A microarray analysis of temporal gene expression profiles in thermally injured human skin.

Partial-thickness burns incite a multitude of responses which eventually culminate in cutaneous wound repair. We hypothesized that these events would evoke extensive alterations in gene expression thereby orchestrating the complexity of spatial and temporal events that characterize "normal" human wound healing. In the present study, gene expression from partial-thickness areas at defined temporal periods (1-3 days, 4-6 days, and 7-18 days) after injury were compared to normal non-wounded skin. Gene alterations proved extensive (2286 genes). Statistically significant alterations were noted among increased and decreased genes expressed in the three different temporal groupings. Our foundational data (based on samples from 45 individuals) provide a comprehensive molecular gene expression portrait of the cutaneous reparative responses that are initiated during the first 17 days after injury. Our efforts also represent an initial endeavor to move beyond the historically defined "morphological phases" of wound repair toward reporting molecular clues that define the temporal sequence of healing in human subjects. Further analysis of genes that are either affected or remain not affected following injury to normal skin is expected to identify potential targets for therapeutic augmentation or silencing.

[Life experience of adults with unilateral agenesia of the forearm: effect of prosthesis on self image and social relations]. / Parcours de vie d'adultes présentant une agénésie unilatérale d'avant-bras: enjeux et incidence du recours à la prothèse sur l'image de soi et les relations sociales.

PURPOSE OF THE STUDY: This study was devoted to better understanding how adults with agenesia of the forearm live their condition. The malformation studied was identical to that of a previous study in children. The present study was designed to provide professionals and parents with a reference system for making therapeutic decisions. MATERIAL AND METHODS: An intensive survey using semi-directive interviews was conducted among adults aged 19 to 37 years, 12 women and 8 men, with unilateral agenesia of the forearm. The majority of the participants had an occupation and an active social and familial life. RESULTS: The survey revealed factors of limitation or progress, expectations and renouncements, marking the life experience of these persons. The prosthesis had a significant impact on their lives. DISCUSSION: Four types of life experience could be identified from the survey data. All four could be understood as a search for equilibrium between internal reality (desired self image) and external reality (image produced by the physical and human environment via the regards of others and obstacles encountered). Several modalities for using a prosthesis, several ways of coping with the absence of a hand, with or without a prosthesis, and several ways of constructing a self-representation were distinguished. Rather than a functional disability, agenesia was found to be perceived as a persistent problem in daily life, generating handicap- or discrimination-producing situations. CONCLUSION: Forearm agenesia creates a situation different from normal and as such makes the question of self-identity and social relations more complex than for others. The comments provided by these young adults who cope with the paradoxical condition of an amputated but functional body demonstrated the central role of the body.

Magnetic resonance spectroscopy: an in vivo tool for monitoring cerebral injury in SIV-infected macaques.

The purpose of our study was to demonstrate the feasibility of using in vivo proton Magnetic Resonance Spectroscopy (MRS) to monitor the brain manifestations of SIV infection in the macaque model of AIDS. Previous spectroscopy work on macaque brain tissue and in vivo work in humans is reviewed to provide the motivation and context for this study. We collected 34 MRS data sets on 14 uninfected rhesus macaques. From this data, we demonstrate that we are capable of detecting changes similar to those observed in human MRS studies for most metabolites using less than 10 animals. The juvenile macaques utilized in this study demonstrate age-related changes in the levels of N-acetyl aspartate (NAA), a neuronal marker. The quantity and distribution of neurochemicals in the macaque are found to be slightly, but significantly, different than in the human.

[Unilateral forearm agenesis and prosthesis]. / Agénésie unilatérale d'avant-bras et prothétisation.

PURPOSE OF THE STUDY: Antebrachial agenesis is a congenital deformity which is not invalidating for the children who have a level of independence comparable to that of other children of the same age. Although the appropriateness of a prosthesis is rarely questioned by healthcarers, it is clear that it is the healthcarers' own representation of this condition (their knowledge of the deformity and of the prosthesis proposed) that leads to the indication. The purpose of this study was to better understand the respective representations of unilateral antebrachial agenesis to help determine appropriate health care proposals. MATERIAL AND METHODS: An intensive survey using semi-directive interviews was conducted in 16 families. Group interviews with three healthcare teams were then conducted. RESULTS: Three leading topics appeared: worry about the social integration of the child, a paradoxical representation of the child perceived as independent but handicapped, and a largely negative image of the prosthesis. There was a rather important difference in the representations formulated by the parents and by the healthcarers. DISCUSSION: The discussion focused on awareness of the narcissistic content of the expectations and the plastic and functional implications of prosthesis fitting, perceived differently by parents and healthcarers. CONCLUSION: The nature of the expected result involves a change in the representation of the child more than a change in the child's body, a concept which in itself is not a true objective of healthcare. Taken the understandably difficult position of healthcarers, it might be useful to propose a different scheme for the first consultation.

