[Aplasia cutis congenita and antithyroid drugs during pregnancy: Case series and literature review]. / Aplasie cutanée congénitale et antithyroïdiens de synthèse au cours de la grossesse : série de cas et revue de la littérature.

BACKGROUND: Aplasia cutis congenita (ACC) following in utero exposure to antithyroid drugs such as methimazole/carbimazole (MTZ/CMZ) has been reported since 1972. Though currently included in MTZ/CMZ embryopathy, it remains poorly characterized and is little discussed. Having seen two cases within a short period of time, we carried out a literature review and searched the French pharmacovigilance database for notification of cases. PATIENTS AND METHODS: We performed a search of the literature in the Medline database using the following keywords: "aplasia cutis congenita", "birth skin defects", "pregnancy" and "drug". All articles reporting cases of ACC following in utero exposure to antithyroid drugs were included. All cases of ACC under antithyroid drugs reported to French pharmacovigilance centres were analysed. RESULTS: Three hundred and sixty-eight articles were retrieved and 31 were analysed, including a further 4, mentioned in selected articles, giving 59 cases of ACC under MTZ/CMZ reported in the literature and having an intrinsic accountability score of plausible or dubious. ACC was typically isolated, single, small in size, and localised on the median scalp area. Exposure occurred in the first weeks of gestation. There were 6 familial cases involving siblings. Ten ACC and MTZ/CMZ cases were reported to pharmacovigilance centres in France. DISCUSSION: Practitioners should be aware of ACC following MTZ/CMZ exposure in utero, whether it occurs in isolation or not. It is likely a teratogenic effect of MTZ/CMZ enhanced by a genetic predisposition.

[Free fasciocutaneous parascapular flap. Coverage of extensive skin and soft tissue defects]. / Freie fasziokutane Paraskapularlappenplastik. Deckung ausgedehnter Haut-Weichteil-Defekte.

Coverage of extensive tissue defects is one of the tasks of plastic surgery. For the surgeon there are a series of possibilities differing in safety level and difficulty. With extensively exposed bones, however, there is mostly the indication for free tissue transfer. In the following case a possibility of wound closure of an extensive defect by one single free flap without preconditioning the tissue is demonstrated.

Evaluation of candidate spermatogonial markers ID4 and GPR125 in testes of adult human cadaveric organ donors.

The optimal markers for human spermatogonial stem cells (SSCs) are not known. Among the genes recently linked to SSCs in mice and other animals are the basic helix-loop-helix transcription factor ID4 and the orphan G-protein-coupled receptor GPR125. While ID4 and GPR125 are considered putative markers for SSCs, they have not been evaluated for coexpression in human tissue. Furthermore, neither the size nor the character of the human spermatogonial populations that express ID4 and GPR125, respectively, are known. A major barrier to addressing these questions is the availability of healthy adult testis tissue from donors with no known reproductive health problems. To overcome this obstacle, we have employed healthy testicular tissue from a novel set of organ donors (n = 16; aged 17-68 years) who were undergoing post-mortem clinical organ procurement. Using immunolabelling, we found that ID4 and GPR125 are expressed on partially overlapping spermatogonial populations and are more broadly expressed in the normal adult human testis. In addition, we found that expression of ID4 remained stable during ageing. These findings suggest that ID4 and GPR125 could be efficacious for identifying previously unrecognized human spermatogonial subpopulations in conjunction with other putative human stem cell markers, both in younger and older donors.

Robustness and optimal use of design principles of arthropod exoskeletons studied by ab initio-based multiscale simulations.

