The Body Worlds Exhibits and Juvenile Understandings of Death: Do We Educate Children to Science or to Voyeurism?

Gunther von Hagens' development of plastination as a method for preserving human remains has enabled his public display of skinless, dissected bodies in a series of popular international exhibitions entitled Body Worlds. These spectacular displays claim to be educative, democratizing the study of anatomy and liberating it from the traditional confines of professional medical study. However, Body Worlds has raised various ethical objections to its commercial purpose, sourcing of some bodies and arrangement of bodies in poses or dissections that some viewers find offensive. Here we consider a different, often overlooked ethical conundrum raised by these exhibitions: the likelihood that the viewing of plastinates posed in 'frozen motion' is ill­suited to the psychological development of young children (5-10 years old) whose understanding of death is still in formation. Often young children mistake corpses for models, even for living beings if they are posed in arrested motion. The educative value of Body Worlds for younger viewers is questionable and the display may even interfere with their understanding of death. If the exhibition of human remains can be justified where their authenticity can be made known to viewers and the remains invested by them with sympathetic emotional meaning, it may be pointless if not unethical to show quasi­lifelike posed plastinates to young children in lieu of replica models.

Facial soft tissue changes after transverse palatal distraction in adult patients.

This longitudinal study investigated the 3-D facial soft-tissue response to transverse palatal bone-anchored osteodistraction in 18 adult patients. Laser-scanned facial surface data were obtained for all patients before (T(0)), 6 months (T(1)) and 1 year (T(2)) after transverse palatal distraction. The averaged facial morphologies at T(0), T(1) and T(2) were calculated and compared. Sagittal and vertical measurements were obtained from lateral cephalograms to evaluate skeletal and dental movements. Pre- and immediate post-distraction dental casts were used to investigate transverse maxillary movements. Cutaneous changes were mainly observed in the paranasal regions and cheeks, in the range 1-3 mm, reflecting the underlying increase in the maxillary width. A significant enlargement of the nasal base was also demonstrated. The absolute magnitude of these facial changes was limited but clinically relevant. Variable skeletal movements were observed. These were of low magnitude and no systematic tendency could be demonstrated statistically. Significant changes were documented only with regard to orthodontic repositioning of the upper and lower incisors. The mean transverse increases in the maxillary dental arch were 6.7 mm at the intercanine, 6.8 mm at the interpremolar, and 6.1 mm at the intermolar levels.

Reconstruction of facial morphology from laser scanned data. Part I: reliability of the technique.

OBJECTIVES: The aim of this study was to evaluate the effects of scanning parameters on the precision of the data acquired using a facial laser scanner and to assess the reliability of automatic model recording in humans. METHODS: Data were acquired using a laser scanner (Cyberware 3030RGB); analysis and measurements were performed with Rapid Form 2004 software. A mannequin and six volunteers were scanned to investigate the effects of environmental conditions, positioning, head orientation, and software procedures. Precision and accuracy of the data were evaluated comparing six linear measures calculated on scanned data with those obtained directly. Two sessions with different head inclination were performed. The reliability of repeated scans was also assessed measuring the distance between the surfaces reconstructed from two separate scans of the same subject, at 12 anatomical points, in 5 subjects, during two sessions using a different head inclination. Differences were analysed using paired t-tests or analysis of variance (ANOVA). RESULTS: The accuracy of scanning was +/-0.65 mm. The development of a specific protocol resulted in a mean scanning error of 1-1.2 mm and a recording error of 0.3-0.4 mm on repeated scans of human subjects. CONCLUSIONS: This study indicates that scanning of the human face may be hampered by errors and artefacts, mainly due to movements. While the effect of trembling and involuntary movements during the exam may be minimized using faster scanning devices, comparative observation over time may be affected by unreal differences due to the uncertainty of facial expression. The overall error is, however, in the range useful for most clinical studies.

Expression of neuropeptides and growth-associated protein 43 (GAP-43) in cutaneous and mucosal nerve structures of the adult rat lower lip after mental nerve section.

