Evaluation of the quality of the management of cancer of the corpus uteri--selection of relevant quality indicators and implementation in Belgium.

OBJECTIVE: Describe the methodology and selection of quality indicators (QI) to be implemented in the EFFECT (EFFectiveness of Endometrial Cancer Treatment) project. EFFECT aims to monitor the variability in Quality of Care (QoC) of uterine cancer in Belgium, to compare the effectiveness of different treatment strategies to improve the QoC and to check the internal validity of the QI to validate the impact of process indicators on outcome. METHODS: A QI list was retrieved from literature, recent guidelines and QI databases. The Belgian Healthcare Knowledge Center methodology was used for the selection process and involved an expert's panel rating the QI on 4 criteria. The resulting scores and further discussion resulted in a final QI list. An online EFFECT module was developed by the Belgian Cancer Registry including the list of variables required for measuring the QI. Three test phases were performed to evaluate the relevance, feasibility and understanding of the variables and to test the compatibility of the dataset. RESULTS: 138 QI were considered for further discussion and 82 QI were eligible for rating. Based on the rating scores and consensus among the expert's panel, 41 QI were considered measurable and relevant. Testing of the data collection enabled optimization of the content and the user-friendliness of the dataset and online module. CONCLUSIONS: This first Belgian initiative for monitoring the QoC of uterine cancer indicates that the previously used QI selection methodology is reproducible for uterine cancer. The QI list could be applied by other research groups for comparison.

[Distal radial-ulnar arthrosis and radial-carpal arthrosis: evaluation on a population from the end of the 15th century to the beginning of the 18th century]. / Arthrose radio-ulnaire inférieure et arthrose radio-carpienne: étude d'une population fin XVe--début XVIIIe siècle.

The authors report on a study on the wrists from a medieval population (end of the 15th-century, beginning of the 18th century). The distal radio-ulnar arthrosis and the radio-carpal arthrosis were assessed after a macroscopic examination of the wrist bones. Statistical treatment of the data led to correlations with age, sex and bilateral nature of injuries. The distal radio-ulnar arthrosis has statistic correlation with age (P < 0.05). There is no relationship between sex and bilateral nature of injuries. For the radio-carpal arthrosis, injuries are often present for elderly woman (P < 0.01) and young man (P < 0.05). The bilateral nature of arthrosis increases with age (P < 0.05). The wrists which are damaged by the distal radio-ulnar arthrosis are often associated with radio-carpal injuries (P < 0.05). The absence of any obvious osseous traumatic aetiology suggests a bilateral ligamentous distension for women and elderly men. A traumatic ligament rupture can be incriminated for young men maybe related to repeated microtraumatic activities.

[Thumb arthritis yesterday and today. Epidemiologic comparison in an ancient population]. / La rhizarthrose d'hier et d'aujourd'hui. Comparaison épidémiologique à partir d'une population ancienne.

The aim of the study was to assess the rate of thumb osteoarthritis in an ancient population (before the industrial revolution) according to the age, the sex and the side affected, and to compare the results to the current epidemiologic data. This study was performed in bones from the convent graveyard of the Soeurs Grises de Beauvais (15th to 18th century). The rate of thumb osteoarthritis was assessed in 73 adult individuals (34 men and 39 women) divided into 2 age groups: 35-49 and over 50. The rates of thumb osteoarthritis in each group were compared according to different factors (age, sex, side affected). The statistical study showed a higher rate of thumb osteoarthritis in elder people in general, and in male but not in female individuals. The rate of bilateral thumb osteoarthritis was higher in women. However, no difference was found between both sides of human body whatever the age or sex. As for the female population, the results were identical those of the current data. However, there was a higher rate of thumb osteoarthritis in men of any age group. A functional fatigue could provide a higher rate of secondary thumb osteoarthritis since the women in this series (nuns), who were less affected by overwork, had a rate of primary thumb osteoarthritis identical to the rate found in the current literature.

Brief communication: An early case of hydrocephalus: the Middle Paleolithic Qafzeh 12 child (Israel).