Recently, we proposed a hierarchical model for the elastic properties of mineralized lobster cuticle using (i) ab initio calculations for the chitin properties and (ii) hierarchical homogenization performed in a bottom-up order through all length scales. It has been found that the cuticle possesses nearly extremal, excellent mechanical properties in terms of stiffness that strongly depend on the overall mineral content and the specific microstructure of the mineral-protein matrix. In this study, we investigated how the overall cuticle properties changed when there are significant variations in the properties of the constituents (chitin, amorphous calcium carbonate (ACC), proteins), and the volume fractions of key structural elements such as chitin-protein fibers. It was found that the cuticle performance is very robust with respect to variations in the elastic properties of chitin and fiber proteins at a lower hierarchy level. At higher structural levels, variations of design parameters such as the volume fraction of the chitin-protein fibers have a significant influence on the cuticle performance. Furthermore, we observed that among the possible variations in the cuticle ingredients and volume fractions, the experimental data reflect an optimal use of the structural variations regarding the best possible performance for a given composition due to the smart hierarchical organization of the cuticle design.

Influence of microstructure on deformation anisotropy of mineralized cuticle from the lobster Homarus americanus.

The exoskeleton of the American lobster Homarus americanus is a hierarchically organized nano-composite material consisting of organic chitin-protein fibers associated with inorganic calcium carbonate. The presence of a well-developed and periodically arranged pore canal system leads to a honeycomb-like structure. The concomitant presence of the twisted plywood arrangement of the mineralized chitin-protein fibers alters the elastic properties, the deformation behavior, and fracture behavior compared to classical honeycomb structures. By performing compression tests in various directions of the cuticle we examined the anisotropic elastic-plastic deformation and fracture behavior of mineralized parts of the exoskeleton. By applying digital image correlation during compression testing, the evolution of the elastic-plastic deformation at the microscopic scale was observed with high resolution and simultaneously global stress and strain data were acquired. Shear tests were performed in order to determine the fracture energy for different shear planes and directions. The investigation of the microstructure after plastic deformation revealed the underlying deformation mechanisms of lobster endocuticle from the claws under different loading conditions. For evaluating the effect of hydration the samples were tested both in the dry and in the wet state.

[Pneumatic tube net conveying systems in the hospital environment]. / Systèmes de transport par réseaux de pneumatiques en milieu hospitalier.

The primary aim for having recourse to a pneumatic tube net to convey blood samples, is to shorten the turn around time in which transport delay is the major issue: this represents the logical answer to this question, as opposed to point of care testing. It also permits saving in transport personnel. It is of the highest importance of having recourse only to a high quality equipment (robust, reliable) likely to face the heavy workload occurring in a hospital environment, avoiding the use of light structures primarily designed for cash remittance. Implanting such a net in newly constructed structures is generally easy, while connecting the net into old buildings might meet some space limiting difficulties. Detailed prior planning of the network is a major issue for success.

Experimental investigation of the elastic-plastic deformation of mineralized lobster cuticle by digital image correlation.

This study presents a novel experimental approach to the characterization of the deformation of a mineralized biological composite using arthropod cuticle as a model material. By performing tensile tests combined with a detailed strain analysis via digital image correlation, the elastic-plastic deformation behavior of the endocuticle of the American lobster Homarus americanus is examined. The test specimens originate from the pincher and crusher claws. For evaluating the effect of moisture on the deformation behavior, the samples are tested both in dry and in wet state. Sample characterization using the digital image correlation method requires a stochastic spot pattern on the sample surface. Digital images are then taken at subsequent deformation stages during the mechanical test. These images are used to calculate the displacement, the displacement gradient, and the strain fields via pattern correlation. The method is applied both, at a global scale to measure with high precision the stress-strain behavior of the bulk cuticle and at a microscopic scale to reveal strain heterogeneity, strain patterning, and strain localization phenomena.

Sex-specific fetal weight prediction by ultrasound.

