settings and may travel to private residences or businesses. Contraindications to massage include deep vein thrombosis, bleeding disorders or taking blood thinners such as warfarin, damaged blood vessels, weakened bones from cancer, osteoporosis, or fractures, and fever.

Beneficial effects
Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state of anxiety. Additional testing has shown an immediate increase in, and expedited recovery periods for, muscle performance. Theories behind what massage might do include enhanced skeletal muscle regrowth and remodeling, blocking nociception (gate control theory), activating the parasympathetic nervous system, which may stimulate the release of endorphins and serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving sleep.

Massage is hindered from reaching the gold standard of scientific research, which includes placebo-controlled and double blind clinical trials. Developing a "sham" manual therapy for massage would be difficult since even light touch massage could not be assumed to be completely devoid of effects on the subject. It would also be difficult to find a subject that would not notice that they were getting less of a massage, and it would be impossible to blind the therapist. Massage can employ randomized controlled trials, which are published in peer reviewed medical journals. This type of study could increase the credibility of the profession because it displays that purported therapeutic effects are reproducible.

Single-dose effects

 * Pain relief: Relief from pain due to musculoskeletal injuries and other causes is cited as a major benefit of massage. A 2015 Cochrane Review concluded that there is very little evidence that massage is an effective treatment for lower back pain. A meta-analysis conducted by scientists at the University of Illinois Urbana-Champaign failed to find a statistically significant reduction in pain immediately following treatment. Weak evidence suggests that massage may improve pain in the short term for people with acute, sub-acute, and chronic lower back pain.
 * State anxiety: Massage has been shown to reduce state anxiety, a transient measure of anxiety in a given situation.
 * Blood pressure and heart rate: Massage has been shown to temporarily reduce blood pressure and heart rate.

Multiple-dose effects

 * Pain relief: Massage may reduce pain experienced in the days or weeks after treatment.
 * Trait anxiety: Massage has been shown to reduce trait anxiety; a person's general susceptibility to anxiety.
 * Depression: Massage has been shown to reduce subclinical depression.

Neuromuscular effects
Massage has been shown to reduce neuromuscular excitability by measuring changes in the Hoffman's reflex (H-reflex) amplitude. A decrease in peak-to-peak H-reflex amplitude suggests a decrease in motoneuron excitability. Others explain, "H-reflex is considered to be the electrical analogue of the stretch reflex... and the reduction" is due to a decrease in spinal reflex excitability. Field (2007) confirms that the inhibitory effects are due to deep tissue receptors and not superficial cutaneous receptors, as there was no decrease in H-reflex when looking at light fingertip pressure massage. It has been noted that "the receptors activated during massage are specific to the muscle being massaged," as other muscles did not produce a decrease in H-reflex amplitude.

Regulations
Because the art and science of massage is a globally diverse phenomenon, different legal jurisdictions sometimes recognize and license individuals with titles, while other areas do not. Examples are:
 * Registered massage therapist (RMT) Canada
 * Remedial massage therapist (RMT) New Zealand
 * Certified massage therapist (CMT) New Zealand
 * Licensed massage practitioner (LMP)
 * Licensed massage therapist (LMT)
 * Licensed massage and bodywork therapist (LMBT) North Carolina
 * Therapeutic massage therapist (TMT) South Africa

In some jurisdictions, practicing without a license is a crime. One such jurisdiction is Washington state, where any health professionals practicing without a license can be issued a fine and charged with a misdemeanor offense.

Canada
In regulated provinces massage therapists are known as Registered Massage Therapists, in Canada six provinces regulate massage therapy: British Columbia, Ontario, Newfoundland and Labrador, Prince Edward Island, Saskatchewan, and New Brunswick. Registered Massage Therapy in British Columbia is regulated by the College of Massage Therapists of British Columbia (CMTBC). Regulated provinces have, since 2012, established inter-jurisdiction competency standards. Quebec is not provincially regulated. Massage therapists may obtain a certification with one of the various associations operating. There is the Professional Association of Specialized Massage Therapists of Quebec, also named Mon Réseau Plus, which represents 6,300 massage therapists (including ortho therapist, natural therapists, and others), the Quebec Federation of massage therapists (FMQ), and the Association québécoise des thérapeutes naturals; however, none of these are regulated by provincial law.

Canadian educational institutions undergo a formal accreditation process through the Canadian Massage Therapy Council for Accreditation (CMTCA).

China
Most types of massage, with the exception of some traditional Chinese medicine, are not regulated in China. Although illegal in China, some of the smaller massage parlors are sometimes linked to the sex industry and the government has taken a number of measures in recent times to curb this. In a nationwide crackdown known as the yellow sweep ("Yellow" in Mandarin Chinese refers to sexual activities or pornographic content), limitations on the design and operation of massage parlors have been placed, going so far as requiring identification from customers who visit massage establishments late at night and logging their visits with the local police.

France
France requires three years of study and two final exams in order to apply for a license.

Germany
In Germany, massage is regulated by the government on a federal and national level. Only someone who has completed 3,200 hours of training (theoretical and practical) can use the professional title "Masseur und Medizinischer Bademeister" 'Masseur and Medical Spa Therapist'. This person can prolong his training depending on the length of professional experience to a Physiotherapist (1 year to 18 months additional training). The Masseur is trained in Classical Massage, Myofascial Massage, Exercise, and Movement Therapy. During the training, they will study anatomy, physiology, pathology, gynecology, podiatry, psychiatry, psychology, surgery, dermiatry, and orthopedics. They are trained in Electrotherapy and Hydrotherapy. Hydrotherapy includes Kneipp, Wraps, underwater massage, therapeutic washing, Sauna, and Steambath. A small part of their training will include special forms of massage which are decided by the local college, for example, foot reflex zone massage, Thai Massage, etc. Finally, a graduate is allowed to treat patients under the direction of a doctor. Graduates are regulated by the professional body which regulates Physiotherapists. This includes restrictions on advertising and the oath of confidentiality to clients.

India
In India, massage therapy is licensed by The Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) under the Ministry of Health and Family Welfare (India) in March 1995. Massage therapy is based on Ayurveda, the ancient medicinal system that evolved around 600 BC. In ayurveda, massage is part of a set of holistic medicinal practices, contrary to the independent massage system popular in some other systems. In Siddha, Tamil traditional medicine from south India, massage is termed as "Thokkanam" and is classified into nine types, each for a specific variety of diseases.

Japan

In Japan, shiatsu is regulated but oil massage and Thai massage are not. Prostitution in Japan is not heavily policed, and prostitutes posing as massage therapists in "fashion health" shops and "pink salons" are fairly common in the larger cities.

Myanmar
In Myanmar, massage is unregulated. However, it is necessary to apply for a spa license with the government to operate a massage parlor in major cities such as Yangon. Blind and visually impaired people can become masseurs, but they are not issued licenses. There are a few professional spa training schools in Myanmar but these training centers are not accredited by the government.

