Sebum rheology evaluated by two methods in vivo. Split-face study of the effect of a cosmetic formulation

Modulation of the rheological characteristics of sebum at the surface of the skin might represent a valuable strategy for the treatment of seborrhea. In this field, only a small number of studies have addressed sebum diffusion within the stratum corneum. In an open, split-face study conducted on 20 men, we measured the sebosuppressive effect of Effidrate cream which is based on a glycerol alkyl-ether. Measurements were made in the morning at three-week intervals for a total period of 3 months. Sebum casual levels and sebum excretion rates were measured using a SM810 Sebumeter. Lipid-absorbent Sebutape was also used to collect all the sebum released from infundibular reservoirs over a four-hour period. Clinical assessments were relatively uninformative but the photometric measurements showed that Effidrate cream had a sebosuppressive action. The underlying biological mechanism remains unclear but a hypothesis based on enhanced sebum absorption by the stratum corneum is discussed.

Field enhancement and apertureless near-field optical spectroscopy of single molecules

We report on fluorescence enhancement in near field optical spectroscopy by apertureless microscopy. Our apertureless microscope is designed around a confocal fluorescence microscope associated with an AFM head. First, we show that the confocal microscope alone allows single molecule imaging and single molecule fluorescence analysis. When associated with the AFM head, we demonstrate, for the first time to our knowledge, that single molecule fluorescence is enhanced under the silicon tip. We tentatively attribute this effect to field enhancement under the tip.

Efficacy of protective creams in a modified repeated irritation test. Methodological aspects

The effect of 3 protective creams and petrolatum was tested in a repetitive irritation test. On 15 healthy volunteers, the irritants (sodium lauryl sulfate 10%, sodium hydroxide 0.5%, lactic acid 15%, and toluene undiluted) were applied on the paravertebral skin of the mid-back after 30 min pretreatment with the products tested. The volunteers were treated for 9 days. The irritant cutaneous reactions were quantified by erythema score, transepidermal water loss, and chromametry. The results showed a specific profile of efficacy against the 4 irritants used. For all creams a significant protective effect was obtained against irritation by sodium lauryl sulfate, sodium hydroxide and lactic acid in different degrees. Less efficacy was observed against toluene. Even an amplification of inflammation by pretreatment with 1 product could be demonstrated. The results indicate that a 1-week period of cumulative irritation might be enough to evaluate the efficacy of protective creams against most irritants.

Evaluation of decoquinate to treat experimental cryptosporidiosis in kids

The purpose of this trial was to evaluate the effects of decoquinate at 2.5 mg/kg/day for 21 days to prevent an experimental cryptosporidiosis in kids. Twenty 1-day-old male kids (French Alpin), fed initially goat colostrum heated 1 h at 56 degrees C and fed twice daily with nonmedicated milk replacer, were assigned into 2 groups. Kids of both groups were orally inoculated with 10(6) Cryptosporidium parvum (D0 = inoculation day). Group A kids were kept as nonmedicated controls and group B kids were orally medicated with 2.5 mg/kg/day of decoquinate (Deccox L. Rhône Poulenc Animal Nutrition) for 21 days from D-3 to D17. The studied criteria were body weight gain, oocyst shedding and specific anti-C. parvum immune response. In group A, the inoculation was not followed by mortality; but only by diarrhea and high oocyst shedding. Decoquinate reduced the severity of cryptosporidiosis in group B kids. The treatment prevented episodes of diarrhea and weight gain decrease for the D0-D7 and D0-D14 disease periods but did not allow a better final weight gain. The oocyst shedding was decreased in number and in duration. This parasitic development has induced a specific anti-C. parvum immune response. This drug is well-tolerated by animals and may be recommended in the prevention of ruminant cryptosporidiosis, a disease which has very limited treatment options.