CT guided pararectal seed implant for localized prostate cancer: a preliminary report.

One hundred and fifty-two patients were treated with CT guided pararectal prostate seed implant (CPSI) alone or in combination with external-beam 3D conformal radiation therapy (EB3DRT) and Androgen Blockage Hormone Therapy (HT). A decrease and normalization in PSA values was seen following treatment in all groups. However, a better therapeutic response was observed in the individuals that received CPSI and EB3DRT with hormone therapy.

Atomic carbon as a terminal ligand: studies of a carbidomolybdenum anion featuring solid-state (13)C NMR data and proton-transfer self-exchange kinetics.

Anion [CMo(N[R]Ar)(3)](-) (R = C(CD(3))(2)CH(3) or (t)Bu, Ar = 3,5-C(6)H(3)Me(2)) containing one-coordinate carbon as a terminal substituent and related molecules have been studied by single-crystal X-ray crystallography, solution and solid-state (13)C NMR spectroscopy, and density functional theory (DFT) calculations. Chemical reactivity patterns for [CMo(N[R]Ar)(3)](-) have been investigated, including the kinetics of proton-transfer self-exchange involving HCMo(N[R]Ar)(3), the carbidomolybdenum anion's conjugate acid. While the Mo triple bond C bond lengths in [K(benzo-15-crown-5)(2)][CMo(N[R]Ar)(3)] and the parent methylidyne, HCMo(N[R]Ar)(3), are statistically identical, the carbide chemical shift of delta 501 ppm is much larger than the delta 282 ppm shift for the methylidyne. Solid-state (13)C NMR studies show the carbide to have a much larger chemical shift anisotropy (CSA, 806 ppm) and smaller (95)Mo--(13)C coupling constant (60 Hz) than the methylidyne (CSA = 447 ppm, (1)J(MoC) = 130 Hz). DFT calculations on model compounds indicate also that there is an increasing MoC overlap population on going from the methylidyne to the terminal carbide. The pK(a) of methylidyne HCMo(N[R]Ar)(3) is approximately 30 in THF solution. Methylidyne HCMo(N[R]Ar)(3) and carbide [CMo(N[R]Ar)(3)](-) undergo extremely rapid proton-transfer self-exchange reactions in THF, with k = 7 x 10(6) M(-1) s(-1). Besides being a strong reducing agent, carbide [CMo(N[R]Ar)(3)](-) reacts as a nucleophile with elemental chalcogens to form carbon-chalcogen bonds and likewise reacts with PCl(3) to furnish a carbon-phosphorus bond.

Chronic ulcers and myasis as ports of entry for Clostridium tetani.

Evaluating tetanus immune status is not yet the usual clinical practice regarding patients with chronic ulcers or myasis. However, of 858 tetanus patients at Hospital Couto Maia (Salvador, Bahia, Brazil) aged 1 year or above, 2 had pressure ulcers and 17 had chronic ulceration of the lower limbs where these skin lesions were the ports of entry for Clostridium tetani. In these 19 cases, the following predisposing factors were described: venous insufficiency (n=6), sickle cell anemia (n=2), Hansen s disease (n=1), malnutrition (n=1), diabetes mellitus (n=1), trauma (n=1) and unknown factors (n=7). In 6 other cases, in addition to the Hansen s disease patient, the port of entry for tetanus was the site of extraction of Tunga penetrans larvae. In these 25 cases, the majority of patients (68%) were over 40 years old (17/25) and all of these patients stated that they had either not followed a tetanus toxoid vaccination regimen (19/25), or had partially completed such a regimen, or did not give precise information (6/25). Among the same series studied, over half (52%) of the patients died (13/25). We conclude that tetanus prevention must be included in the treatment of chronic skin ulcer patients, vaccination coverage should be increased among older people, and strategies aimed at improving coverage for all age groups must be reviewed.

The lateral notch sign associated with acute anterior cruciate ligament disruption.