Remains of 15 hominids were recovered within a Mousterian archaeological context in the cave of Qafzeh, Israel. Dated to ca. 95 kyr BP, this skeletal material has been crucial for understanding biological, chronological, and cultural aspects of anatomically modern ancient Homo sapiens. The high proportion of children (N = 8) in Qafzeh Cave is unique among Middle Palaeolithic sites and encourages the search for skeletal evidence of disease and trauma. We report on the case of one child, Qafzeh 12, ca. 3 years old (according to modern human reference standards), who manifests some outstanding skeletal abnormalities that indicate hydrocephalus.

Locomotion and body proportions of the Saint-Césaire 1 Châtelperronian Neandertal.

The initial Upper Paleolithic (Châtelperronian) of western Europe was associated with late European Neandertals, best known through the Saint-Césaire 1 partial skeleton. Biomechanical cross-sectional analysis of the Saint-Césaire 1 femoral diaphysis at the subtrochanteric and midshaft levels, given the plasticity of mammalian diaphyseal cortical bone, provides insights into the habitual levels and patterns of loading on the lower limbs from body mass, proportions, and locomotion. The overall robustnesses of the femoral diaphyses of European Neandertals and early modern humans are similar once contrasts in body proportions are incorporated into the body size scaling. Saint-Césaire 1 matches these samples only if it is provided with Neandertal-like hyperarctic body proportions. And the rounded proximal femoral diaphysis of Saint-Césaire 1 is similar to those of earlier Neandertals, likely also reflecting similar cold-adapted broad pelvic regions. However, although morphologically similar to those of archaic Homo, the Saint-Césaire 1 femoral midshaft exhibits the anteroposterior reinforcement characteristic of early modern humans. Consequently, Saint-Césaire 1 appears as a morphological Neandertal with hyperarctic body proportions who nonetheless had shifted locomotor patterns to more closely resemble those of other Upper Paleolithic humans.

An adolescent female Neandertal mandible from Montgaudier Cave, Charente, France.

In 1974, an incomplete human mandible was discovered in the site of Montgaudier Cave, along the Tardoire (Charente), France. The mandible was found in association with stone tools and animal bones in geological deposits referable to the very end of the Middle Pleistocene or the beginning of the Upper Pleistocene. The mandible preserves much of the anterior part of the body and three permanent teeth: left lateral incisor, canine and first molar. Estimates based on tooth eruption of modern humans, as well as occlusal wear and root development, suggest an age at death of between 12.5 and 14.5 years. Morphologically, the fossil possesses features, such as a lack of a chin and multiple mental foramina, which have been observed on immature Neandertal mandibular specimens from Europe. Comparison with these immature European Neandertals indicates that the jaw and teeth of the Montgaudier mandible are small for its chronological age, suggesting it was that of a female.

Dimensions of cervical vertebral bodies according to age and sex.

A biometric comparative roentgenological study of the cervical vertebral bodies was performed, according to age and sex, from lateral roentgenograms of 120 adult cervical regions. The sexual dimorphism already described by many authors was confirmed. The vertebral bodies of C2, C3, and C7 have the more variable structure according to age. The results of our measurements are in accordance with clinical findings and provide data on the structural changes of the cervical spine during ageing. In anthropological terms, the vertebral body of C2, in particular its antero-posterior diameter, is the best age indicator, irrespective of individual and exterior variables.

Thermoluminescence dating of the late Neanderthal remains from Saint-Césaire.

Anatomically modern humans have long been thought to have been responsible for the Aurignacian and Châtelperronian industries of the early Upper Palaeolithic of Western Europe, whereas the Middle Palaeolithic Mousterian industry has been attributed to Neanderthals. The presence of both Middle and Upper Palaeolithic strata at Saint-Césaire in France offers an excellent opportunity for studying the cultural transition between the two. Saint-Césaire is the only Châtelperronian site that has yielded really diagnostic hominid fossils, and the discovery there of Neanderthal remains alongside Châtelperronian tools cast doubt on the exclusive association between industries and taxon. We report thermoluminescence dates for 20 burnt flints from the site. Those found near the Neanderthal remains were dated at 36,300 +/- 2,700 years BP (before present), making this specimen the youngest Neanderthal dated so far. This date places the stratum close in age to several French but much younger than some Spanish Aurignacian sites believed to have been occupied by modern humans. The possibility of contact between the West European Neanderthals and the intrusive modern humans who replaced them cannot therefore be excluded.