Mexico
In Mexico massage therapists, called sobadores, combine massage using oil or lotion with a form of acupuncture and faith. Sobadores are used to relieve digestive system problems as well as knee and back pain. Many of these therapists work out of the back of a truck, with just a curtain for privacy. By learning additional holistic healer's skills in addition to massage, the practitioner may become a curandero.

In some jurisdictions, prostitution in Mexico is legal, and prostitutes are allowed to sell sexual massages. These businesses are often confined to a specific area of the city, such as the Zona Norte in Tijuana.

New Zealand
In New Zealand, massage is unregulated. There are two levels of registration with Massage New Zealand, the professional body for massage therapists within New Zealand, although neither of these levels are government recognized. Registration at the certified massage therapist level denotes competency in the practice of relaxation massage. Registration at the remedial massage therapist denotes competency in the practice of remedial or orthopedic massage. Both levels of registration are defined by agreed minimum competencies and minimum hours.

South Africa
In South Africa, massage is regulated, but enforcement is poor. The minimum legal requirement to be able to practice as a professional massage therapist is a two-year diploma in therapeutic massage and registration with the Allied Health Professions Council of SA (AHPCSA). The qualification includes 240 credits, about 80 case studies, and about 100 hours of community service.

South Korea
In South Korea, blind and visually impaired people can become licensed masseurs.

Thailand
In Thailand, Thai massage is officially listed as one of the branches of traditional Thai medicine, recognized and regulated by the government. It is considered to be a medical discipline in its own right and is used for the treatment of a wide variety of ailments and conditions. Massage schools, centers, therapists, and practitioners are increasingly regulated by the Ministries of Education and Public Health in Thailand.

United Kingdom
To practice commercial massage or massage therapy in the UK, an ITEC or VTCT certificate must be obtained through training which includes Beauty and Spa Therapy, Hairdressing, Complementary Therapies, Sports & Fitness Training and Customer Service.

Therapists with appropriate paperwork and insurance may join the Complementary and Natural Healthcare Council (CNHC), a voluntary, government regulated, professional register. Its key aim is to protect the public.

In addition, there are many professional bodies that have a required minimum standard of education and hold relevant insurance policies including the Federation of Holistic Therapists (FHT), the Complementary Therapists Association (CThA), and the Complementary Health Professionals (CHP). In contrast to the CNHC these bodies exist to support therapists rather than clients.

United States
According to research done by the American Massage Therapy Association, as of 2012 in the United States, there are between 280,000 and 320,000 massage therapists and massage school students. As of 2011, there were more than 300 accredited massage schools and programs in the United States. Most states have licensing requirements that must be met before a practitioner can use the title "massage therapist", and some states and municipalities require a license to practice any form of massage. If a state does not have any massage laws then a practitioner need not apply for a license with the state. Training programs in the US are typically 500 hours to 1000 hours in total training time and can award a certificate, diploma, or degree depending on the particular school. There are around 1,300 programs training massage therapists in the US; study will often include anatomy and physiology, kinesiology, massage techniques, first aid and CPR, business, ethical and legal issues, and hands-on practice along with continuing education requirements if regulated. The Commission on Massage Therapy Accreditation (COMTA) is one of the organizations that works with massage schools in the U.S. and there are almost 300 schools that are accredited through this agency.

Forty-seven states, Puerto Rico, and the District of Columbia currently offer some type of credential to professionals in the massage and bodywork field—usually licensure, certification or registration. Forty-five states require some type of licensing for massage therapists. There are two nationally recognized tests gain a massage therapy license, as well as state specific exams. In the US, thirty-eight states accept the now defunct National Certification Board for Therapeutic Massage and Bodywork's (NCBTMB) certification program as a basis for granting licenses either by rule or statute. The NCBTMB formerly offered the designation Nationally Certified in Therapeutic Massage and Bodywork (NCTMB) but now only offers its certificate program, Board Certification in Therapeutic Massage and Bodywork (BCTMB) which does not qualify for licensure. Forty-three states, as well as Puerto Rico and the District of Colombia, accept the Massage & Bodywork Licensing Examination (MBLEx), administered by the Federation of State Massage Therapy Boards (FSMTB). Between 10% and 20% of towns or counties independently regulate the profession. These local regulations can range from prohibition on opposite sex massage, fingerprinting and venereal checks from a doctor, to prohibition on house calls because of concern regarding sale of sexual services.

In the US, licensure is the highest level of regulation and this restricts anyone without a license from practicing massage therapy or calling themselves by that protected title. Certification allows only those who meet certain educational criteria to use the protected title and registration only requires a listing of therapists who apply and meet an educational requirement. In the US, most certifications are locally based. A massage therapist may be certified, but not licensed. Licensing requirements vary per state, and often require additional criteria be met in addition to attending an accredited massage therapy school and passing a required state-specified exam. Only Kansas, Minnesota, and Wyoming, California and Vermont do not require a license or a certification at the state level. Some states allow license reciprocity, where licensed massage therapists who relocate can relatively easily obtain a license in their new state.

In 1997 there were an estimated 114 million visits to massage therapists in the US. Massage therapy is the most used type of alternative medicine in hospitals in the United States. Between July 2010 and July 2011 roughly 38 million adult Americans (18 percent) had a massage at least once.

People state that they use massage because they believe that it relieves pain from musculoskeletal injuries and other causes of pain, reduces stress and enhances relaxation, rehabilitates sports injuries, decreases feelings of anxiety and depression, and increases general well-being.

In a poll of 25–35-year-olds, 79% said they would like their health insurance plan to cover massage. In 2006 Duke University Health System opened up a center to integrate medical disciplines with CAM disciplines such as massage therapy and acupuncture. There were 15,500 spas in the United States in 2007, with about two-thirds of the visitors being women.

The number of visits rose from 91 million in 1999 to 136 million in 2003, generating a revenue that equals $11 billion. Job outlook for massage therapists was also projected to grow at 20% between 2010 and 2020 by the Bureau of Labor Statistics, faster than the average.

title: Massage


text:
Biofilm

A biofilm is a syntrophic community of microorganisms in which cells stick to each other and often also to a surface. These adherent cells become embedded within a slimy extracellular matrix that is composed of extracellular polymeric substances (EPSs). The cells within the biofilm produce the EPS components, which are typically a polymeric combination of extracellular polysaccharides, proteins, lipids and DNA. Because they have a three-dimensional structure and represent a community lifestyle for microorganisms, they have been metaphorically described as "cities for microbes".

Biofilms may form on living (biotic) or non-living (abiotic) surfaces and can be common in natural, industrial, and hospital settings. They may constitute a microbiome or be a portion of it. The microbial cells growing in a biofilm are physiologically distinct from planktonic cells of the same organism, which, by contrast, are single cells that may float or swim in a liquid medium. Biofilms can form on the teeth of most animals as dental plaque, where they may cause tooth decay and gum disease.