Interference of HIV-1 Nef in the sphingomyelin transduction pathway activated by tumour necrosis factor-alpha in human glial cells

OBJECTIVE

The HIV-1 nef gene product, thought to interact with mediators of cell signalling, is overexpressed during the restricted HIV-1 infection of human astrocytes. This infection can be reactivated following exposure to tumour necrosis factor (TNF)-alpha. We examined the possibility that Nef alters the TNF-alpha-induced cell signalling in astroglioma cells through the sphingomyelin pathway.

METHODS

Sphingomyelinase activation by TNF-alpha was analysed in U251MG glial cells constitutively expressing Nef and compared with U251MG cells stably transfected with the expression vector alone. The consequent effect on the cellular proliferative response and induction of nuclear factor NF-kappa B and AP-1 binding activities were examined.

RESULTS

A marked enhancement in the levels of ceramide, a product of the sphingomyelin hydrolysis, was observed in U251MG-Nef upon stimulation with TNF-alpha. In contrast, ceramide levels in control cells were barely increased under similar conditions. A concomitant reduction of sphingomyelin level occurred in U251MG-Nef cells. In addition, the reduced survival rate of U251MG cells resulting from TNF-alpha activation was prevented in the presence of Nef. Furthermore, electrophoretic mobility shift assays indicated that nef expression inhibits AP-1 activation without altering the induction of NF-kappa B.

CONCLUSION

These results strongly suggest that nef expression in U251MG cells modulates the sphingomyelinase signalling pathway triggered by TNF-alpha, thus leading to important modifications in the activation and proliferation of glial cells. They also provide new insights to explain the widespread reactive astrogliosis observed in AIDS-associated neuropathological disorders.

Perception of risk, choice of maternity site, and socio economic level of twin mothers

The objective of this study was to determine if access to high level health facility (level 3 perinatal center) is related to socio-economic level of the mother and to her perception of risk for a twin birth. A retrospective questionnaire was administrated to the mothers of twins during the first post parum days in each of the 27 maternity sites within a defined geographical district near Paris (Hauts de Seine). The survey instrument was designed to precisely characterize the socioeconomic status of the parents, to measure the perceived risk for the twins expressed by the mother, to measure the relationship between the choice of a maternity site (level 1, 2 or 3) by socioeconomic level, and to measure the fetal and neonatal death rates by socioeconomic status. The opinion of mothers of twins about specific risk for her and for her children is very different by socioeconomic levels, as is the choice of level 3. This is discussed with the rates of fetal and neonatal death rates by socioeconomic level. In the absence of a policy of regionalization of perinatal care, the discriminant factor for access to high level care (level 3 maternity site) is the socioeconomic level.

Undertreatment in a nonselected population of adult patients with asthma

BACKGROUND AND AIM

The question of undertreatment has frequently been raised concerning the management of asthma but, to date, very few studies have been carried out. In those studies that have been performed, the methodology was inadequate because they were conducted on a selected population of patients with asthma or by interviewing doctors. As part of the European Community Respiratory Health Survey, nonselected patients with asthma (22 to 44 years old) in two French cities (Paris and Montpellier), were examined to assess possible undertreatment.

METHODS

Patients with asthma were recruited according to a positive response to questions on asthma in a questionnaire and a positive methacholine challenge. The severity of asthma was assessed by a cumulative score, which has previously been shown to be significantly correlated with the validated clinical score of Aas. Patients were asked to attend the clinic and bring with them any medications that they regularly received. The optimal treatment of asthma was based on the International Consensus Report on the Management of Asthma.

RESULTS

According to the international guidelines, among the patients who required antiinflammatory treatment, 86.4% were undertreated in Paris and 66.7% were undertreated in Montpellier (p < 0.03, chi square test). Moreover, among the patients with severe asthma, 85% and 60%, respectively, were not receiving an antiinflammatory treatment.

CONCLUSION

This study is the first to highlight the magnitude of undertreatment of patients with asthma in a nonselected population.

