Factors predictive of leg-ulcer healing in sickle cell disease: a multicentre, prospective cohort study.

BACKGROUND: Leg ulcers (LUs) are a chronic and severe complication of sickle cell disease (SCD). A prospective study in patients with SCD to identify factors associated with complete healing and recurrence of LUs is lacking. OBJECTIVES: To determine clinical and biological factors associated with SCD-LU complete healing and recurrence. METHODS: This prospective, observational cohort study was conducted at two adult SCD referral-centre sites (2009-2015) and included 98 consecutive patients with at least one LU lasting ≥ 2 weeks. The primary end points compared patients with healed vs. nonhealed LUs at week 24, and patients with vs. without recurrence during follow-up. RESULTS: The median (interquartile range) LU area, duration and follow-up were, respectively, 6·2 cm2 (3-12·8), 9 weeks (4-26) and 65·8 weeks (23·8-122·1). At week 24, LUs were healed in 47% of patients, while 49% of LUs recurred. Univariate analyses identified inclusion LU area < 8 cm2 (82% vs. 35%; P < 0·001), inclusion LU duration < 9 weeks (65% vs. 35%; P = 0·0013) and high median fetal haemoglobin level (P = 0·008) as being significantly associated with complete healing at week 24, and low lactate dehydrogenase level (P = 0·038) as being associated with recurrence. Multivariate analyses retained LU area < 8 cm2 (odds ratio 6·73, 95% confidence interval 2·35-19. 31; P < 0·001) and < 9 weeks' duration (OR 3·19, 95% confidence interval 1·16-8·76; P = 0·024) as being independently associated with healing at week 24. Factors independently associated with recurrence could not be identified. CONCLUSIONS: SCD-LU complete healing is independently associated with the clinical characteristics of LUs rather than the clinical or biological characteristics of SCD.

[Ankle brachial index: motivations, training, and practices among 165 general practitioners in Île-de-France]. / Index de pression systolique et médecine de ville : motivation, formation, mesure et valorisation de l'acte. Enquête auprès d'un échantillon de 165 médecins généralistes d'Île-de-France.

UNLABELLED: Peripheral arterial disease (PAD) is under-diagnosed despite its predictive value for cardiovascular mortality. The ankle brachial index (ABI), a simple reliable measure recommended by the French health authorities to detect and evaluate the severity of PAD, is used by too few general practitioners (GPs). OBJECTIVE: This study aimed at identifying motivations and barriers for using ABI in general practice. METHOD: A representative, descriptive, cross-sectional survey was conducted amongst 165 GPs practicing in Île-de-France who were interviewed using stratified quotas. RESULTS: Although 1 out of 5 GPs considered ABI to be an irrelevant indicator, most had a favorable opinion about its use (OR: 4.9 [CI 95 %: 4.2-5.7]). Only 42 % (CI 95 %: 34 %-49 %) of GPs knew ABI was recommended by the health authorities. This information had a critical impact on the acceptance of ABI relevancy (OR: 3.7 [CI 95 %: 3.2-4.2]). Training reinforced acceptance (OR: 5.0 [CI 95 %: 4.4-5.6]) and pre-residency education provided a better understanding of ABI (OR: 2.8 [CI 95 %: 2.3-3.4]). Time needed to measure ABI was the main barrier (OR: 0.6 [CI 95 %: 0.6-0.7]). A Doppler-calculation kit (OR: 11.8 [CI 95 %: 8.9-15.6]), equipment cost≤300Euros (OR: 3.4 [CI 99 %: 3.0-3.9]), a specific fee in addition to the regular consultation fee (OR: 2.6 [CI 95 %: 2.3-3.0]) and inclusion of ABI in the GP's evaluation scheme (OR: 2.6 [CI 95 %: 2.3-2.9]) would motivate more GPs. Seven out of 10 GPs agreed that ABI has a positive impact on patient adherence to treatment and follow-up, but ABI remained underexploited for symptomatic patients (OR: 0.4 [CI 95 %: 0.3-0.4]). CONCLUSION: Better communication and training together with an upgraded status for ABI would provide motivation for GPs to measure ABI.