Microbes form a biofilm in response to a number of different factors, which may include cellular recognition of specific or non-specific attachment sites on a surface, nutritional cues, or in some cases, by exposure of planktonic cells to sub-inhibitory concentrations of antibiotics. A cell that switches to the biofilm mode of growth undergoes a phenotypic shift in behavior in which large suites of genes are differentially regulated.

A biofilm may also be considered a hydrogel, which is a complex polymer that contains many times its dry weight in water. Biofilms are not just bacterial slime layers but biological systems; the bacteria organize themselves into a coordinated functional community. Biofilms can attach to a surface such as a tooth or rock, and may include a single species or a diverse group of microorganisms. Subpopulations of cells within the biofilm differentiate to perform various activities for motility, matrix production, and sporulation, supporting the overall success of the biofilm. The biofilm bacteria can share nutrients and are sheltered from harmful factors in the environment, such as desiccation, antibiotics, and a host body's immune system. A biofilm usually begins to form when a free-swimming, planktonic bacterium attaches to a surface.

Origin of biofilms
Biofilms are thought to have arisen during primitive Earth as a defense mechanism for prokaryotes, as the conditions at that time were too harsh for their survival. They can be found very early in Earth's fossil records (about 3.25 billion years ago) as both Archaea and Bacteria, and commonly protect prokaryotic cells by providing them with homeostasis, encouraging the development of complex interactions between the cells in the biofilm.

Formation of biofilms
The formation of a biofilm begins with the attachment of free-floating microorganisms to a surface. The first colonist bacteria of a biofilm may adhere to the surface initially by the weak van der Waals forces and hydrophobic effects. If the colonists are not immediately separated from the surface, they can anchor themselves more permanently using cell adhesion structures such as pili. A unique group of Archaea that inhabit anoxic groundwater have similar structures called hami. Each hamus is a long tube with three hook attachments that are used to attach to each other or to a surface, enabling a community to develop. Hyperthermophilic archaeon Pyrobaculum calidifontis produce bundling pili which are homologous to the bacterial TasA filaments, a major component of the extracellular matrix in bacterial biofilms, which contribute to biofilm stability. TasA homologs are encoded by many other archaea, suggesting mechanistic similarities and evolutionary connection between bacterial and archaeal biofilms.

Hydrophobicity can also affect the ability of bacteria to form biofilms. Bacteria with increased hydrophobicity have reduced repulsion between the substratum and the bacterium. Some bacteria species are not able to attach to a surface on their own successfully due to their limited motility but are instead able to anchor themselves to the matrix or directly to other, earlier bacteria colonists. Non-motile bacteria cannot recognize surfaces or aggregate together as easily as motile bacteria.

During surface colonization bacteria cells are able to communicate using quorum sensing (QS) products such as N-acyl homoserine lactone (AHL). Once colonization has begun, the biofilm grows by a combination of cell division and recruitment. Polysaccharide matrices typically enclose bacterial biofilms. The matrix exopolysaccharides can trap QS autoinducers within the biofilm to prevent predator detection and ensure bacterial survival. In addition to the polysaccharides, these matrices may also contain material from the surrounding environment, including but not limited to minerals, soil particles, and blood components, such as erythrocytes and fibrin. The final stage of biofilm formation is known as development, and is the stage in which the biofilm is established and may only change in shape and size.

The development of a biofilm may allow for an aggregate cell colony (or colonies) to be increasingly tolerant or resistant to antibiotics. Cell-cell communication or quorum sensing has been shown to be involved in the formation of biofilm in several bacterial species.

Development

Biofilms are the product of a microbial developmental process. The process is summarized by five major stages of biofilm development, as shown in the diagram below:

Dispersal
Dispersal of cells from the biofilm colony is an essential stage of the biofilm life cycle. Dispersal enables biofilms to spread and colonize new surfaces. Enzymes that degrade the biofilm extracellular matrix, such as dispersin B and deoxyribonuclease, may contribute to biofilm dispersal. Enzymes that degrade the biofilm matrix may be useful as anti-biofilm agents. Evidence has shown that a fatty acid messenger, cis-2-decenoic acid, is capable of inducing dispersion and inhibiting growth of biofilm colonies. Secreted by Pseudomonas aeruginosa, this compound induces cyclo heteromorphic cells in several species of bacteria and the yeast Candida albicans. Nitric oxide has also been shown to trigger the dispersal of biofilms of several bacteria species at sub-toxic concentrations. Nitric oxide has potential as a treatment for patients that have chronic infections caused by biofilms.

It was generally assumed that cells dispersed from biofilms immediately go into the planktonic growth phase. However, studies have shown that the physiology of dispersed cells from Pseudomonas aeruginosa biofilms is highly different from that of planktonic and biofilm cells. Hence, the dispersal process is a unique stage during the transition from biofilm to planktonic lifestyle in bacteria. Dispersed cells are found to be highly virulent against macrophages and Caenorhabditis elegans, but highly sensitive towards iron stress, as compared with planktonic cells.

Furthermore, Pseudomonas aeruginosa biofilms undergo distinct spatiotemporal dynamics during biofilm dispersal or disassembly, with contrasting consequences in recolonization and disease dissemination. Biofilm dispersal induced bacteria to activate dispersal genes to actively depart from biofilms as single cells at consistent velocities but could not recolonize fresh surfaces. In contrast, biofilm disassembly by degradation of a biofilm exopolysaccharide released immotile aggregates at high initial velocities, enabling the bacteria to recolonize fresh surfaces and cause infections in the hosts efficiently. Hence, biofilm dispersal is more complex than previously thought, where bacterial populations adopting distinct behavior after biofilm departure may be the key to survival of bacterial species and dissemination of diseases.

Properties
Biofilms are usually found on solid substrates submerged in or exposed to an aqueous solution, although they can form as floating mats on liquid surfaces and also on the surface of leaves, particularly in high humidity climates. Given sufficient resources for growth, a biofilm will quickly grow to be macroscopic (visible to the naked eye). Biofilms can contain many different types of microorganism, e.g. bacteria, archaea, protozoa, fungi and algae; each group performs specialized metabolic functions. However, some organisms will form single-species films under certain conditions. The social structure (cooperation/competition) within a biofilm depends highly on the different species present.

Extracellular matrix
The EPS matrix consists of exopolysaccharides, proteins and nucleic acids. A large proportion of the EPS is more or less strongly hydrated, however, hydrophobic EPS also occur; one example is cellulose which is produced by a range of microorganisms. This matrix encases the cells within it and facilitates communication among them through biochemical signals as well as gene exchange. The EPS matrix also traps extracellular enzymes and keeps them in close proximity to the cells. Thus, the matrix represents an external digestion system and allows for stable synergistic microconsortia of different species. Some biofilms have been found to contain water channels that help distribute nutrients and signalling molecules. This matrix is strong enough that under certain conditions, biofilms can become fossilized (stromatolites).