Comparative effects of haloacetic acids in whole embryo culture

A major class of disinfection by-products in drinking water are the haloacetic acids. Both dichloro- and trichloroacetic acids are teratogenic when administered to rats throughout organogenesis. However, there is little information regarding the developmental toxicity of other haloacetic acids. Therefore, 3-6 somite staged CD-1 mouse embryos were exposed to acetic acid (AA) or mono- (M), di- (D), and tri- (T) substituted fluoro- (F), chloro- (C), or bromo- (B) acetic acids in whole embryo culture in order to evaluate the effects of these agents on development. A 24 hour exposure to the haloacetic acids produced dysmorphogenesis. Effects on neural tube development ranged from prosencephalic hypoplasia to non-closure defects throughout the cranial region. Exposure to the haloacetic acids affected optic development, produced malpositioned and/or hypoplastic pharyngeal arches, and resulted in perturbation of heart development. In order to determine the relative toxicities of these agents, benchmark concentrations were calculated as the lower 95% confidence interval of the concentration that produced a 5% increase in neural tube defects. The benchmark concentrations occurred over a wide range with DFA (5912.6 microM) and MBA (2.7 microM) at the extremes. Using the benchmark concentrations to compare the chemicals gives a ranking of the agents in order of increasing potency as: DFA < TFA < DCA < AA < TBA < or = TCA < DBA < MCA < MBA. TCA and DCA have demonstrated ability to disrupt development in vivo but were among the least potent haloacetic acids in vitro. Because of the potential for widespread exposure to haloacetic acids in drinking water and the incomplete toxicity profile of these chemicals, further work on their developmental effects is warranted.

Maternal-fetal hemorrhage: a reappraisal

PURPOSE

To determine the frequency of maternal-fetal hemorrhage at or above 1 microliter of maternal whole blood.

METHODS

Seventy-three mothers whose red blood cells bore an Rh antigen (Rh D, Rh c, Rh E) that was absent on red blood cells of their newborns were identified and a new cytological method, the Kleihauerimmunogold-silver-staining technique, was applied on the blood of their neonates to detect and quantify maternal red blood cells. Stringent precautions were taken to avoid contaminations of neonatal blood samples by adult red blood cells.

RESULTS

Maternal red blood cells were present in 3 newborns, a frequency of 4% (95% Cl: 1-11%), and the estimated volumes of hemorrhage were 0.8, 1.5, and 101 microliters of maternal whole blood. No obstetric factor was clearly associated in this limited study with the occurrence of maternal-fetal hemorrhage.

CONCLUSIONS

Mother-to-fetus microtransfusion greater than 1 microliter is infrequent at or near delivery, and it may be observed after an uncomplicated pregnancy and vaginal delivery.

Variations in response of four lines of ring-necked pheasants to infection with marble spleen disease virus

This study evaluated the response and susceptibility of four lines of ring-necked pheasants to infection with marble spleen disease (MSD) virus. Fifteen birds of the following lines were used: the standard ring-necked gamebird, the highly inbred jumbo white, the Sichuan, and the first-generation cross of the Sichuan and the standard gamebird. Baseline immune responses were assessed at 6 weeks of age by lymphoblastogenesis assays. All birds were orally challenged at 7 weeks of age with cell -culture-propagated MSD virus. Eight birds of each group were necropsied at 6-7 days post-inoculation (PI), and gross splenic lesions were recorded. Appropriate tissue sections were collected, fixed in 10% buffered formalin, and routinely processed for microscopic evaluation. The remaining birds were bled weekly from week 2 through week 8 Pl. Serum was tested for antibodies to MSD virus using a commercial enzyme-linked immunosorbent assay kit. Results of the lymphoblastogenesis assays and the gross and microscopic lesion incidences indicated that variations did exist between several lines evaluated. The jumbo white pheasant had significantly higher lymphoblastogenesis stimulation index and was more resistant to developing gross and histologic lesions than was the standard ring-necked gamebird.