OBJECTIVE: To improve sonographic birth-weight prediction by developing fetal gender-specific formulae. METHODS: This was a retrospective cross-sectional study. Two gender-specific formulae were produced from the data of 527 patients and the data of a further 349 patients were used to evaluate the formulae. Inclusion criteria were a singleton live fetus, gestational age above 25 weeks, birth weight between 1000 g and 4500 g and fetal biometry within 8 days of delivery. Data retrieval was specifically for the purpose of this study. RESULTS: To yield the best-fit weight formula for each fetal gender we employed step-wise regression analysis based on fractional polynomials with the biometric parameters biparietal diameter (BPD), head circumference (HC), transverse abdominal diameter (TAD), abdominal circumference (AC) and femur length (FL): estimated fetal weight for girls (g) = - 4035.275 + 1.143 x BPD3 + 1159.878 x AC1/2 + 10.079 x FL3 - 81.277 x FL2 [in cm]; estimated fetal weight for boys (g) = 43576.579 + 1913.853 x log10BPD + 0.01323 x HC3 + 55.532 x AC2 - 13602.664 x AC1/2 - 0.721 x AC3 + 2.31 x FL3 [in cm]. These formulae showed superior results compared with those of conventional weight formulae. CONCLUSION: Gender-related fetal weight calculation allows optimized prediction of fetal weight at birth.

[Performance limiting causes in single use unit systems for the measurement of PO2 and PCO2 in blood]. / Facteurs de limitation des performances des appareils a cassettes a usage unique pour la mesure de la PO2 et de la PCO2 du sang total.

Having had the opportunity of testing two of the three commercially available single use unit systems (i-STAT and OPTI-1), we have listed a series of performance limiting factors which they share, even though, their detectors being based on different methodologies, they have specific causes of dysfunction. PO2 detectors face the worse problems for different reasons. Temperature control is critical: the cassette or at last the detectors, the internal solution and the specimen have to be heated to 37 C, thermostabilisation to one tenth of degree centigrade is a must. Gas equilibration between liquid phases, the outside ambiance and the plastic material can raise problems: a decrease of the external barometric pressure alters the result, an absence of oxygen buffer capacity can induce modifications of the PO2 in the solutions. The transition of the detectors from a dry to a wet stage can provoke changes of the final result in case of accidental pre-humidication of the cassette. The presence of a single internal solution generates problems linked to a single point calibrage procedure which is a source of variability. The general quality of the cassette can only be evaluated by numerous internal electronic checks: increasing the severity of the controls improves quality but increases the number of rejected cassettes. External quality control through classical procedures are not applicable and finally the quality of the cassettes depends primarily on rigorous manufacturing conditions.

[Analytical performances of the i-STAT portable clinical analyzer for the measurement of PO2 and PCO2]. / Evaluation des performances analytiques du i-STAT portable clinical analyzer pour la détermination des pressions partielles d'oxygène et de gaz carbonique dans le sang total.

Aware of some limitations on blood gas results, we performed an extensive evaluation before introducing i-STATs in our hospitals. Three i-STATs were tested in parallel with an ABL-520, on three types of cartridges (EG7, EG6 and EG3), using tonometered whole blood (9 gas levels, n = 720) and aqueous QC solutions (3 levels, n = 600). Reference systems were the theoretical calculated values from gas composition used for tonometry and results given by the ABL-520, respectively. On aqueous controls dispersion intervals reached 10-20 mmHg for both analytes for inter-lot as well as intra-lot data. PO2 values on blood showed marked dispersion: 5 mmHg (CV = 2 to 7%) at clinically critical levels. PCO2 showed several (10%) major outliers: mV recording of the PCO2 electrode allowed to incriminate a pre-humidification problem (due to incorrect shipping conditions). Once outliers have been discarted, there still was a 5 mmHg non negligible residual dispersion (CV = 3 to 5%). i-STAT analytical performances for blood gases which are the analytes whose determination at the bed-side is potentially the most useful, do not match capabilities of classical laboratory instruments. Thus even though the i-STAT approach represents a seducive solution for the STAT problem, for the moment, it's use cannot be recommended in a hospital environment where classical instruments can be made available.

Health care providers' missed opportunities for preventing femicide.