Bacteria living in a biofilm usually have significantly different properties from free-floating bacteria of the same species, as the dense and protected environment of the film allows them to cooperate and interact in various ways. One benefit of this environment is increased resistance to detergents and antibiotics, as the dense extracellular matrix and the outer layer of cells protect the interior of the community. In some cases antibiotic resistance can be increased up to 5,000 times. Lateral gene transfer is often facilitated within bacterial and archaeal biofilms and can leads to a more stable biofilm structure. Extracellular DNA is a major structural component of many different microbial biofilms. Enzymatic degradation of extracellular DNA can weaken the biofilm structure and release microbial cells from the surface.

However, biofilms are not always less susceptible to antibiotics. For instance, the biofilm form of Pseudomonas aeruginosa has no greater resistance to antimicrobials than do stationary-phase planktonic cells, although when the biofilm is compared to logarithmic-phase planktonic cells, the biofilm does have greater resistance to antimicrobials. This resistance to antibiotics in both stationary-phase cells and biofilms may be due to the presence of persister cells.

Habitats
Biofilms are ubiquitous in organic life. Nearly every species of microorganism have mechanisms by which they can adhere to surfaces and to each other. Biofilms will form on virtually every non-shedding surface in non-sterile aqueous or humid environments. Biofilms can grow in the most extreme environments: from, for example, the extremely hot, briny waters of hot springs ranging from very acidic to very alkaline, to frozen glaciers.

Biofilms can be found on rocks and pebbles at the bottoms of most streams or rivers and often form on the surfaces of stagnant pools of water. Biofilms are important components of food chains in rivers and streams and are grazed by the aquatic invertebrates upon which many fish feed. Biofilms are found on the surface of and inside plants. They can either contribute to crop disease or, as in the case of nitrogen-fixing rhizobia on root nodules, exist symbiotically with the plant. Examples of crop diseases related to biofilms include citrus canker, Pierce's disease of grapes, and bacterial spot of plants such as peppers and tomatoes.

Percolating filters
Percolating filters in sewage treatment works are highly effective removers of pollutants from settled sewage liquor. They work by trickling the liquid over a bed of hard material which is designed to have a very large surface area. A complex biofilm develops on the surface of the medium which absorbs, adsorbs and metabolises the pollutants. The biofilm grows rapidly and when it becomes too thick to retain its grip on the media it washes off and is replaced by newly grown film. The washed off ("sloughed" off) film is settled out of the liquid stream to leave a highly purified effluent.

Slow sand filter
Slow sand filters are used in water purification for treating raw water to produce a potable product. They work through the formation of a biofilm called the hypogeal layer or Schmutzdecke in the top few millimetres of the fine sand layer. The Schmutzdecke is formed in the first 10–20 days of operation and consists of bacteria, fungi, protozoa, rotifera and a range of aquatic insect larvae. As an epigeal biofilm ages, more algae tend to develop and larger aquatic organisms may be present including some bryozoa, snails and annelid worms. The surface biofilm is the layer that provides the effective purification in potable water treatment, the underlying sand providing the support medium for this biological treatment layer. As water passes through the hypogeal layer, particles of foreign matter are trapped in the mucilaginous matrix and soluble organic material is adsorbed. The contaminants are metabolised by the bacteria, fungi and protozoa. The water produced from an exemplary slow sand filter is of excellent quality with 90–99% bacterial cell count reduction.

Rhizosphere
Plant-beneficial microbes can be categorized as plant growth-promoting rhizobacteria. These plant growth-promoters colonize the roots of plants, and provide a wide range of beneficial functions for their host including nitrogen fixation, pathogen suppression, anti-fungal properties, and the breakdown of organic materials. One of these functions is the defense against pathogenic, soil-borne bacteria and fungi by way of induced systemic resistance (ISR) or induced systemic responses triggered by pathogenic microbes (pathogen-induced systemic acquired resistance). Plant exudates act as chemical signals for host specific bacteria to colonize. Rhizobacteria colonization steps include attractions, recognition, adherence, colonization, and growth. Bacteria that have been shown to be beneficial and form biofilms include Bacillus, Pseudomonas, and Azospirillum. Biofilms in the rhizosphere often result in pathogen or plant induced systemic resistances. Molecular properties on the surface of the bacterium cause an immune response in the plant host. These microbe associated molecules interact with receptors on the surface of plant cells, and activate a biochemical response that is thought to include several different genes at a number of loci. Several other signaling molecules have been linked to both induced systemic responses and pathogen-induced systemic responses, such as jasmonic acid and ethylene. Cell envelope components such as bacterial flagella and lipopolysaccharides, which are recognized by plant cells as components of pathogens. Certain iron metabolites produced by Pseudomonas have also been shown to create an induced systemic response. This function of the biofilm helps plants build stronger resistance to pathogens.

Plants that have been colonized by PGPR forming a biofilm have gained systemic resistances and are primed for defense against pathogens. This means that the genes necessary for the production of proteins that work towards defending the plant against pathogens have been expressed, and the plant has a "stockpile" of compounds to release to fight off pathogens. A primed defense system is much faster in responding to pathogen induced infection, and may be able to deflect pathogens before they are able to establish themselves. Plants increase the production of lignin, reinforcing cell walls and making it difficult for pathogens to penetrate into the cell, while also cutting off nutrients to already infected cells, effectively halting the invasion. They produce antimicrobial compounds such as phytoalexins, chitinases, and proteinase inhibitors, which prevent the growth of pathogens. These functions of disease suppression and pathogen resistance ultimately lead to an increase in agricultural production and a decrease in the use of chemical pesticides, herbicides, and fungicides because there is a reduced amount of crop loss due to disease. Induced systemic resistance and pathogen-induced systemic acquired resistance are both potential functions of biofilms in the rhizosphere, and should be taken into consideration when applied to new age agricultural practices because of their effect on disease suppression without the use of dangerous chemicals.

Mammalian gut
Studies in 2003 discovered that the immune system supports biofilm development in the large intestine. This was supported mainly with the fact that the two most abundantly produced molecules by the immune system also support biofilm production and are associated with the biofilms developed in the gut. This is especially important because the appendix holds a mass amount of these bacterial biofilms. This discovery helps to distinguish the possible function of the appendix and the idea that the appendix can help reinoculate the gut with good gut flora. However, modified or disrupted states of biofilms in the gut have been connected to diseases such as inflammatory bowel disease and colorectal cancer.