C2-ceramide primes specifically for the superoxide anion production induced by N-formylmethionylleucyl phenylalanine (fMLP) in human neutrophils

Activated sphingomyelinases release ceramide molecules believed to be involved in intracellular signalling. The present study investigated whether soluble C2-ceramide modulates some of the effects of N-formylmethionylleucyl phenylalanine (fMLP) and other agonists on human neutrophils (or polymorphonuclear leukocytes-PMN); principally superoxide anion (O2-) production. The preincubation of PMN for 15 min with C2-ceramide increased by up to almost 3-fold the amounts of O2- generated in response to 0.1 and 1 microM fMLP. Priming was detected at C2-ceramide concentrations of 2 microM to 4 microM per million PMN. Though less potent than C2-ceramide, C6-ceramide (N-hexanoylsphingosine) could prime for O2- generated in response to 0.1 microM fMLP, with maximal effects obtained at 10-20 microM. In contrast, micromolar concentrations of sphingosine, dihydroceramide, and ceramide-phosphate, failed to exert any potentiating effect on fMLP-induced O2- generation. As expected, TNF-alpha (1000 U/ml), also primed for fMLP-induced O2- production; however, the combination of TNF-alpha and C2-ceramide showed no additive effect. Moreover, S. aureus sphingomyelinase (0.1 U/ml), was unable to reproduce the priming effects of C2-ceramide and TNF-alpha. C2-ceramide at 2 microM did not enhance the production of O2- induced by 100 nM recombinant human interleukin-8 (IL-8), leukotriene B4 (LTB4), platelet-activating factor (PAF) or 20 mM sodium fluoride (NaF). Furthermore, C2-ceramide (2 microM) did not enhance the mobilization of calcium, the release of arachidonic acid or the accumulation of phosphatidylethanol, induced by 100 nM fMLP. This suggests that probably neither phospholipases C, A2 or D (PLC, PLA2, PLD) were involved in the priming effect by C2-ceramide. However, C2-ceramide inhibited in a dose-related manner the production of O2- induced by phorbol 12-myristate 13-acetate (PMA) and mezerein. Furthermore, PMA-stimulated PLD activity was also significantly reduced by a preincubation of PMN with C2-ceramide. The priming of O2- production by C2-ceramide could involve yet unidentified mechanisms specific for fMLP, or it might imply that cytokines such as TNF-alpha have different mechanisms than C2-ceramide.

Social groups and prevention of preterm births in a population of twin mothers

Prenatal care was equally distributed to all twin pregnant women of the district of Haut de Seine in France in 1989-91, without differences by socio-economic level. No difference in rates of preterm births and very early preterm births (26-31 weeks) was measured by socioeconomic level among twin pregnancies.

[Changes in the high-amplification electrocardiogram after myocardial revascularization. Comparison between coronary artery bypass and angioplasty]

The signal-averaged electrocardiogram (SA-ECG) was studied in 148 patients undergoing myocardial revascularisation either by coronary bypass surgery (CBS) (64 cases) or transluminal angioplasty (PTCA) (84 cases). The investigation was performed before the procedure, at day 7 (D7) and after 3 months (D120). No difference was observed in the SA-ECG between the two groups before revascularisation. The CBS population was older, more symptomatic and had more severe lesions than the PTCA population. One hundred and thirty-nine patients were followed up until the end of the study protocol (CBS = 63; PTCA = 76). Two criteria of the SA-ECG were significantly modified after CBS: QRS duration (p < 0.05) and Under 40 (p < 0.01). No significant changes were observed after PTCA. In the patients with late potentials (LP) before revascularisation, the mean value of these criteria (Under 40 and Last 40) were significantly modified after CBS (U40 = 54.3 +/- 16 to 35.4 +/- 15; p < 0.01) (L40 = 11.9 +/- 4.7 to 26.1 +/- 24.3; p < 0.01). No changes in these criteria were observed after PTCA. The value of negativation of the criteria of LP for patients with two criteria of positivity was 71.1% after CBS compared with 25% after PTCA (not significant). These observations support the hypothesis of a favourable modification of the arrhythmogenic substrate after myocardial revascularisation, especially by CBS.