[Radiation arteritis- and radiodermitis-induced leg ulcer: surgical revascularization]. / Un ulcère de jambe par artérite radique et radio-dermite. Revascularisation chirurgicale.

A forty-four-year old man was hospitalized for diagnosis and treatment of a left leg ulcer which did not heal despite good compliance with a three-month medical regimen. Twenty years before he had undergone surgical curettage and radiotherapy (81 gy) for an osteosarcoma of the upper third of the left tibia. He was considered completely cured with regular findings. On examination he had a 5 X 7 cm deep ulcer with raised margins and no signs of infection, localized on the radiodermatitis on the medial aspect of his left leg. Arterial examination confirmed the left arteriopathy with absence of distal pulses; the Ankle Brachial Pressure Index was 0.69 and the foot TcPO2 27 mmHg. Arteriography confirmed the localized left lesions with three distal popliteal and proximal arterial occlusions, all other arteries being strictly normal. Arterial and dermatological radiation leg ulcer was retained as the etiological diagnosis. As the ulcer was very painful, extensive and limited walking distance, surgical revascularisation was undertaken because endoluminal revascularization was impossible. A femoroperoneal saphenous bypass was performed with surgical incisions beyond the radiodermatitis area. Two months after a split skin graft, the ulcer was considered healed and the patency of the by-pass confirmed on duplex examination. This is the first case report of a successful distal by-pass performed for radiation arteritis and ulcer healing. Long-term follow up should be reported.

[Study of the effect of season on the frequency of side effects or antihypertensive agents]. / Etude de l'influence de la saison sur la fréquence des effets indésirables chez des hypertendus sous traitements antihypertenseurs.

OBJECTIVES: To evaluate the influence of season on side effects of antihypertensive treatments in hypertensive patients followed by cardiologists. METHODS: In 12,071 hypertensive subjects, referred to cardiologists, a questionnaire with 14 possible side effects due to antihypertensive treatment was administered during the consultation. Details on antihypertensive treatment and cardiovascular characteristics were obtained from medical records. This evaluation was obtained in patients recruited during summer (7,438 patients) and during winter (4,633 patients). RESULTS: In this population of treated hypertensives, blood pressure level was < 140/90 mmHg in 28%, and 50% were treated with a monotherapy. At least one side effect was declared by 40% of cases, and it was observed dyspnea (10%), dizziness (8%), fatigue (8%), palpitations (6%), ankle oedema (5%), headaches (5%). The higher rate was observed in patients on monotherapy, most frequent side effects were fatigue (9%) on beta-blockers, cough (9%) on ACEI, oedema (18%) on calcium antagonists, dyspnea (9%) on diuretics, dizziness on ARB (8%) and central acting agents (18%). Regression analysis indicates that female patient, uncontrolled BP, age less than 50, and greater number of antihypertensive tablets were independent determinants for at least one side effects under antihypertensive treatments. Season was not a significant determinant of side effect appearance. CONCLUSION: This study indicates that during hypertensive treatments, at least one side effect is declared by 40% of patients. A female patient, uncontrolled for BP, aged less of 50 and treated with a multiple therapy is more prone to complain of side effects, but season was not a significant determinant of its appearance.

[Influence of protocol on the quality of blood pressure self-monitoring]. / Influence du protocole sur la qualité de l'automesure tensionnelle.

OBJECTIVES: To determine the minimum number of self-measurements of blood pressure to provide the maximum quality and reliability during home-blood pressure monitoring. METHODS: We studied 38 hypertensive subjects in which we compared self-reported with electronically stored home BP (OMRON HEM 720 CIC). Subjects were asked to measure BP in the sitting position, three times consecutively in the morning and three times in the evening during 7 consecutive days. BP values over the 7 days were averaged and the differences with BP recorded over the first day (6 values per day), the first 2 days, the first 3 days, the first 4 days, the first 5 days and the first 6 days were calculated. Confidence interval were calculated. RESULTS: We observed that 47% of patients completed the entire protocol (42 measurements over 7 days), but 89% completed 4 days with 6 measurements. Erroneous reporting was evident in 10% of patients. In patients which performed 100% of the 42 planned values, confidence interval for the mean value was < 4 mmHg for SBP and < 3 mmHg for DBP when the patient completed a 4 days protocol with a minimum of 4 measurements per day. CONCLUSIONS: These results indicate that determining average home blood pressure over 4 consecutive days with 2 measurements twice daily, is the minimum protocol that provides a reliable estimate of home blood pressure with a good quality of patient reporting.