Human environment
In the human environment, biofilms can grow in showers very easily since they provide a moist and warm environment for them to thrive. They can form inside water and sewage pipes and cause clogging and corrosion. On floors and counters, they can make sanitation difficult in food preparation areas. In soil, they can cause bioclogging. In cooling- or heating-water systems, they are known to reduce heat transfer. Biofilms in marine engineering systems, such as pipelines of the offshore oil and gas industry, can lead to substantial corrosion problems. Corrosion is mainly due to abiotic factors; however, at least 20% of corrosion is caused by microorganisms that are attached to the metal subsurface (i.e., microbially influenced corrosion).

Ship fouling
Bacterial adhesion to boat hulls serves as the foundation for biofouling of seagoing vessels. Once a film of bacteria forms, it is easier for other marine organisms such as barnacles to attach. Such fouling can reduce maximum vessel speed by up to 20%, prolonging voyages and consuming fuel. Time in dry dock for refitting and repainting reduces the productivity of shipping assets, and the useful life of ships is also reduced due to corrosion and mechanical removal (scraping) of marine organisms from ships' hulls.

Stromatolites
Stromatolites are layered accretionary structures formed in shallow water by the trapping, binding and cementation of sedimentary grains by microbial biofilms, especially of cyanobacteria. Stromatolites include some of the most ancient records of life on Earth, and are still forming today.

Dental plaque
Within the human body, biofilms are present on the teeth as dental plaque, where they may cause tooth decay and gum disease. These biofilms can either be in an uncalcified state that can be removed by dental instruments, or a calcified state which is more difficult to remove. Removal techniques can also include antimicrobials.

Dental plaque is an oral biofilm that adheres to the teeth and consists of many species of both bacteria and fungi (such as Streptococcus mutans and Candida albicans), embedded in salivary polymers and microbial extracellular products. The accumulation of microorganisms subjects the teeth and gingival tissues to high concentrations of bacterial metabolites which results in dental disease. Biofilm on the surface of teeth is frequently subject to oxidative stress and acid stress. Dietary carbohydrates can cause a dramatic decrease in pH in oral biofilms to values of 4 and below (acid stress). A pH of 4 at body temperature of 37 °C causes depurination of DNA, leaving apurinic (AP) sites in DNA, especially loss of guanine.

Dental plaque biofilm can result in dental caries if it is allowed to develop over time. An ecologic shift away from balanced populations within the dental biofilm is driven by certain (cariogenic) microbiological populations beginning to dominate when the environment favors them. The shift to an acidogenic, aciduric, and cariogenic microbiological population develops and is maintained by frequent consumption of fermentable dietary carbohydrate. The resulting activity shift in the biofilm (and resulting acid production within the biofilm, at the tooth surface) is associated with an imbalance of demineralization over remineralization, leading to net mineral loss within dental hard tissues (enamel and then dentin), the symptom being a carious lesion, or cavity. By preventing the dental plaque biofilm from maturing or by returning it back to a non-cariogenic state, dental caries can be prevented and arrested. This can be achieved through the behavioral step of reducing the supply of fermentable carbohydrates (i.e. sugar intake) and frequent removal of the biofilm (i.e., toothbrushing).

Intercellular communication
A peptide pheromone quorum sensing signaling system in S. mutans includes the competence stimulating peptide (CSP) that controls genetic competence. Genetic competence is the ability of a cell to take up DNA released by another cell. Competence can lead to genetic transformation, a form of sexual interaction, favored under conditions of high cell density and/or stress where there is maximal opportunity for interaction between the competent cell and the DNA released from nearby donor cells. This system is optimally expressed when S. mutans cells reside in an actively growing biofilm. Biofilm grown S. mutans cells are genetically transformed at a rate 10- to 600-fold higher than S. mutans growing as free-floating planktonic cells suspended in liquid.

When the biofilm, containing S. mutans and related oral streptococci, is subjected to acid stress, the competence regulon is induced, leading to resistance to being killed by acid. As pointed out by Michod et al., transformation in bacterial pathogens likely provides for effective and efficient recombinational repair of DNA damages. It appears that S. mutans can survive the frequent acid stress in oral biofilms, in part, through the recombinational repair provided by competence and transformation.

Predator-prey interactions

Predator-prey interactions between biofilms and bacterivores, such as the soil-dwelling nematode Caenorhabditis elegans, had been extensively studied. Via the production of sticky matrix and formation of aggregates, Yersinia pestis biofilms can prevent feeding by obstructing the mouth of C. elegans. Moreover, Pseudomonas aeruginosa biofilms can impede the slithering motility of C. elegans, termed as 'quagmire phenotype', resulting in trapping of C. elegans within the biofilms and preventing the exploration of nematodes to feed on susceptible biofilms. This significantly reduced the ability of predator to feed and reproduce, thereby promoting the survival of biofilms. Pseudomonas aeruginosa biofilms can also mask their chemical signatures, where they reduced the diffusion of quorum sensing molecules into the environment and prevented the detection of C. elegans.

Taxonomic diversity
Many different bacteria form biofilms, including gram-positive (e.g. Bacillus spp, Listeria monocytogenes, Staphylococcus spp, and lactic acid bacteria, including Lactobacillus plantarum and Lactococcus lactis) and gram-negative species (e.g. Escherichia coli, or Pseudomonas aeruginosa). Cyanobacteria also form biofilms in aquatic environments.

Biofilms are formed by bacteria that colonize plants, e.g. Pseudomonas putida, Pseudomonas fluorescens, and related pseudomonads which are common plant-associated bacteria found on leaves, roots, and in the soil, and the majority of their natural isolates form biofilms. Several nitrogen-fixing symbionts of legumes such as Rhizobium leguminosarum and Sinorhizobium meliloti form biofilms on legume roots and other inert surfaces.

Along with bacteria, biofilms are also generated by archaea and by a range of eukaryotic organisms, including fungi e.g. Cryptococcus laurentii and microalgae. Among microalgae, one of the main progenitors of biofilms are diatoms, which colonise both fresh and marine environments worldwide.

For other species in disease-associated biofilms and biofilms arising from eukaryotes, see below.

Infectious diseases
Biofilms have been found to be involved in a wide variety of microbial infections in the body, by one estimate 80% of all infections. Infectious processes in which biofilms have been implicated include common problems such as bacterial vaginosis, urinary tract infections, catheter infections, middle-ear infections, formation of dental plaque, gingivitis, coating contact lenses, and less common but more lethal processes such as endocarditis, infections in cystic fibrosis, and infections of permanent indwelling devices such as joint prostheses, heart valves, and intervertebral disc. The first visual evidence of a biofilm was recorded after spine surgery. It was found that in the absence of clinical presentation of infection, impregnated bacteria could form a biofilm around an implant, and this biofilm can remain undetected via contemporary diagnostic methods, including swabbing. Implant biofilm is frequently present in "aseptic" pseudarthrosis cases. Furthermore, it has been noted that bacterial biofilms may impair cutaneous wound healing and reduce topical antibacterial efficiency in healing or treating infected skin wounds. The diversity of P. aeruginosa cells within a biofilm is thought to make it harder to treat the infected lungs of people with cystic fibrosis. Early detection of biofilms in wounds is crucial to successful chronic wound management. Although many techniques have developed to identify planktonic bacteria in viable wounds, few have been able to quickly and accurately identify bacterial biofilms. Future studies are needed to find means of identifying and monitoring biofilm colonization at the bedside to permit timely initiation of treatment.