We prospectively studied all of the patients with anterior cruciate ligament disruptions who sought treatment at the senior author's office during a 36-month period. Plain radiographs identified depressions measuring 2 mm or more in the lateral femoral condyle (lateral notch sign) in 9 of 120 knees (7.5%) with acute anterior cruciate ligament disruption and in 2 of 44 knees (4.5%) with chronic pivot shift instability. The depression ranged from 2 to 6 mm deep and from 20 to 25 mm long. The mean age for acutely injured patients with lateral notch signs was 17.2 years, 6 years younger than the mean age of the group with acutely injured anterior cruciate ligaments as a whole. Ten of the 11 patients (91%) with lateral notch signs were men, and all 6 patients with depressions shallower than prior descriptions of the notch sign were men. In contrast, 67% (N = 110) of the entire group of patients who had anterior cruciate ligament disruption were men. Ten of the 11 patients (91%) with the lateral notch signs and 4 of the 6 patients (66%) with minimal depressions also had lateral meniscus tears, while 58 of 147 patients (39%) without lateral femoral condyle depression had lateral meniscus tears. Previous reports that the lateral notch is a sign of chronic anterior cruciate ligament deficiency with recurrent pivot shifts are not supported by the number of prospectively recognized acute lateral femoral notch signs in this series. We found the presence of radiographic changes in the lateral femoral condyle to have statistically significant correlations with young age, male sex, lateral meniscus tears in general and anterior-horn lateral meniscus tears specifically, and lateral femoral chondral lesions.

A "crush study" review of micrograft survival.

BACKGROUND: Poor growth has been reported after densely packed megasessions. These reports have been fairly consistent. Despite these statements, excellent growth is seen in the majority of their cases. The author's have theorized that iatrogenic trauma from inappropriate graft handling is one etiology that substantially contributes to poor growth. OBJECTIVE: The purpose of this preliminary "crush study" is to: 1) ascertain if follicular trauma directly causes a decreased growth; and 2) consider contributing factors and ways to decrease the incidence of trauma. RESULTS: Initial observations indicate that follicles demonstrate excellent growth, but reduced yields have been noted with less skilled technicians. It appears that graft injury is easily induced with micrografts. CONCLUSIONS: Our findings demonstrate that trauma may increase in direct proportion to the removal of dermis and subcutaneous tissue.

Circadian relationships between circulating atrial natriuretic peptides and serum calcium and phosphate in healthy humans.

Long-acting natriuretic peptide (LANP), vessel dilator (VSDL), and atrial natriuretic factor (ANF) consisting of amino acids (aa) 1 to 30, 31 to 67, and 99 to 126, respectively, of the 126-aa ANF prohormone circulate in humans. Among the biologic properties of these peptides is the ability of ANF to decrease intracellular calcium concentrations. To determine if atrial natriuretic peptides are directly related to serum calcium and/or phosphate in healthy normocalcemic humans, we examined 21 24-hour profiles of VSDL, LANP, ANF, and serum calcium and phosphate in 14 healthy humans. VSDL, LANP, and ANF each had significant (P < .001) circadian rhythms, with peak concentrations late during sleep (at 4:00 AM) being nearly twice the concentrations in the afternoon and evening. Serum calcium and phosphate also had significant circadian rhythms (P < .001) with troughs nearly opposite to those of the atrial natriuretic peptides, suggesting that atrial peptides may be important in the modulation of the circadian rhythms of calcium and phosphate. The nearly identical circadian rhythms of the atrial natriuretic peptides and of parathyroid hormone (PTH) reported by others, along with evidence that PTH may increase atrial peptide release, suggest that some of the effects attributed to PTH may be mediated by atrial natriuretic peptides.

Circadian relationships between circulating atrial natriuretic peptides and serum sodium and chloride in healthy humans.

Long-acting natriuretic peptide (LANP), vessel dilator (VSDL), and atrial natriuretic factor (ANF) consisting of amino acids 1-30, 31-67, and 99-126 of the 126 amino acid ANF prohormone, respectively, circulate in humans and have potent natriuretic properties. To determine whether these peptides have a direct relationship to serum Na and/or Cl, we examined 21 24-hour profiles of these peptides and Na and Cl in 14 healthy humans. LANP, VSDL, ANF, and Cl had significant (p < 0.001) circadian rhythms with peak concentrations at 04.00 h. The circadian rhythm of serum Na was exactly opposite. Sodium correlated negatively with LANP (p = 0.021) and ANF (p = 0.007), while Cl correlated positively with LANP (p = 0.003) and VSDL (p = 0.001). These data suggest that the atrial peptides may be important for the maintenance of serum Na and Cl within their normal ranges and in the modulation of their daily circadian rhythms.

