Separation of congenital embryonic syndactylies in children: dorsal or volar flap? About a comparative retrospective series.

Congenital syndactylies account for 1 to 2 out of 2000 birth defects. Although several types of syndactylies exist, we only studied embryonic syndactylies. The goal of our study was to compare 2 types of coverage flap for the reconstruction of the finger web spaces: a volar flap described by Blauth and a dorsal flap described by Gilbert. Between 1993 and 2015, children affected by simple and complex syndactylies (partial or complete) were treated in 2 french pediatric hospitals and were selected for our analytic, comparative, retrospective review. The 2 hospitals used different surgical techniques: one used a volar flap described by Blauth and the other a dorsal flap described by Gilbert. The children were followed up to look for signs according to the stages of the Classification of Withey and to evaluate a global result according to the score of Withey. Our secondary criteria of judgement were the aspect of the surgical scar according to the VSS (Vancouver Scar Scale) and the satisfaction of the parents and children. The age of the children, need for a surgical revision and time of last follow- up were also studied. We found statistically significant differences between group I (volar flap) and group II (dorsal flap) in favor of the volar flap: higher scores of Withey (even when the number of commissures was increasing) and better VSS (regardless of the number of web spaces treated). There was no statistically significant difference between the 2 groups in terms of age, follow-up, or rate of surgical revision. All in all, the volar flap presented less sequelae in terms of scar retraction. Regardless of the flap used, the cosmetic results of the full-thickness skin graft used impacted the result both on the receiving site (dyschromia, hairiness) and the donor site.

Technical feasibility of robot-assisted minimally-invasive neurolysis of the lateral cutaneous nerve of thigh: About a case.

To limit the risk of iatrogenic neuroma and recurrence after surgical treatment of meralgia paresthetica, some authors have recently developed a technique of endoscopic neurolysis of the lateral cutaneous nerve of thigh (LCNT) below the level of the inguinal ligament. We report the case of a robot-assisted endoscopic technique underneath the inguinal ligament. A 62-year-old patient suffering of idiopathic meralgia paresthetica for the past 18 months received a Da Vinci robot-assisted minimally-invasive 10cm long neurolysis, of which 1/3 was situated above the level of the inguinal ligament and 2/3 below it. The patient was discharged the following day without complications. At 6-months follow-up the pain was rated 0/10 compared to 5/10 pre-operatively. Robot-assisted endoscopic neurolysis of the LCNT retains the advantages of conventional endoscopy and enables to approach the nerve in the most frequently compressed zone underneath the inguinal ligament. The three-dimensional view offered by robotic surgery facilitates the dissection. The superiority of this technique remains to be demonstrated by comparing it to conventional techniques.

The effect of a passive stretch training protocol on performance during a drop jump in humans.

AIM: Our study's aim is to show how a five-week stretch training protocol, based on passive stretching, can change muscle performance during a drop jump (stretch shortening cycle). METHODS: This study observes in 8 healthy subjects (four males and four females), the effect of a 5-week passive stretch training protocol on the stretch shortening cycle (SSC) during the performance of a drop jump, and identify the architectural changes in the muscle. Subjects underwent measurements of their drop jump performance 3 times before, and 3 times after, the stretch training protocol. For the muscle tendon unit (MTU), changes were measured using the Hawkins and Hull's model. In order to calculate the length changes in the MTU, we measured the ankle and knee angles. For changes in the fascicle, the pennation angle and the thickness of the gastrocnemius medialis (GM) muscle were measured. RESULTS: After the 5-week stretch training protocol, a significant increase in flexibility was observed in the fascicle during the first phase of the jump (a shortening of 10% after training vs. 20% before). No significant change was observed in the tendon, while the MTU showed a highly significant improvement (P<0.01) in muscle compliance during the landing phase. The average performance during the drop jump also showed a highly significant change (P<0.01). CONCLUSION: The results show a higher degree of flexibility in the MTU, enabled the latter to store more energy which was then converted to kinetic energy during the push-off phase of the drop jump.

Development of an optimized procedure for the preparation of rat intestinal microsomes: comparison of hepatic and intestinal microsomal cytochrome P450 enzyme activities in two rat strains.