It has been shown that biofilms are present on the removed tissue of 80% of patients undergoing surgery for chronic sinusitis. The patients with biofilms were shown to have been denuded of cilia and goblet cells, unlike the controls without biofilms who had normal cilia and goblet cell morphology. Biofilms were also found on samples from two of 10 healthy controls mentioned. The species of bacteria from intraoperative cultures did not correspond to the bacteria species in the biofilm on the respective patient's tissue. In other words, the cultures were negative though the bacteria were present. New staining techniques are being developed to differentiate bacterial cells growing in living animals, e.g. from tissues with allergy-inflammations.

Research has shown that sub-therapeutic levels of β-lactam antibiotics induce biofilm formation in Staphylococcus aureus. This sub-therapeutic level of antibiotic may result from the use of antibiotics as growth promoters in agriculture, or during the normal course of antibiotic therapy. The biofilm formation induced by low-level methicillin was inhibited by DNase, suggesting that the sub-therapeutic levels of antibiotic also induce extracellular DNA release. Moreover, from an evolutionary point of view, the creation of the tragedy of the commons in pathogenic microbes may provide advanced therapeutic ways for chronic infections caused by biofilms via genetically engineered invasive cheaters who can invade wild-types 'cooperators' of pathogenic bacteria until cooperator populations go to extinction or overall population 'cooperators and cheaters ' go to extinction.

Pseudomonas aeruginosa
P. aeruginosa represents a commonly used biofilm model organism since it is involved in different types of biofilm-associated chronic infections. Examples of such infections include chronic wounds, chronic otitis media, chronic prostatitis and chronic lung infections in cystic fibrosis (CF) patients. About 80% of CF patients have chronic lung infection, caused mainly by P. aeruginosa growing in a non-surface attached biofilms surround by PMN. The infection remains present despite aggressive antibiotic therapy and is a common cause of death in CF patients due to constant inflammatory damage to the lungs. In patients with CF, one therapy for treating early biofilm development is to employ DNase to structurally weaken the biofilm.

Biofilm formation of P. aeruginosa, along with other bacteria, is found in 90% of chronic wound infections, which leads to poor healing and high cost of treatment estimated at more than US$25 billion every year in the United States. In order to minimize the P. aeruginosa infection, host epithelial cells secrete antimicrobial peptides, such as lactoferrin, to prevent the formation of the biofilms.

Streptococcus pneumoniae
Streptococcus pneumoniae is the main cause of community-acquired pneumonia and meningitis in children and the elderly, and of sepsis in HIV-infected persons. When S. pneumoniae grows in biofilms, genes are specifically expressed that respond to oxidative stress and induce competence. Formation of a biofilm depends on competence stimulating peptide (CSP). CSP also functions as a quorum-sensing peptide. It not only induces biofilm formation, but also increases virulence in pneumonia and meningitis.

It has been proposed that competence development and biofilm formation is an adaptation of S. pneumoniae to survive the defenses of the host. In particular, the host's polymorphonuclear leukocytes produce an oxidative burst to defend against the invading bacteria, and this response can kill bacteria by damaging their DNA. Competent S. pneumoniae in a biofilm have the survival advantage that they can more easily take up transforming DNA from nearby cells in the biofilm to use for recombinational repair of oxidative damages in their DNA. Competent S. pneumoniae can also secrete an enzyme (murein hydrolase) that destroys non-competent cells (fratricide) causing DNA to be released into the surrounding medium for potential use by the competent cells.

The insect antimicrobial peptide cecropin A can destroy planktonic and sessile biofilm-forming uropathogenic E. coli cells, either alone or when combined with the antibiotic nalidixic acid, synergistically clearing infection in vivo (in the insect host Galleria mellonella) without off-target cytotoxicity. The multi-target mechanism of action involves outer membrane permeabilization followed by biofilm disruption triggered by the inhibition of efflux pump activity and interactions with extracellular and intracellular nucleic acids.

Escherichia coli
Escherichia coli biofilms are responsible for many intestinal infectious diseases. The Extraintestinal group of E. coli (ExPEC) is the dominant bacterial group that attacks the urinary system, which leads to urinary tract infections. The biofilm formation of these pathogenic E. coli is hard to eradicate due to the complexity of its aggregation structure, and it has a significant contribution to developing aggressive medical complications, increase in hospitalization rate, and cost of treatment. The development of E. coli biofilm is a common leading cause of urinary tract infections (UTI) in hospitals through its contribution to developing medical device-associated infections. Catheter-associated urinary tract infections (CAUTI) represent the most common hospital-acquired infection due to the formation of the pathogenic E. coli biofilm inside the catheters.

Staphylococcus aureus
Staphylococcus aureus pathogen can attack skin and lungs, leading to skin infection and pneumonia. Moreover, the biofilm infections network of S. aureus plays a critical role in preventing immune cells, such as macrophages from eliminating and destroying bacterial cells. Furthermore, biofilm formation by bacteria, such as S. aureus, not only develops resistance against antibiotic medication but also develop internal resistance toward antimicrobial peptides (AMPs), leading to preventing the inhibition of the pathogen and maintaining its survival.

In medicine
It is suggested that around two-thirds of bacterial infections in humans involve biofilms. Infections associated with the biofilm growth usually are challenging to eradicate. This is mostly due to the fact that mature biofilms display antimicrobial tolerance, and immune response evasions. Biofilms often form on the inert surfaces of implanted devices such as catheters, prosthetic cardiac valves and intrauterine devices. Some of the most difficult infections to treat are those associated with the use of medical devices.

The rapidly expanding worldwide industry for biomedical devices and tissue engineering related products is already at $180 billion per year, yet this industry continues to suffer from microbial colonization. No matter the sophistication, microbial infections can develop on all medical devices and tissue engineering constructs. 60-70% of hospital-acquired infections are associated with the implantation of a biomedical device. This leads to 2 million cases annually in the U.S., costing the healthcare system over $5 billion in additional healthcare expenses.

The level of antibiotic resistance in a biofilm is much greater than that of non-biofilm bacteria, and can be as much as 5,000 times greater. The extracellular matrix of biofilm is considered one of the leading factors that can reduce the penetration of antibiotics into a biofilm structure and contributes to antibiotic resistance. Further, it has been demonstrated that the evolution of resistance to antibiotics may be affected by the biofilm lifestyle. Bacteriophage therapy can disperse the biofilm generated by antibiotic-resistant bacteria.