Economic impact and clinical benefits of pharmacist involvement on surgical wards

A one-year pilot project was performed to assess the economic and clinical benefit of pharmacist involvement on the surgical wards of a 600-bed tertiary care, teaching hospital. A total of 405 recommendations were collected with a physician acceptance rate of 90%. From these recommendations, 1416 patient follow-ups were performed to document outcome. The total documented cost avoidance of the pharmacists' activities was $33,265.58. The total annual drug expenditure for the department of surgery declined by $59,662 representing a 9% decrease over the previous year with the greatest decline involving antimicrobials which decreased by $52,587 compared with the previous year. Most of the cost-avoidance in this area was attributable to antimicrobial selection and dosing adjustment in renal impairment. Pharmacist-directed pharmacokinetic monitoring of aminoglycosides resulted in a clinical success rate of 93.8% for treatment regimens and a 6.2% incidence of nephrotoxicity. Housestaff education aimed at improving prescribing practices were identified and provided for select agents including midazolam, ketorolac, vancomycin and aminoglycosides. As well, select recommendations were documented which illustrated the benefit to patient care of pharmacist involvement. Pharmacist involvement on the surgery services produced both financial and clinical benefits.

Pain and quality of life in patients with acute duodenal ulcer treated with ranitidine

BACKGROUND

The various components of pain and quality of life in duodenal ulcer patients receiving antisecretory drugs have not been studied to date.

METHODS

Ninety-five patients with epigastric pain and duodenal ulcer at endoscopy completed this prospective, multicenter, open-study. All were treated with effervescent ranitidine 300 mg daily for 4 weeks. The following parameters were assessed: (a) disappearance of duodenal ulcer pain by self-evaluation and on a weekly visual analogue scale (VAS) from 0 to 100; (b) evolution of sensory and affective components of ulcer pain by the Validated French Version of the McGill Pain Questionnaire (Questionnaire Douleur de Saint-Antoine, QDSA); (c) quality of life by the Nottingham Health Profile (NHP) which includes six criteria: pain, mobility, energy, emotions, sleep and social isolation.

RESULTS

Forty-nine, 66 and 87% of the patients were pain-free during the day-time after 7, 14 and 28 days, respectively. Corresponding figures for the night-time were 80%, 88% and 97% respectively. Median time to disappearance of ulcer pain was 8 days. VAS self-assessment showed a significant decrease each week throughout the treatment period (P = 0.001). Sensory and affective QDSA scores were significantly improved after the second day and at each assessment during the 28 days of treatment (P = 0.001). Physical as well as affective aspects of quality of life were significantly improved after 28 days for each of the six criteria explored (P = 0.001). The duodenal ulcer healing rate was 86% after 4 weeks of treatment.

CONCLUSIONS

Using complementary scales measuring different aspects of ulcer pain, sensory and affective components improved significantly from the second day of treatment with ranitidine 300 mg. A significant improvement in quality of life is observed after a 4-week treatment. QDSA and NHP appear to be useful evaluation tools of duodenal ulcer pain and quality of life.

Prevalence of sporadic medullary thyroid carcinoma: the importance of routine measurement of serum calcitonin in the diagnostic evaluation of thyroid nodules

OBJECTIVE

The prevalence of sporadic forms of medullary thyroid carcinoma (MTC) has been studied in patients living in an area of moderate iodine deficiency. Such forms of MTC are usually diagnosed after surgery and have little chance of definitive cure. Using the measurement of basal serum calcitonin (CT) levels in a large series of patients with both thyroid disease and normal 24-hour urinary iodine excretion, we assessed the prevalence of MTC and, in patients affected with the disease, we also evaluated the stage of the disease according to surgical findings and post surgical plasma CT levels.

PATIENTS

A prospective study of 657 patients with thyroid disease (469 with nodular and 188 with non-nodular thyroid disease). As controls, 40 normal subjects were also studied.