The objective of this study was to characterize cytochrome P450 (CYP) activities in both intestinal and hepatic microsomes from Wistar and Sprague-Dawley rats. Specific probes for measuring CYP activities were selected using rat recombinant CYP. The intestinal microsome preparation was optimized getting a more relevant and reproducible abundance of CYPs to measure CYP activities. Testosterone, propranolol, diclofenac, and midazolam were determined as specific substrates of rat CYP2C11, CYP2D2, CYP2C6, and CYP3A, respectively. Ethoxyresorufin and pentoxyresorufin were not specific substrates of CYP1A2 and CYP2B1, respectively. Hepatic and intestinal microsomes expressed active CYP1A1, CYP1A2, CYP2B1, and CYP3A2. Only liver expressed active CYP2C6, CYP2C11, and CYP2D2. Wistar liver expressed more active CYP1A and CYP3A2, but less active CYP2B1 than Wistar intestine. Sprague-Dawley liver expressed more active CYP2B1 and CYP3A2, but less active CYP1A than Sprague-Dawley intestine. In conclusion, CYP activities were qualitatively equivalent but not quantitatively in both strains.

DNA of some anaerobic rumen fungi: G + C content determination.

The nuclear DNAs from five species of anaerobic rumen fungi have been isolated and purified by means of two extraction methods (with and without 8 M urea). Their G + C contents have been characterized by the thermal denaturation procedure of Marmur and Doty. As has already been shown in Neocallimastix frontalis, the results obtained by the two techniques demonstrated a very low G + C content (less than 20%) and the constant presence of satellite DNA.

Gamma-carboxyglutamic acid in urine of newborn infants.

Gamma-Carboxyglutamic acid (GLA) was measured in the urines obtained from 11 full-term infants, 48 pre-term infants appropriate for gestational age (AGA), and 25 small-for-gestational age (SGA) infants. Separation was performed by high resolution anion exchange chromatography. The results were similar in both AGA and SGA infants. During the first 3 days of life, urinary GLA mean (and range) was 1.66 (0.34-4.60) in the low birth weight infants versus 0.88 (0.26-1.38) in the full-term infants and 0.76 (0.62-1.15) mumol . kg-1 X 24 h-1 in the control adults. In the low birth weight infants, urinary GLA fell from 2.79 (0.61-5.75) at age 1-3 days, to 1.55 (0.26-4.04) mumol/24 h at day 8 (p less than 0.01); it then rose again slowly to 2.12 (0.65-3.93) mumol/24 h at day 45. In these infants there was no correlation between urinary GLA excretion and birth weight or gestational age, or urinary hydroxyproline or serum alkaline phosphatase. Despite the well-known reduced blood levels of vitamin K dependent coagulation factors in neonates, these results show that urinary GLA excretion is at least similar to the excretion in adults. These data suggest that these neonates can carboxylate glutamic acid and that the newborn infant has a high bone turnover.

An evaluation of the mutagenic, carcinogenic and teratogenic potential of microwaves.

A notable proportion of the population is exposed to an increasing number of devices emitting microwaves, a form of non-ionizing electromagnetic radiation in the range 300-30000 mHz. The activation energy of microwave radiations is too small to directly modify any chemical bonds in the irradiated matter. At microwave frequencies the macroscopic dielectric properties of tissues are strongly determined by their water content. Tissues like muscle, brain, skin, with a high water content, have higher permittivity and conductivity values than bone or fat with low water contents. Owing to the energy transfer, to living tissues, by a dipolar relaxation mechanism of water molecules, the penetration of microwaves is limited and one observes a fast and very efficient heat-loss production. A review of the available literature shows that most results on the mutagenicity of microwaves are negative or can often be explained by a temperature enhancement. If microwaves are apparently unable to damage DNA at sub-thermal exposure levels, some results indicate, however, that they might easily potentiate the damaging action of other DNA antagonist agents such as UV or chemicals.

[Are there risk factors for pure systolic hypertension?]. / Existe-t-il des facteurs de risque de l'hypertension systolique pure?