It has been shown that the introduction of a small current of electricity to the liquid surrounding a biofilm, together with small amounts of antibiotic can reduce the level of antibiotic resistance to levels of non-biofilm bacteria. This is termed the bioelectric effect. The application of a small DC current on its own can cause a biofilm to detach from its surface. A study showed that the type of current used made no difference to the bioelectric effect.

In industry
Biofilms can also be harnessed for constructive purposes. For example, many sewage treatment plants include a secondary treatment stage in which waste water passes over biofilms grown on filters, which extract and digest organic compounds. In such biofilms, bacteria are mainly responsible for removal of organic matter (BOD), while protozoa and rotifers are mainly responsible for removal of suspended solids (SS), including pathogens and other microorganisms. Slow sand filters rely on biofilm development in the same way to filter surface water from lake, spring or river sources for drinking purposes. What is regarded as clean water is effectively a waste material to these microcellular organisms. Biofilms can help eliminate petroleum oil from contaminated oceans or marine systems. The oil is eliminated by the hydrocarbon-degrading activities of communities of hydrocarbonoclastic bacteria (HCB). Biofilms are used in microbial fuel cells (MFCs) to generate electricity from a variety of starting materials, including complex organic waste and renewable biomass. Biofilms are also relevant for the improvement of metal dissolution in bioleaching industry, and aggregation of microplastics pollutants for convenient removal from the environment.

Food industry
Biofilms have become problematic in several food industries due to the ability to form on plants and during industrial processes. Bacteria can survive long periods of time in water, animal manure, and soil, causing biofilm formation on plants or in the processing equipment. The buildup of biofilms can affect the heat flow across a surface and increase surface corrosion and frictional resistance of fluids. These can lead to a loss of energy in a system and overall loss of products. Along with economic problems, biofilm formation on food poses a health risk to consumers due to the ability to make the food more resistant to disinfectants As a result, from 1996 to 2010 the Centers for Disease Control and Prevention estimated 48 million foodborne illnesses per year. Biofilms have been connected to about 80% of bacterial infections in the United States.

In produce, microorganisms attach to the surfaces and biofilms develop internally. During the washing process, biofilms resist sanitization and allow bacteria to spread across the produce, especially via kitchen utensils. This problem is also found in ready-to-eat foods, because the foods go through limited cleaning procedures before consumption Due to the perishability of dairy products and limitations in cleaning procedures, resulting in the buildup of bacteria, dairy is susceptible to biofilm formation and contamination. The bacteria can spoil the products more readily and contaminated products pose a health risk to consumers. One species of bacteria that can be found in various industries and is a major cause of foodborne disease is Salmonella. Large amounts of Salmonella contamination can be found in the poultry processing industry as about 50% of Salmonella strains can produce biofilms on poultry farms. Salmonella increases the risk of foodborne illnesses when the poultry products are not cleaned and cooked correctly. Salmonella is also found in the seafood industry where biofilms form from seafood borne pathogens on the seafood itself as well as in water. Shrimp products are commonly affected by Salmonella because of unhygienic processing and handling techniques The preparation practices of shrimp and other seafood products can allow for bacteria buildup on the products.

New forms of cleaning procedures are being tested to reduce biofilm formation in these processes which will lead to safer and more productive food processing industries. These new forms of cleaning procedures also have a profound effect on the environment, often releasing toxic gases into the groundwater reservoirs. As a response to the aggressive methods employed in controlling biofilm formation, there are a number of novel technologies and chemicals under investigation that can prevent either the proliferation or adhesion of biofilm-secreting microbes. Latest proposed biomolecules presenting marked anti-biofilm activity include a range of metabolites such as bacterial rhamnolipids and even plant- and animal-derived alkaloids.

In aquaculture

In shellfish and algal aquaculture, biofouling microbial species tend to block nets and cages and ultimately outcompete the farmed species for space and food. Bacterial biofilms start the colonization process by creating microenvironments that are more favorable for biofouling species. In the marine environment, biofilms could reduce the hydrodynamic efficiency of ships and propellers, lead to pipeline blockage and sensor malfunction, and increase the weight of appliances deployed in seawater. Numerous studies have shown that biofilm can be a reservoir for potentially pathogenic bacteria in freshwater aquaculture. Moreover, biofilms are important in establishing infections on the fish. As mentioned previously, biofilms can be difficult to eliminate even when antibiotics or chemicals are used in high doses. The role that biofilm plays as reservoirs of bacterial fish pathogens has not been explored in detail but it certainly deserves to be studied.

Eukaryotic
Along with bacteria, biofilms are often initiated and produced by eukaryotic microbes. The biofilms produced by eukaryotes is usually occupied by bacteria and other eukaryotes alike, however the surface is cultivated and EPS is secreted initially by the eukaryote. Both fungi and microalgae are known to form biofilms in such a way. Biofilms of fungal origin are important aspects of human infection and fungal pathogenicity, as the fungal infection is more resistant to antifungals.

In the environment, fungal biofilms are an area of ongoing research. One key area of research is fungal biofilms on plants. For example, in the soil, plant associated fungi including mycorrhiza have been shown to decompose organic matter and protect plants from bacterial pathogens.

Biofilms in aquatic environments are often founded by diatoms. The exact purpose of these biofilms is unknown, however there is evidence that the EPS produced by diatoms facilitates both cold and salinity stress. These eukaryotes interact with a diverse range of other organisms within a region known as the phycosphere, but importantly are the bacteria associated with diatoms, as it has been shown that although diatoms excrete EPS, they only do so when interacting with certain bacteria species.

Horizontal gene transfer
Horizontal gene transfer is the lateral transfer of genetic material between cellular organisms. It happens frequently in prokaryotes, and less frequently in eukaryotes. In bacteria, horizontal gene transfer can occur through transformation (uptake of free floating DNA in the environment), transduction (virus mediated DNA uptake), or conjugation (transfer of DNA between pili structures of two adjacent bacteria). Recent studies have also uncovered other mechanisms, such as membrane vesicle transmission or gene transfer agents. Biofilms promote horizontal gene transfer in a variety of ways.Bacterial conjugation has been shown to accelerate biofilm formation in difficult environment due to the robust connections established by the conjugative pili. These connections can often foster cross-species transfer events due to the diverse heterogeneity of many biofilms. Additionally, biofilms are structurally confined by a polysaccharide matrix, providing the close spatial requirements for conjugation. Transformation is also frequently observed in biofilms. Bacterial autolysis is a key mechanism in biofilm structural regulation, providing an abundant source of competent DNA primed for transformative uptake. In some instances, inter-biofilm quorum sensing can enhance the competence of free floating eDNA, further promoting transformation. Stx gene transfer through bacteriophage carriers has been witnessed within biofilms, which suggests that biofilms are also a suitable environment for transduction. Membrane vesicles HGT occurs when released membrane vesicles (containing genetic information) fuse with a recipient bacteria, and release genetic material into the bacteria's cytoplasm. Recent research has revealed that membrane vesicle HGT can promote single-strain biofilm formation, yet the role membrane vesicle HGT plays in the formation of multistrain biofilms is still unknown. GTAs, or gene transfer agents, are phage-like particles produced by the host bacteria and contain random DNA fragments from the host bacteria genome. HGT within biofilms can confer antibiotic resistance or increased pathogenicity across the biofilms' population, promoting biofilm homeostasis.