Modulation of B cell stimulation by maternal serum.

Anti-IgM stimulation of B cells is decreased in the presence of maternal serum as compared to control media. This inhibiting influence of maternal serum is observed during the priming of the B cells. The progression of B cells into cellular proliferation was not influenced by maternal serum. At the level of the immunoglobulin secretion, the influence of maternal serum was also shown. A significant down regulation of the IgM, no change of the IgG production, and an enhanced secretion of IgA and IgE was demonstrated in the presence of maternal serum as compared to control media. It has been suggested that the maternal IgG fraction contains a molecule partly responsible for these changes. Furthermore, the CD23 antigen is increased when B cells are stimulated in the presence of a pool of maternal IgG. All the findings concerning maternal IgG were more pronounced when retroplacental IgG was used instead of peripheral maternal IgG. This observation suggests that the factor responsible for the B cell changes is released at the fetomaternal interface.

Thermoluminescence dating of Neanderthal and early modern humans in the Near East.

Archaeological excavations in Europe provide no evidence for the first modern humans pre-dating Neanderthal man. In the Near East, however, a quite different sequence seems to have pertained. Thermoluminescence dating indicates that at some sites the modern humans were settled some 30,000 years before the Neanderthals. This raises the possibility of two lines of descent from a common ancestor.

A reappraisal of the anatomical basis for speech in Middle Palaeolithic hominids.

The recovery of a fossil hominid skeleton with a complete hyoid bone from Mousterian deposits in Kebara Cave, Israel, provides new evidence pertaining to the evolution of speech. Previous studies of speech in the Middle Palaeolithic (most notably those on Neandertals) have focused on the basicranium as an indicator of speech capabilities. This work critiques the use of the basicranium and instead presents the anatomical relations of the hyoid and adjacent structures in living humans as a basis for understanding the form of the vocal tract. The size and morphology of the hyoid from Kebara and its relations to other anatomical components are almost identical to those in modern humans, suggesting that Middle Palaeolithic populations were anatomically capable of fully modern speech.

Modulation of class II histocompatibility antigen expression by maternal serum.

Human maternal serum has been shown to down-regulate the expression of MHC class II antigen in three distinct circumstances. Cord blood mononuclear cells, incubated in the mother's own serum, showed significant modulation of class II antigen expression. This was also the case for unrelated donor lymphocytes, incubated in pooled maternal serum. One neoplastic line (Daudi) was further shown to down-regulate class II antigen expression. In this last case, the down-regulating effect persisted over a 10-day period during which maternal serum was renewed regularly. Retroplacental serum was more MHC class II-inhibiting than peripheral serum. This down-regulating effect does not apply to maternal lymphocytes. The inhibitory effect is thought to be due to a factor, yet to be defined, included in the maternal IgG fraction. Regular assays made throughout pregnancy showed that the class II inhibiting component appears early (5th week), reaches its peak value at the 12th week, and disappears 2 or 3 weeks after delivery.

A Middle Palaeolithic human hyoid bone.

The origin of human language, and in particular the question of whether or not Neanderthal man was capable of language/speech, is of major interest to anthropologists but remains an area of great controversy. Despite palaeoneurological evidence to the contrary, many researchers hold to the view that Neanderthals were incapable of language/speech, basing their arguments largely on studies of laryngeal/basicranial morphology. Studies, however, have been hampered by the absence of unambiguous fossil evidence. We now report the discovery of a well-preserved human hyoid bone from Middle Palaeolithic layers of Kebara Cave, Mount Carmel, Israel, dating from about 60,000 years BP. The bone is almost identical in size and shape to the hyoid of present-day populations, suggesting that there has been little or no change in the visceral skeleton (including the hyoid, middle ear ossicles, and inferentially the larynx) during the past 60,000 years of human evolution. We conclude that the morphological basis for human speech capability appears to have been fully developed during the Middle Palaeolithic.