Nuclear DNA content and base composition in 28 taxa of Musa.

The nuclear DNA content of 28 taxa of Musa was assessed by flow cytometry, using line PxPC6 of Petunia hybrida as an internal standard. The 2C DNA value of Musa balbisiana (BB genome) was 1.16 pg, whereas Musa acuminata (AA genome) had an average 2C DNA value of 1.27 pg, with a difference of 11% between its subspecies. The two haploid (IC) genomes, A and B, comprising most of the edible bananas, are therefore of similar size, 0.63 pg (610 million bp) and 0.58 pg (560 million bp), respectively. The genome of diploid Musa is thus threefold that of Arabidopsis thaliana. The genome sizes in a set of triploid Musa cultivars or clones were quite different, with 2C DNA values ranging from 1.61 to 2.23 pg. Likewise, the genome sizes of tetraploid cultivars ranged from 1.94 to 2.37 pg (2C). Apparently, tetraploids (for instance, accession I.C.2) can have a genome size that falls within the range of triploid genome sizes, and vice versa (as in the case of accession Simili Radjah). The 2C values estimated for organs such as leaf, leaf sheath, rhizome, and flower were consistent, whereas root material gave atypical results, owing to browning. The genomic base composition of these Musa taxa had a median value of 40.8% GC (SD = 0.43%).

[Outcome of patients with systemic rheumatic diseases admitted to intensive care units: a retrospective study of 39 cases]. / Pronostic des maladies systémiques admises en réanimation: étude rétrospective de 39 séjours.

PURPOSE: Patients with systemic rheumatic diseases are rarely admitted in intensive care units and very few studies focusing on the prognosis of those patients have been published. METHODS: Retrospective study over seven years in two intensive care units. RESULTS: Among 33 patients with systemic disease diagnosed 90 +/- 133 months before admission in the intensive care unit, who were aged 50 +/- 21 years and represented a total of 39 stays in the intensive care unit, the main cause of admission was acute respiratory failure (33%). Mean simplified acute physiology score (SAPS II) was 47 +/- 22. Two-thirds of the patients were under mechanical ventilation. Infection was diagnosed in 33% of the cases and exacerbation of the systemic rheumatic disease in 26%. Nosocomial infection was found in 19 patients (49%). Ten patients died during their stay in the intensive care unit, six from infection, three from an exacerbation of the systemic rheumatic disease, one from an unidentified cause. CONCLUSION: Even if severity scores of patients suffering from systemic diseases are higher at admission in intensive care units than those of other patients, there is no relevant reason to refuse critical care to these patients.

Cytometric determination of genome size and base composition of tree species of three genera of Casuarinaceae.

The genome size and base composition of diploid plant species from three genera of the Casuarinaceae family were determined by flow cytometry. Casuarina glauca Sieb. ex Spring. and Gymnostoma deplancheana (Miq.) L. Johnson showed a small genome with 2C = 0.70 pg, 58.6% AT, 40.5% GC for the first species and 2C = 0.75 pg, 58.7% AT, 40.5% GC for the second. Allocasuarina verticillata (Lam.) L. Johnson had a larger genome: 2C = 1.90 pg, 59.3% AT, 41.1% GC. One haploid genome of C. glauca is therefore about 340×106 base pairs. In leaves, roots or bark of these three species, polysomaty was virtually absent: a maximum frequency of 4C nuclei of only 0.08 was found in bark of C. glauca. The genome sizes of C. glauca and G. deplancheana are among the smallest described for higher plants. Small genome size, diploidy and the absence of polysomaty are advantageous traits for facilitating molecular approaches to improvement of these actinorhizal plants and developing the study of their symbiotic interactions with Frankia.

Roscovitine, a novel cyclin-dependent kinase inhibitor, characterizes restriction point and G2/M transition in tobacco BY-2 cell suspension.