Pure systolic hypertension (PSH) is mainly observed in subjects over 60 years of age, and it is always due to a loss of compliance of the greater arteries. Blood pressure itself is partly responsible for loss of compliance, but other factors have been suggested. We have investigated this matter in a study of 3,388 subjects aged from 20 to 69 years. In a first stage, PSH patients (systolic BP greater than or equal to 160; diastolic BP less than 95 mmHg), aged from 50 to 59 years, were compared with normotensive subjects (systolic BP less than 140; diastolic BP less than 95 mmHg) and with other types of hypertensive patients with regard to cigarette smoking, alcohol consumption, obesity and plasma cholesterol, triglycerides, gamma-GT, glucose and uric acid levels. Several of these variables were significantly higher in all hypertensive patients than in normotensive subjects, but cigarette smoking and gamma-GT levels were predominantly or exclusively higher in PSH patients. In a second stage, correlations between differential BP and the variables listed above were studied in subjects with two levels of diastolic BP: 70-79 and 80-89 mmHg, thus taking into account all degrees between normal BP and PSH proper. Weakly positive correlations were found with alcohol consumption, plasma gamma-GT and glucose levels, and with percentages of smokers or ex-smokers. It is therefore conceivable that in addition to BP itself other factors, such as alcohol consumption, cigarette smoking and hyperglycaemia, contribute to the loss of arterial compliance progressively leading to pure systolic hypertension.

[Cancer of the thyroid in children. 14 cases]. / Le cancer du corps thyroïde chez l'enfant. Quatorze observations.

Fourteen cases of thyroid gland carcinoma in children (mean age: 10 years) were reviewed. Scintigraphy showed a cold nodule in 10 and diffuse heterogeneous uptake indicating undifferentiated carcinoma in 3. The clinical risk of these tumours resides in alterations of the thyroid gland and in lymph node involvement. The favourable long-term prognosis in children justifies a conservative surgical treatment. Pulmonary metastases respond well to radioactive iodine. TSH secretion must be completely suppressed by continuous hormonal treatment. Anticancerous irradiation is fraught with potential dangers.

[Serum ferritin in premature infants]. / Ferritine sérique chez le prématuré.

This study was carried out in twenty-two newborn of birthweight lower than 2 000 g at four and six weeks to determine normal values of serum ferritin in preterm infants and pathological factors who influenced this evolution. Serum ferritin was measured by a kit using a sandwich radioimmunometric method. Elevated values are found in the series of fifteen preterm infants without pathology, with a decreasing evolution. There is no difference in median values at four (266 +/- 91 ng/ml) and six (279 +/- 162) weeks. There is no correlation between serum ferritin values and gestational age nor with hemoglobin values. Serum ferritin values are elevated by inflammatory pathology, blood transfusions and in this case no represent stain pool.

[Neonatal ulcero-necrotizing enterocolitis and aspergillosis]. / Entérocolite ulcéro-nécrotique néonatale et aspergillose.

A preterm infant of 33 weeks of gestation and very small birthweight 1040 g developed on the third day of life a necrotizing enterocolitis with spontaneous perforation. Peritoneal fluid and small bowel meconium was cultured and revealed Aspergillus Niger. The literature is reviewed with seven cases of aspergillosis in newborn period. The infant is dead on the tenth day of life from periventricular haemorrhage. Necropsy was performed and revealed no secondary aspergillosis localisation.

Nutrition, general health status and oral health status in hospitalised elders.

Biological malnutrition was assessed and correlated with salivary flow rates and oral health in 99 elderly, hospitalised non-psychiatric patients. The indicators of protein malnutrition used were arm circumference and serum albumin level and the indicators of energy malnutrition the body mass-index and the triceps skin-fold thickness. Unstimulated and stimulated salivary flow rates were measured according to Sreebny et al. Of the patients, 40% showed severely and 46% moderately reduced serum albumin levels and the anthropometric measurements indicated malnutrition in about 50%. Unstimulated hyposialia (< or = 0.1 ml/min) and stimulated hyposialia (< or = 0.5 ml/min) were observed in 17% and 26.5%, respectively. Significant associations (P < or = 0.05) were found between stimulated/unstimulated hyposialia and biological malnutrition. There was a negative relationship between the number of masticatory movements until swallowing a standard biscuit and skin fold thickness (P < or = 0.05). Current weight loss and biological malnutrition were related to poor appetite (P < or = 0.05). The study has confirmed poor general and oral health status as well as protein-energy malnutrition among elderly hospitalised patients. This situation was associated with loss of appetite, reduced salivary flow rates and a certain impairment of masticatory function which could jeopardise the reversibility of malnutrition and lead to increased morbidity and mortality.