Examples
Conjugative plasmids may encode biofilm-associated proteins, such as PtgA, PrgB, or PrgC which promote cell adhesion (required for early biofilm formation). Genes encoding type III fimbriae are found in pOLA52 (Klebsiella pneumoniae plasmid) which promote conjugative-pilus-dependent biofilm formation.

Transformation commonly occurs within biofilms. A phenomenon called fratricide can be seen among streptococcal species in which cell-wall degrading enzymes are released, lysing neighboring bacteria and releasing their DNA. This DNA can then be taken up by the surviving bacteria (transformation). Competence stimulating peptides may play an important role in biofilm formation among S. pneumoniae and S. mutans as well. Among V. cholerae, the competence pilus itself promotes cell aggregation through pilus-pilus interactions at the beginning of biofilm formation.

Phage invasion may play a role in biofilm life cycles, lysing bacteria and releasing their eDNA, which strengthens biofilm structures and can be taken up by neighboring bacteria in transformation. Biofilm destruction caused by the E. coli phage Rac and the P. aeruginosa prophage Pf4 causes detachment of cells from the biofilm. Detachment is a biofilm phenomenon which requires more study, but is hypothesized to proliferate the bacterial species that comprise the biofilm.

Membrane vesicle HGT has been witnessed occurring in marine environments, among Neisseria gonorrhoeae, Pseudomonas aeruginosa, Helicobacter pylori, and among many other bacterial species. Even though membrane vesicle HGT has been shown as a contributing factor in biofilm formation, research is still required to prove that membrane vesicle mediated HGT occurs within biofilms. Membrane vesicle HGT has also been shown to modulate phage-bacteria interactions in Bacillus subtilis SPP1 phage-resistant cells (lacking the SPP1 receptor protein). Upon exposure to vesicles containing receptors, transduction of pBT163 (a cat-encoding plasmid) occurs, resulting in the expression of the SPP1 receptor protein, opening the receptive bacteria to future phage infection.

Recent research has shown that the archaeal species H. volcanii has some biofilm phenotypes similar to bacterial biofilms such as differentiation and HGT, which required cell-cell contact and involved formation of cytosolic bridges and cellular fusion events.

Cultivation devices
There is a wide variety of biofilm cultivation devices to mimic natural or industrial environments. Although it is important to consider that the particular experimental platform for biofilm research determines what kind of biofilm is cultivated and the data that can be extracted. These devices can be grouped into the following: Introduction to Serratia marcescens and Biofilm Formation Serratia marcescens is a Gram-negative bacterium that can produce red pigment called prodigiosin when under certain specific environmental conditions. It is a fairly common opportunistic pathogen that can form biofilms on various surfaces, including medical devices such as catheters and implants, as well as natural environments like soil and water.
 * microtiter plate (MTP) systems and MBEC Assay® [formerly the Calgary Biofilm Device (CBD)]
 * BioFilm Ring Test (BRT) or clinical Biofilm Ring Test (cBRT)
 * Robbins Device or modified Robbins Device (such as the MPMR-10PMMA or the Bio-inLine Biofilm Reactor)
 * Drip Flow Biofilm Reactor®
 * rotary devices (such as the CDC Biofilm Reactor®, the Rotating Disk Reactor, the Biofilm Annular Reactor, the Industrial Surfaces Biofilm Reactor, or the Constant Depth Film Fermenter)
 * flow chambers or flow cells (such as the Coupon Evaluation Flow Cell, Transmission Flow Cell, and Capillary Flow Cell from BioSurface Technologies)
 * microfluidic approaches, such as 3D-bacterial "biofilm-dispersal-then-recolonization" (BDR) microfluidic model

Control Mechanisms of Biofilm Formation The journal article "Biofilm Formation and Sloughing in Serratia marcescens Are Controlled by Quorum Sensing and Nutrient Cues" suggests that biofilm formation by S. marcescens is a process controlled by both nutrient cues and the quorum-sensing system. Quorum sensing influences the bacterium's ability to adhere to surfaces and establish mature biofilms, whereas the availability of specific nutrients can enhance or inhibit biofilm development. The article explains that S. marcescens undergoes a formation process reliant on the quorum-sensing system. It creates biofilms that ultimately develop into a highly porous, thread-like structure composed of chains of cells, filaments, and cell clusters.

Structural Characteristics of S. marcescens Biofilms The formation of biofilms by S. marcescens is a serious concern because of its ability to adhere to and colonize surfaces, protecting host immune responses and antimicrobial agents. This strength makes infections caused by S. marcescens challenging to treat, specifically in hospitals where the bacterium can cause severe, and specific, infections.

Clinical and Industrial Implications Research has shown that S. marcescens biofilms exhibit complex structural organization, including the formation of microcolonies and channels that facilitate nutrient and waste exchange. The production of extracellular polymeric substances (EPS) is a key factor in biofilm development, contributing to the bacterium's adhesion and resistance to antimicrobial agents. In addition to its role in healthcare-associated infections, S. marcescens biofilms have been implicated in the deterioration of industrial equipment and processes. For example, biofilm growth in cooling towers can lead to biofouling and reduced efficiency.

Strategies for Biofilm Control Efforts to control and prevent biofilm formation by S. marcescens involve the use of antimicrobial coatings on medical devices, the development of targeted biofilm disruptors, and improved sterilization protocols. Further research into the molecular mechanisms governing S. marcescens biofilm formation and persistence is crucial for developing effective strategies to combat its associated risks. The use of indole compounds has been studied to be used as protection against biofilm formation, as seen in the journal article "Antibiofilm and Antivirulence Properties of Indoles Against Serratia marcescens." Indoles, which are aromatic heterocyclic compounds that have been found to possess antibiofilm and antivirulence properties against S. marcescens, hold promise as potential therapeutic agents and offer an alternative approach to managing biofilm-related infections and mitigating bacterial resistance.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Biofilm


text:
Protium (disambiguation)

Protium or hydrogen-1 is the most common isotope of the element hydrogen, with one proton, one electron, and no neutrons.

Protiim may also refer to:
 * Protium (plant), a genus of chiefly tropical American trees in the family Burseraceae, having fragrant wood
 * Cadence Protium, hardware accelerated prototyping platforms for early software development by Cadence Design Systems

title: Protium (disambiguation)