BACKGROUND: Homicide of women (femicide) by intimate partners is the most serious form of violence against women. The purpose of this analysis of a larger multisite study was to describe health care use in the year prior to murder of women by their intimate partner in order to identify opportunities for intervention to prevent femicide. METHODS: A sample of femicide cases was identified from police or medical examiner records. Participants (n = 311) were proxy informants (most often female family members) of victims of intimate partner femicide from 11 U.S. cities. Information about prior domestic abuse and use of health care and other helping agencies for victims and perpetrators was obtained during structured telephone interviews. RESULTS: Most victims had been abused by their partners (66%) and had used health care agencies for either injury or physical or mental health problems (41%). Among women who had been pregnant during the relationship, 23% were beaten by partners during pregnancy. Among perpetrators with fair or poor physical health, 53% had contact with physicians and 15% with fair or poor mental health had seen a doctor about their mental health problem. Among perpetrators with substance problems, 5.4% had used alcohol treatment programs and 5.7% had used drug treatment programs. CONCLUSIONS: Frequent contacts with helping agencies by victims and perpetrators represent opportunities for the prevention of femicide by health care providers.

Spatiotemporal self-organization in a surface reaction: from the atomic to the mesoscopic scale.

Scanning tunneling microscopy data revealed the atomic processes in propagating reaction fronts that occur in the catalytic oxidation of hydrogen on Pt(111). The fronts were also characterized on mesoscopic length scales with respect to their velocity and width. Simulations on the basis of a reaction-diffusion model reproduce the experimental findings qualitatively well. The quantitative comparison reveals the limitations of this traditional approach to modeling spatiotemporal pattern formation in nonlinear dynamics.

Reliability of bimanual pelvic examinations performed in emergency departments.

OBJECTIVE: To test the reliability of bimanual pelvic examinations performed in emergency departments by emergency medicine physicians. DESIGN: Prospective observational study; 2 examiners each recorded various pelvic examination findings on 186 patients. SETTING: A private university hospital and a public county hospital staffed by attending emergency medicine physicians who share an emergency medicine residency program. SUBJECTS: Senior resident (3rd or 4th year) and attending emergency physicians. MAIN OUTCOME MEASURES: Percentage of agreement and percentage of positive agreement for cervical motion tenderness, uterine tenderness, adnexal tenderness, adnexal mass, and uterine size (within 2 cm). RESULTS: The agreement ranged between 71% and 84%, but the percentage of positive agreement was much lower, ranging from 17% to 33%. Agreement for uterine size, within 2 cm, was 60%. CONCLUSION: The findings of bimanual pelvic examinations performed by emergency physicians in an emergency department have poor interexaminer reliability.

Recommendations for measurement of and conventions for reporting sodium and potassium by ion-selective electrodes in undiluted serum, plasma or whole blood. International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). IFCC Scientific Division Working Group on Selective Electrodes.

Ion-selective electrodes (ISEs) respond to ion-activity and therefore do not sense substance concentration directly. However, it is recognized that sodium and potassium in plasma will continue to be expressed for clinical purposes in terms of substance concentration (mmol/l). A convention is proposed whereby for routine clinical purposes results of ISE measurements of sodium and potassium in undiluted plasma should be reported in terms of substance concentration (mmol/l). In specimens with normal concentrations of plasma water, total CO2, lipids, protein and pH, the values will concur with the total substance concentration as determined for example by flame atomic emission spectrometry (FAES) or ISE measurements on diluted samples. In specimens with abnormal concentrations of plasma water, the results will differ. However, under these circumstances, measurements of sodium and potassium by ISE in the undiluted sample will more appropriately reflect the activity of sodium and potassium and are therefore clinically more relevant than the determination in diluted samples. Detailed recommendations are made about practical procedures to achieve this. The recommended name for this quantity is the substance concentration of ionized sodium or ionized potassium in plasma, as opposed to total sodium or total potassium determined by, e.g. FAES, or ISE measurements on diluted samples.