Although the developmental programs of plants and animals differ, key regulatory components of their cell cycle have been conserved. Particular attention has been paid to the role of the complexes between highly conserved cyclin and cyclin-dependent kinases in regulating progression through the cell cycle. The recent demonstration that roscovitine is a potent and selective inhibitor of the animal cyclin-dependent kinases cdc2 (CDK1), CDK2 and CDK5 prompted an investigation into its effects on progression through the plant cell cycle. Roscovitine induced arrests both in late G1 and late G2 phase in BY-2 tobacco cell suspensions. Both block were fully reversible when roscovitine was used at concentrations similar to those used in the animal system. Stationary-phase cells subcultured in the presence of roscovitine were arrested at a 2C DNA content. This arrest was more efficient without exogenous addition of plant growth regulator. Roscovitine induced a block in G1 earlier than that induced by aphidicolin. S-phase synchronized cells treated with roscovitine were arrested at a 4C DNA content at the G2/ M transition. The expression analysis of a mitotic cyclin (NTCYC1) indicated that the roscovitine-induced G2 block probably occurs in late G2. Finally, cells in metaphase were insensitive to roscovitine. The purified CDK/cyclin kinase activities of late G1 and early M arrested cells were inhibited in vitro by roscovitine. The implications of these experimental observations for the requirement for CDK activity during progression through the plant cell cycle are discussed.

Membrane-Associated and Soluble Lipoxygenase Isoforms in Tomato Pericarp (Characterization and Involvement in Membrane Alterations).

Membrane-associated and soluble lipoxygenases from green tomato (Lycopersicon esculentum Mill. cv Ailsa Craig) fruit have been identified. Microsomal lipoxygenase was localized partly in the plasma membrane and tonoplast fractions. The possibilities of glycosyl-phosphatidylinositol or transmembrane polypeptide anchors in the membrane were ruled out by differential solubilization and temperature-induced phase separation in Triton X-114. High performance liquid chromatography of reaction products combined with polarography showed that tomato lipoxygenase is capable of specific oxygenation of fatty acids esterified in phospholipids. This possibility of direct action on membrane phospholipids strengthened the hypothesis of a role for lipoxygenase in plant senescence and membrane turnover. Membrane-associated lipoxygenase is polymorphic, with two forms differing by their isoelectric points (pls) (around 4.2 and 5.1). The pl of the soluble lipoxygenase corresponds to the minor microsomal enzyme, with a pl of 5.1. The charge-differing isoforms were separated and analyzed by western blotting using anti-soybean lipoxygenase antibodies. A single polypeptide with an apparent molecular weight of 92,000 was identified in each case for the soluble and microsomal enzymes. It is suggested that a charge modification of the soluble lipoxygenase allows its association with the membrane.

Identification and characterization of lipoxygenase isoforms in senescing carnation petals.

A membrane-associated lipoxygenase and a soluble lipoxygenase have been identified in carnation (Dianthus caryophyllus L. cv Rêve) petals. Treatments of microsomal membranes by nonionic or zwitterionic detergents indicated that lipoxygenase is tightly bound to the membranes. By phase separation in Triton X-114, microsomal lipoxygenase can be identified in part as an integral membrane protein. Soluble lipoxygenase had an optimum pH range of 4.9 to 5.8, whereas microsomal lipoxygenase exhibited maximum activity at pH 6.1. Both soluble and membrane-associated lipoxygenases produced carbonyl compounds and hydroperoxides simultaneously, in the presence of oxygen. The membranous enzyme was fully inhibited by 0.1 millimolar n-propyl gallate, nordihydroguaiaretic acid, or salicylhydroxamic acid, but the effect of the three inhibitors on the soluble enzyme was much lower. The soluble lipoxygenase is polymorphic and three isoforms greatly differing by their isoelectric points were identified. Lipoxygenase activity in flowers was maximal at the beginning of withering, both in the microsomal and the soluble fractions. Substantial variations in the ratio of the two forms of lipoxygenase were noted at different sampling dates. Our results allowed us to formulate the hypothesis of a strong association of one soluble form with defined membrane constituents.