MEASUREMENTS

In all patients: (1) measurement of basal serum CT, free T4, total T3, TSH levels and serum TSH-receptor, peroxidase and thyroglobulin (Tg) antibody concentrations, (2) thyroid ultrasonography, (3) fine needle aspiration cytology (FNAC). In patients with increased basal CT levels: (1) measurement of serum CT levels during pentagastrin test prior to surgery, (2) histological examination and immunostaining with both anti-CT and anti-Tg antibodies of all the nodular thyroid tissue surgically removed, (3) measurement of basal and pentagastrin stimulated serum CT values after surgery.

RESULTS

All the patients with non-nodular thyroid disease had normal basal CT levels. Four patients (0.84%) with nodular thyroid disease (2 with uninodular and 2 with multinodular goitre) had both elevated basal and pentagastrin stimulated CT levels. In the two patients with uninodular goitre, FNAC was suggestive of MTC in 1 (nodular diameter 8.0 cm) and of follicular carcinoma in 1 (nodular diameter 2.5 cm). Histological examination of the nodules confirmed these histotypes. Immunostaining with anti-CT antibodies was positive in the former patient but also in the latter. FNAC was suggestive of benign adenomatous tissues in the two patients with multinodular goitre. Histological examination of all the thyroid nodules confirmed the cytological findings. However, serial sections through the gland in each of these two patients showed an occult follicular carcinoma which had, however, positive staining with anti-CT antibodies. Furthermore, immunostaining with anti-Tg antibodies was negative in the patient with MTC but positive in the 3 patients with follicular carcinoma. Finally, both basal and pentagastrin stimulated CT levels remained elevated after total thyroidectomy only in the patient with FNAC suggesting MTC.

CONCLUSIONS

This study demonstrates a surprisingly high prevalence of sporadic forms of medullary thyroid carcinoma in patients with nodular thyroid disease. Such forms of medullary thyroid carcinoma seem to be unrelated to iodine intake and may be pure or mixed with a follicular carcinoma. In these mixed thyroid carcinomas, only the neoplastic follicular pattern was seen on both cytological and histological examination. Routine measurements of serum calcitonin levels should therefore be considered an integral part of the diagnostic evaluation of thyroid nodules. Indeed, increasing the accuracy of diagnosis of medullary thyroid carcinoma encourages the surgeon to perform more radical treatment, thus achieving more frequent normalization of post-operative serum calcitonin levels.

Is prevention of preterm births in twin pregnancies possible? Analysis of the results of a prevention program in France (1989-1991)

OBJECTIVES

A policy aimed at the prevention of early preterm births in twin pregnancies has been evaluated. The prevention program included: early diagnosis of twinning, information of the mothers about the risk of prematurity, attempts to restrain physical activity and early work leave prescription when indicated.

STUDY DESIGN

Cohort study of all twin births in a given geographical area (Hauts-de-Seine district); 546 mothers with pregnancy duration of > or = 26 weeks were included; 1088 newborns were followed up to the 28th day of life.

RESULTS

The recommended prevention program is largely used (88% of early diagnosis of twinning, 62% of the women informed and 73% of prescription for reduced physical activity). The very preterm (26-28 weeks) and early preterm (< or = 32 weeks) birth rates are low: 1.5 and 8.5%, respectively. The stillbirth rate is 11 per thousand and the neonatal mortality rate (0-27 days) is 10 per thousand live births, with a persistent difference between the first and the second twin.

CONCLUSION

The present study demonstrates the open access and acceptability of the prevention policy; in addition, the perinatal outcomes are better than those of comparable published cohorts.

Comparison of four fixatives for routine splenic histology and immunohistochemical staining for group II avian adenovirus

Four different fixatives, A, B, C, and D, were compared for use in routine histology of splenic tissue and for immunohistochemical staining to detect group II avian adenoviral antigen. Sixteen pheasants were experimentally infected with type II adenovirus; spleens from each bird were harvested, divided, and treated with each of the four fixatives. All four fixatives were adequate for routine histology. Fixative B was significantly more sensitive for immunohistochemistry than the three other fixatives, and it also detected the viral antigens at the highest dilutions of the primary antibody.