The reinnervation of the adult rat lower lip has been investigated after unilateral section of the mental nerve. Rats were sacrificed at 4, 7, 9, 14, 30, and 90 days after the operation. A further group of animals with section of the mental nerve and block of the alveolar nerve regeneration, was sacrificed at 14 days. Specimens were processed for immunocytochemistry with antibodies against PGP 9.5, GAP-43 or neuropeptides (CGRP, SP and VIP). Four days after nerve section, axonal degeneration seems evident in the mental nerve branches and inside skin and mucosa. GAP-43 immunoreactivity is intense in the mental nerve 7 days after nerve section and it reaches its maximal expression and distribution in peripheral nerve fibres at 14 days. At 30 days, the decline in its expression is associated with the increase of PGP9.5-, SP-, and CGRP immunopositivity. VIP is observed only in perivascular fibres at all times observed. Present results suggest that, after sensory denervation of the rat lip, nerve fibres in skin and mucosa remain at lower density than normal. The different time courses in the expression of neuropeptides and GAP-43 suggest a possible early involvement of GAP-43 in peripheral nerve regeneration.

Cutaneous innervation in hereditary sensory and autonomic neuropathy type IV.

The authors investigated immunocytochemically the innervation of a skin biopsy in a rare case of hereditary sensory and autonomic neuropathy type IV. A few protein gene product 9.5-, growth-associated protein 43-, calcitonin gene-related peptide-, and substance P-immunoreactive nerve fibers were observed in the deeper regions of the dermis. Neuropeptide Y-, nitric oxide-, and vasoactive intestinal polypeptide-immunoreactive fibers were completely absent. Their observations support the hypothesis that the sensory and autonomic defects reported in hereditary sensory and autonomic neuropathy are based on profound developmental alterations of the peripheral nervous system.

Immunocytochemical evidence of plasticity in the nervous structures of the rat lower lip.

In this immunocytochemical study we investigated the distribution of nervous structures in the lower lip of adult rats. The region is characterized by a rich cutaneous and mucosal sensory innervation originating from terminal branches of the trigeminal system. Lower lip innervation was investigated by detection of the general neuronal marker protein gene product 9.5 (PGP 9.5) and the growth-associated protein 43 (GAP-43), a neurochemical marker of neuronal plasticity. The entire neural network of both cutaneous and mucosal aspects was stained by the antibody to PGP 9.5. In particular, nerve fibers were observed in the submucosal and the subepithelial plexuses. Thin immunoreactive fibers were observed within the epithelial layers ending as free fibers or as fibers associated with immunopositive Merkel cells. Well-identified anatomical structures receiving sensory or autonomic innervation were also surrounded by PGP 9.5-ir nerve fibers, in particular, hair follicles, vibrissae, glands, and blood vessels. GAP-43-immunostained nerve fibers were observed in all these structures; however, they were generally less numerous than the PGP 9.5-immunoreactive elements. An equal amount of PGP 9.5 and GAP-43 immunoreactivity occurred, in contrast, in the subepidermal and the submucosal plexuses, or in the epidermis and the mucosal epithelium. The present results show that GAP-43 is normally expressed in the mature trigeminal sensory system of the rat. Skin and oral mucosa are characterized by continuous remodeling that may also involve the sensory nervous apparatus. Continuous neural remodeling, regeneration and sprouting may be the reason for the observed expression of GAP-43.

Increase of B-50/GAP-43 immunoreactivity in uninjured muscle nerves of MDX mice.

Lack of dystrophin in mdx mice leads to muscle fibre degeneration followed by the formation of new myofibres. This degeneration-regeneration event occurs in clusters. It is accompanied by inflammation and remodelling of the intramuscular terminal nerve fibres. Since the growth-associated protein B-50/GAP-43 has been shown to be involved in axonal outgrowth and synaptic remodelling following neuronal injury, we have investigated the presence of B-50 in gastrocnemius and quadriceps muscles of mdx mice. Using immunocytochemistry we demonstrate increased presence of B-50 in terminal nerve branches at motor endplates of mdx mice, particularly in the clusters of de- and regenerating myofibres. In comparison, the control mice displayed no B-50 immunoreactivity in nerve fibres contacting motor endplates. Our findings indicate that during axonal remodelling and collateral sprouting the B-50 level in the terminal axon arbours is increased although there is no direct injury to the motoneurons. We suggest that the degenerating target and/or the inflammatory reaction induces the increased B-50 level in the motoaxons. The increased B-50 may be important for sprouting of the nerve fibres and re-establishment of synaptic contacts, and in addition, for maturation and survival of the newly formed myofibres.

Plasma amino acid alterations in idiopathic generalized epilepsy: an investigation in probands and their first-degree relatives.

