Chromosomal instability but lack of transformation in human myoblast preparations.

Genetic alterations have recently been described as emerging during the culture of embryonic stem cells or induced pluripotent stem cells, raising concerns about their safety in future clinical use. Myoblasts are adult stem cells with important therapeutic potential that have been used in clinical trials for almost 20 years, but their genome integrity has not yet been established. Here we produced 10 human myoblast preparations and investigated their genomic stability. At the third passage, half of the preparations had a normal karyotype and half showed one to four alterations/30 metaphases. Chromosome 2 trisomy was found in 1-2/30 metaphases and/or 2/100 nuclei by FISH in 3/10 samples, and there was no other recurrent anomaly. When prolonging cultures, these erratic abnormalities were never associated with a growth advantage. Cellular senescence was manifested in all samples by growth arrest before passage 15. Expression of TERT was always negative. Molecular analysis of individual p53 transcripts did not reveal tumorigenic mutations. CGH array (10 samples) and exome sequencing (one sample) failed to detect copy number variations or accumulation of mutations, respectively. Myoblasts did not grow either in soft agar or in vivo after injection in immunodeficient mice. Hence, occasional genomic abnormalities may occur during myoblast culture but are not associated with risk of transformation.

In vivo probe-based confocal laser endomicroscopy in amiodarone-related pneumonia.

Probe-based confocal laser endomicroscopy (pCLE) allows microscopic imaging of the alveoli during bronchoscopy. The objective of the study was to assess the diagnostic accuracy of pCLE for amiodarone-related pneumonia (AMR-IP). Alveolar pCLE was performed in 36 nonsmoking patients, including 33 consecutive patients with acute or subacute interstitial lung disease (ILD), of which 17 were undergoing treatment with amiodarone, and three were amiodarone-treated patients without ILD. Nine out of 17 patients were diagnosed with high-probability AMR-IP (HP-AMR-IP) by four experts, and three separate observers. Bronchoalveolar lavage findings did not differ between HP-AMR-IP and low-probability AMR-IP (LP-AMR-IP) patients. In HP-AMR-IP patients, pCLE showed large (>20 µm) and strongly fluorescent cells in 32 out of 38 alveolar areas. In contrast, these cells were observed in only two out of 39 areas from LP-AMR-IP patients, in one out of 59 areas from ILD patients not receiving amiodarone and in none of the 10 areas from amiodarone-treated patients without ILD (p<0.001; HP-AMR-IP versus other groups). The presence of at least one alveolar area with large and fluorescent cells had a sensitivity, specificity, negative predictive value and positive predictive value for the diagnosis of AMR-IP of 100%, 88%, 100% and 90%, respectively. In conclusion, pCLE appears to be a valuable tool for the in vivo diagnosis of AMR-IP in subacute ILD patients.

Do teaching faculty resources affect the choice of medical career?

The faculty to student (F/S) ratio is a key criterion in ranking medical universities. In France, the registration of students at the medical university in their home region is mandatory. At the end of undergraduate studies, students have to take the National Ranking Exam (NRE), and choice of specialty is based on their rank. The purpose of this study was to investigate the relation between teaching faculty resources in medical universities and the ranking of students on the NRE. All 32 public medical universities with a complete curriculum were included. Correlation of the 2003-2004 F/S ratio with the mean rank of students at the 2004 NRE was assessed using Spearman's rank correlation coefficient [r(s)]. The overall university F/S ratios ranged from 1.16 to 2.62 overall, and from 0.68 to 1.63 and 0.47 to 1.08 for tenured and non-tenured positions, respectively. All were significantly correlated with mean rank at the NRE (r(s) = -0.53, r(s) = -0.50, r(s) = -0.52, respectively, all p < 0.01). As this link between teaching means and students' performance has consequences in the competition for career choice, large disparities among medical universities are not legitimate in a regulated model. Deregulation of regional applications should be considered to come close to equality of opportunity.

[Predictability of the results of the 2004 French national-ranking exam]. / Prévisibilité des résultats de l'epreuve classante nationale 2004.

OBJECTIVE: To assess the individual predictability of success for undergraduate medical students taking the French national-ranking examination (examen classant national [NRE]) in June 2004. METHODS: In total, 86 students in Rouen were classified according to RNE scores. We used the Spearman rank test [rs] to correlate to the RNE score each student's previous test results during the medical curriculum: written exams (first two years of medical classes), clinical skill tests (third- and fourth-year) and the clinical and therapeutic synthesis certificate (CSCT), and the northwest region official RNE practice test. Each student's ECN rank was then predicted by a regression formula. RESULTS: Written exam (r5 = 0.35), third- and fourth-year clinical skill (r(s) = 0.62), CSCT (r(s) = 0.49) and regional practice test (r(s) = 0.56) scores were strongly and significantly associated with the RNE classification. Of the 59 students who took all tests, 12 students (20.3%) diverged from the regression model: three students obtained a national classification substantially better than expected, nine ranked substantially lower than expected. CONCLUSION: Test results during the undergraduate medical curriculum in a cohort of undergraduate medical students were strongly predictive of the RNE results. An identifiable group of students with unstable results could benefit from targeted teaching and individual support. The effect of knowledge of their individual position before the RNE remains to be assessed.

Pleural effusion revealing giant cell arteritis.

Pulmonary involvement is considered to be rare in giant cell arteritis (GCA), usually occurring in the course of the disease. We describe the case of a patient who developed left pleural effusion revealing GCA. Thoracic CT scan demonstrated an abundant left pleural effusion and a thickening of the aortic wall. The patient's condition improved rapidly, with regression of pulmonary clinical features and complete clearance of pleural effusion, after institution of steroid therapy. Our case report reinforces the possibility of unusual presentation of GCA; such a diagnosis should, therefore, be considered in elderly patients presenting with pulmonary manifestations, even in the absence of typical clinical features of temporal arteritis (e.g. headache, jaw claudication, blurred vision, scalp tenderness) or polymyalgia rheumatica.