Tratamiento de la anemia en niños sometidos a hemodiálisis crónica con eritropoyetina humana recombinante / Treatment of anemia in children submitted to chronic hemodialysis with recombinant human erythropoietin

En la insuficiencia renal crónica (IRC), la anemia es una de las complicaciones más frecuentes, ésta es de tipo hipoproliferativo y su principal causa es el déficit relativo de eritropoyetina. El tratamiento fue, hasta la obtención de eritropoyetina por métodos recombinantes (rHuEpo), las transfusiones y los estimulantes eritropoyéticos, como los andrógenos. Actualmente existen muchas evidencias clínicas de la utilidad de la rHuEpo en el tratamiento de la anemia de la IRC. La mayoría de estos ensayos clínicos fueron realizados en adultos y en ellos se mostró no sólo la mejoría de los datos hematimétricos, sino también de la calidad de vida. Este trabajo se realizó en 18 pacientes pediátricos que estaban sometidos a regímenes de hemodiálisis crónica. El objetivo del mismo fue demostrar la seguridad y eficacia de la rHuEpo en los niños durante un año de tratamiento. El 94,2 por ciento de los pacientes evaluados alcanzaron la tasa de hemoglobina que habíamos planeado (10 gr por ciento), el único paciente que no lo logró tenía fibrosis medular. Los efectos adversos fueron similares a los observados en la población de adultos siendo la exacerbación de la hipertensión arterial el más frecuente. En seis niños se evaluó la capacidad física post tratamiento, todos se demosntró una mejoría de los índices de eficiencia. Se concluye que la rHuEpo es efectiva y segura en niños con IRC y anemia aumentando el número de glóbulos rojos evitando las transfusiones y mejorando el rendimiento físico que se relaciona con mejoría en la calidad de vida (AU)

Tratamiento de la anemia en niños sometidos a hemodiálisis crónica con eritropoyetina humana recombinante / Treatment of anemia in children submitted to chronic hemodialysis with recombinant human erythropoietin

En la insuficiencia renal crónica (IRC), la anemia es una de las complicaciones más frecuentes, ésta es de tipo hipoproliferativo y su principal causa es el déficit relativo de eritropoyetina. El tratamiento fue, hasta la obtención de eritropoyetina por métodos recombinantes (rHuEpo), las transfusiones y los estimulantes eritropoyéticos, como los andrógenos. Actualmente existen muchas evidencias clínicas de la utilidad de la rHuEpo en el tratamiento de la anemia de la IRC. La mayoría de estos ensayos clínicos fueron realizados en adultos y en ellos se mostró no sólo la mejoría de los datos hematimétricos, sino también de la calidad de vida. Este trabajo se realizó en 18 pacientes pediátricos que estaban sometidos a regímenes de hemodiálisis crónica. El objetivo del mismo fue demostrar la seguridad y eficacia de la rHuEpo en los niños durante un año de tratamiento. El 94,2 por ciento de los pacientes evaluados alcanzaron la tasa de hemoglobina que habíamos planeado (10 gr por ciento), el único paciente que no lo logró tenía fibrosis medular. Los efectos adversos fueron similares a los observados en la población de adultos siendo la exacerbación de la hipertensión arterial el más frecuente. En seis niños se evaluó la capacidad física post tratamiento, todos se demosntró una mejoría de los índices de eficiencia. Se concluye que la rHuEpo es efectiva y segura en niños con IRC y anemia aumentando el número de glóbulos rojos evitando las transfusiones y mejorando el rendimiento físico que se relaciona con mejoría en la calidad de vida

[Treatment of anemia in children undergoing chronic hemodialysis with recombinant human erythropoietin]. / Tratamiento de la anemia en niños sometidos a hemodiálisis crónica con eritropoyetina humana recombinante.

Anemia associated to chronic renal failure (CRF) is a very frequent disorder. Twenty five per cent of adult patients under hemodialysis require periodical transfusions to maintain acceptable quality of life. This anemia is due mainly to a relative deficit of erythropoietin (EPO). Thanks to recombinant DNA techniques, EPO availability has made it possible to treat this population with the hormone. Most of the reported experience has been obtained from adult patients and literature on children is scarce. For this reason, a controlled prospective trial on 18 patients (9 males and 9 females) with a mean age of 12.4 years (range 7-17) was conducted, evaluating hematimetric response, safety of treatment and effect on quality of life after one year of treatment. Seventeen patients could be evaluated; mean follow-up was of 365 days (180-323). Treatment started with an administration scheme of 25 U/kg/dose, i.v. route, three times weekly, and dose was corrected according to the hematimetric response. Target hemoglobin was set in 10 g%. Mean dose required to reach target was 101.5 +/- 37.7 U/kg/dose (50-200) three times weekly and time elapsed was of 223.3 days (175-355). Only one patient did not achieve target hemoglobin value with the maximal dose planned (200 U/kg/dose). Bone marrow biopsy in this patient showed alpha widespread fibrosis secondary to hyperparathyroidism caused by CRF. Direct correlation was found between the required rHuEPO dose and basal levels of serum alkaline phosphatase (Table 2). Results obtained in status performance on six patients showed significant increase in all the variables under analysis (Table 4).(ABSTRACT TRUNCATED AT 250 WORDS)