Twenty-two plasma amino acids were determined by means of ion-exchange chromatography in 16 previously untreated patients with generalized idiopathic epilepsy and in some of their first-degree relatives (26 subjects), and the results were compared with those obtained from a group of 50 healthy controls. The patients were subsequently treated with valproic acid for one month and then reexamined. In the epileptic subjects, statistical analysis showed significant alterations in the plasma levels of a group of amino acids, including the four associated with neuro-transmission (aspartate, glutamate, glycine, taurine); aspartate, glutamate and glycine levels were also altered in the first-degree relatives. Valproic acid therapy did not affect amino acid levels. If further confirmed, these alterations might be considered possible neurochemical markers of epilepsy.

Allopurinol as add-on therapy in refractory epilepsy: a double-blind placebo-controlled randomized study.

The antiepileptic effect of allopurinol was assessed in a double-blind, randomized, placebo-controlled, cross-over trial in 84 patients with epileptic seizures refractory to standard antiepileptic drugs (AEDs). During a retrospective baseline period, patients experienced at least four seizures of any type per month. The effects of allopurinol and matching placebo were examined for 4-month periods. Allopurinol dosage was 150 mg daily for children weighing < 20 kg and 300 mg daily for other patients. Efficacy analysis based on the Wilcoxon rank-sum test was conducted for the 80 patients who completed the study. No significant period effect or treatment-period interaction was noted. Allopurinol significantly reduced total seizures (p = 0.005), and secondarily generalized seizures (p = 0.0015). Median seizure reduction for total seizures was 10.5 and 27.9% for secondarily generalized seizures. Subjective preferences by clinicians evaluated blindly significantly favored allopurinol. No significant change occurred in the plasma concentration of concomitant AEDs between treatment periods, but serum urate decreased by 32% during allopurinol treatment. No clinically relevant side effects or changes in routine laboratory clinical chemistry or hematology were ascribed to allopurinol.

[Evaluation of the effectiveness of monotherapy in the treatment of epilepsy]. / Valutazione dell'efficacia della monoterapia nel trattamento dell'epilessia.

On 44 patients undergoing monotherapy, with total plasma levels of drug therapeutic range, 33 had a reduction of the frequency of seizures, while the remaining 11 were unmodified. There was 90% improvement in Primary Generalized seizures, 73% in Secondary Generalized and 62% in Partial Complex; 27% of PC, 16% of PG and 16% of SG shifted to polytherapy. Considering that monotherapy can be better managed and is less toxic, we can recommend it as first choice treatment in newcomers, as a maintenance therapy, and as treatment of choice for the gradual elimination of therapy.

Free drug levels monitoring as a detector of false metabolic refractory epilepsy.

Unbound and total plasma levels of carbamazepine (CBZ) and phenobarbital (PB) were evaluated in a group of 12 refractory patients out of 397 subjects, with normal values of total drug concentration and unbound levels below the expected ones. We established a minimal acceptable 'subtherapeutic' free drug level, i.e. less than 9.62 micrograms/ml for PB and 1.36 micrograms/ml for CBZ. PB and CBZ dosages were increased during a 3-month period. We observed a normalization of free levels, unaccompanied by a significant decrease in seizure frequency. Free drug level monitoring may prove to be an unchallenged detector of false metabolic refractory epilepsy.

Epidemiology of Duchenne muscular dystrophy in the province of Turin.

An epidemiological investigation on Duchenne muscular dystrophy in Turin and its province has been carried out for the period 1955-974. The incidence of the disease proved to be 24 X 10(-5), and the prevalence 2.15 X 10(-5). The mutation rate was 80 X 10(-6). The data are compared with the literature. Segregation analysis on many families was performed in order to find the theoretical number of carrier among Duchenne mothers. The importance of epidemiology for genetic counselling is stressed.

[Computerized electroencephalography in acute cerebral ischaemia (author's transl)]. / L'elettroencefalografia computerizzata nella fase acuta dell'infarto cerebrale.

Physiopathological, clinical and therapeutical problems of acute cerebral ischaemia and brain infarction are briefly discussed. In the opinion of the Authors, a first valuable approach to the diagnosis and treatment of these conditions is afforded by the computerized electroencephalography (Berg Fourier Analysis). This investigations proved to be a safe, easy and reliable tool for testing and monitoring the effectiveness of individually selected drugs in early phases of cerebral ischaemia.