Translating the combination of gene therapy and tissue engineering for treating recessive dystrophic epidermolysis bullosa.

The combination of gene therapy and tissue engineering is one of the most promising strategies for the treatment of recessive dystrophic epidermolysis bullosa (RDEB). RDEB is a rare genetic disease characterised by mutations in the COL7A1 gene, encoding type VII collagen (COLVII), which forms anchoring fibrils at the dermal-epidermal junction of the skin. This disease causes severe blistering and only palliative treatments are offered. In this study, the base of a strategy combining gene therapy and a tissue-engineered skin substitute (TES), which would be suitable for the permanent closure of skin wounds, was set-up. As a high transduction efficiency into fibroblasts and/or keratinocytes seems to be a prerequisite for a robust and sustained correction of RDEB, different envelope pseudotyped retroviral vectors and the transduction enhancer EF-C were tested. When green fluorescent protein (GFP) was used as a reporter gene to evaluate the retroviral-mediated gene transfer, the fibroblast infection efficiency was 30 % higher with the Ampho pseudotyped vector as compared with the other pseudotypes. At least a 3.1-fold and a 1.3-fold increased transduction were obtained in fibroblasts and keratinocytes, respectively, with EF-C as compared with polybrene. A continuous and intense deposit of haemagglutinin (HA)-COLVII was observed at the dermal-epidermal junction of self-assembled TESs made of cells transduced with a HA-tagged COL7A1 vector. Furthermore, HA-tagged basal epidermal cells expressing keratin 19 were observed in TESs, suggesting stem cell transduction. This approach could be a valuable therapeutic option to further develop, in order to improve the long-term life quality of RDEB patients.

Fatal case of multiple liver abscesses caused by adult Ascaris lumbricoides.

The present report describes a recent fatal case of multiple liver abscesses caused by adult Ascaris lumbricoides in a 21-month-old child. Most abscesses contained a large number of adult worms and one ruptured into the peritoneal cavity, causing purulent peritonitis.

[Managing adolescent and adult victims of extra-familial rape soon after aggression]. / Prise en charge des adolescents et des adultes victimes de viols extra-familiaux dans les suites récentes de leur agression.

Rape victims often experience severe and prolonged symptoms in the aftermath of the assault. Psychological assistance offered rapidly after the assault should mitigate the intensity and moderate the duration of rape-related problems. This paper tried to identify the widely-accepted therapeutic approaches from a review of the current literature; it has its roots in the clinical experience acquired by our mobile crisis service in this type of situation, too. The goal of the following practices concerning the victim and the victim's immediate family is to assist the victim to reclaim control as quickly as possible over what has happened and to return to a normal functioning. The therapist should adopt an empathetic attitude, actively and instructively, even more so, and in an even more flexible way than for other patients. Knowledge of one's potential reactions to that kind of situation is useful since the counter-transference is here particularly intense. Doubting the patient's word is part of these negative reactions and must be avoided. It is better to respect the victim's feelings of guilt in the first instance. The relating of the facts, despite its cathartic value, should not be imposed on the patient. It should be noted that these last two points are controversial. It is also important to give information, during interviews, about the symptoms which can occur, the defence mechanisms that the individual sets up for just such occasions and on the most common difficulties encountered in personal relationships. In particular, the therapist must verify that concrete measures are taken to protect the victim against another attack. As far as the immediate family is concerned, it seems particularly important to involve them and, better still, meet them. Their reaction to the rape has a determining influence on the victim's capacity to cope with the trauma and its consequences. On the one hand, the immediate family should be helped in giving support to the victim by telling them all the details of what the patient could suffer, their potential reaction towards the victim and the victim's potential reactions towards them. The question of security must also be brought up with the family, in particular the risk of suicide which can be great. On the other hand, it is important to meet the family to give them support because they too may have difficulty in coming to terms with the violence of the aggression and its consequences. These approaches are up to now the only guidelines available since no psychotherapeutic technique (based on controlled studies) has proved to be more efficient than another and since the clinical experience of the authors are leading them to opposite therapeutic options. Different psychotherapeutic techniques are recommended: short therapies such as cognitive-behavioural therapies or hypnosis, or longer ones such as psychoanalytic psychotherapy. Several of these different options, to which must be added physical techniques like relaxation and medication, are often used simultaneously and/or in succession. As for drug treatments no controlled study conducted with this population has proved their efficiency on post-traumatic stress disorder. According to us they are essentially useful in order to diminish the intensity of the symptoms of anxiety.

Tiroidite cronica: avaliacao clinica e laboratorial de 50 casos com especial referencia a puncao biopsia aspirativa com agulha fina. / Chronic thyroiditis: clinical and laboratorial evaluation of 50 cases with special reference to fine-needle aspiration biopsy

Os autores analisam as caracteristicas clinicas e laboratoriais, com especial enfase a citologia por biopsia aspirativa com agulha fina, em 50 pacientes portadores de tiroidite cronica. A incidencia de tiroidite cronica foi maior no sexo feminino e no grupo de bocio difuso. A cintilografia mostrou hipocaptacao difusa em 52,63% dos casos, bem como os anticorpos positivos em mais de 47%. Com base nos resultados citologicos, afirmam ser a tiroidite cronica a causa mais frequente de hipotiroidismo (50,40%), sendo a do tipo Hashimoto a de maior prevalencia. Sugerem a importancia da citologia no diagnostico diferencial de tiroidite cronica e neoplasias malignas. Enfatizam, finalmente, a biopsia aspirativa com agulha fina tecnica de facil execucao e a citologia, metodo seguro e adicional para o estudo das tiroidites, contribuindo substancialmente para deteccao e diagnostico de tiroidite cronica em seu estadio precoce