Frequent homologous recombination events between molecules of one RNA component in a multipartite RNA virus.

Brome mosaic bromovirus (BMV), a tripartite plus-sense RNA virus, has been used as a model system to study homologous RNA recombination among molecules of the same RNA component. Pairs of BMV RNA3 variants carrying marker mutations at different locations were coinoculated on a local lesion host, and the progeny RNA3 in a large number of lesions was analyzed. The majority of doubly infected lesions accumulated the RNA3 recombinants. The distribution of the recombinant types was relatively even, indicating that both RNA3 counterparts could serve as donor or as acceptor molecules. The frequency of crossovers between one pair of RNA3 variants, which possessed closely located markers, was similar to that of another pair of RNA3 variants with more distant markers, suggesting the existence of an internal recombination hot spot. The majority of crossovers were precise, but some recombinants had minor sequence modifications, possibly marking the sites of imprecise homologous crossovers. Our results suggest discontinuous RNA replication, with the replicase changing among the homologous RNA templates and generating RNA diversity. This approach can be easily extended to other RNA viruses for identification of homologous recombination hot spots.

Associations between malnutrition, poor general health and oral dryness in hospitalized elderly patients.

OBJECTIVE: To obtain information about the possible relationship between symptoms and signs of oral dryness and malnutrition/poor general health in hospitalized older people. DESIGN: A cross-sectional clinical investigation with measurements of unstimulated salivary flow rates (USFR), stimulated salivary flow rates (SSFR), nutritional status, serum albumin concentration and an evaluation of symptoms of oral dryness and loss of appetite by a questionnaire. SUBJECTS AND METHODS: A cohort of 99 elderly, non-psychiatric patients hospitalized for medical reasons; collection of demographic and health data from medical files, collection of USFR and SSFR, measurements of body mass index (BMI), lean body mass, fat body mass, serum album in concentration; completion of a questionnaire related to symptoms of oral dryness and the patients' appreciation of their nutritional status. MAIN OUTCOME MEASURES: SSFR and USFR. RESULTS: Mean age of the 99 patients was 82.5 +/- 4.0 years. Anthropometric examinations indicated malnutrition of severe or intermediate degree in about 50% while 46% showed moderately and 40% severely reduced albumin. Loss of appetite was present in 54% and 51% complained of oral dryness; 17% had an USFR <0.1 ml/min and 26% a SSFR <0.5 ml/min. Significant associations were found between (i) reduced salivary flow rate, malnutrition and reduced serum albumin concentration, (ii) recent loss of appetite and low serum album in concentration and (iii)complaints of oral dryness and reduced salivary flow rates. There were also significant associations between complaints of oral dryness, loss of appetite and low BMI. CONCLUSION: Reduced salivary secretion and complaints of oral dryness could be signs of poor nutritional or general health status of elderly patients. Reduced salivary secretion and feeling of oral dryness could have a negative effect on alimentation, appetite and oral comfort.

RNA recombination in brome mosaic virus: effects of strand-specific stem-loop inserts.

A model system of a single-stranded trisegment Brome mosaic bromovirus (BMV) was used to analyze the mechanism of homologous RNA recombination. Elements capable of forming strand-specific stem-loop structures were inserted at the modified 3' noncoding regions of BMV RNA3 and RNA2 in either positive or negative orientations, and various combinations of parental RNAs were tested for patterns of the accumulating recombinant RNA3 components. The structured negative-strand stem-loops that were inserted in both RNA3 and RNA2 reduced the accumulation of RNA3-RNA2 recombinants to a much higher extent than those in positive strands or the unstructured stem-loop inserts in either positive or negative strands. The use of only one parental RNA carrying the stem-loop insert reduced the accumulation of RNA3-RNA2 recombinants even further, but only when the stem-loops were in negative strands of RNA2. We assume that the presence of a stable stem-loop downstream of the landing site on the acceptor strand (negative RNA2) hampers the reattachment and reinitiation processes. Besides RNA3-RNA2 recombinants, the accumulation of nontargeted RNA3-RNA1 and RNA3-RNA3 recombinants were observed. Our results provide experimental evidence that homologous recombination between BMV RNAs more likely occurs during positive- rather than negative-strand synthesis.