Tratamiento de la anemia en niños sometidos a hemodiálisis crónica con eritropoyetina humana recombinante. / [Treatment of anemia in children undergoing chronic hemodialysis with recombinant human erythropoietin]

Anemia associated to chronic renal failure (CRF) is a very frequent disorder. Twenty five per cent of adult patients under hemodialysis require periodical transfusions to maintain acceptable quality of life. This anemia is due mainly to a relative deficit of erythropoietin (EPO). Thanks to recombinant DNA techniques, EPO availability has made it possible to treat this population with the hormone. Most of the reported experience has been obtained from adult patients and literature on children is scarce. For this reason, a controlled prospective trial on 18 patients (9 males and 9 females) with a mean age of 12.4 years (range 7-17) was conducted, evaluating hematimetric response, safety of treatment and effect on quality of life after one year of treatment. Seventeen patients could be evaluated; mean follow-up was of 365 days (180-323). Treatment started with an administration scheme of 25 U/kg/dose, i.v. route, three times weekly, and dose was corrected according to the hematimetric response. Target hemoglobin was set in 10 g

. Mean dose required to reach target was 101.5 +/- 37.7 U/kg/dose (50-200) three times weekly and time elapsed was of 223.3 days (175-355). Only one patient did not achieve target hemoglobin value with the maximal dose planned (200 U/kg/dose). Bone marrow biopsy in this patient showed alpha widespread fibrosis secondary to hyperparathyroidism caused by CRF. Direct correlation was found between the required rHuEPO dose and basal levels of serum alkaline phosphatase (Table 2). Results obtained in status performance on six patients showed significant increase in all the variables under analysis (Table 4).(ABSTRACT TRUNCATED AT 250 WORDS)

[Does aesthetic surgery form part of mainstream surgery or is it an entirely separate sector? Reflections and proposals for better protection of the public]. / La chirurgie esthétique est-elle une chirurgie à part entière ou une chirurgie entièrement à part? Réflexions et propositions pour une meilleure protection du public.

In contempt of the laws and regulations in force, several thousand unqualified practitioners carry out aesthetic surgery although only a mere few hundred are legally entitled to practice this surgical specialty. We are aware, in the present system which has no efficient control systems, that the public is no longer able to identify this small group of charlatans and incompetents. We call on massive concerted effort by the responsible public authorities to ensure that the general public receives the necessary protection. Amongst others, we demand that: The ministry of health, integrates all medical products and medical devices aimed at the aesthetic sector into the list of medical products and medical devices to marketing authorization (authorization de mise sur le marché--AMM) or to endorsement in compliance with the Huriet Law of 10.12.1988. The conseil national de l'ordre des medecins, (national council of doctors advisory board), ensures that the laws and regulations in force governing the value of diplomas, qualifications and competences are respected, be aware of the obsolescence of the general nature of the medical degree, inapplicable due to the efficiency and thus the dangerous nature of modern medicine. The ministry of justice, clearly defines the nature of the informed consent demanded from the patient prior to any therapeutic treatment, ensures the conditions required for legitimate compensation for prejudices caused by therapeutic risks, specifies the doctor's responsibility without malpractice conditions, be aware of the perverse effects caused by the abandonment of the obligation of means and its replacement by an obligation of results demanded from the doctor, to correct the unjust and anomalous situation which opposes the ten year responsibility of the medical product or medical devices manufacturer with the thirty year responsibility of the doctor using these products or equipment.

Surgically assisted rapid palatal expansion: an outpatient technique with long-term stability.

This study presents the results of surgically assisted rapid palatal expansion done on an outpatient basis in 19 patients with a mean age of 30 years. Postsurgical and postorthodontic evaluation (mean, 2.4 years) showed a mean relapse rate of 8.8% in the canine region, 1% in the premolar region, and 7.7% in the molar region. These results show that the surgical procedure is feasible on an outpatient basis and the technique, as outlined, yields a stable long-term result.