Discrimination of changes in osteoporosis outcomes

The purpose of this paper was to identify existing work related to discrimination, responsiveness, and minimal clinically important differences (MCID) for 4 key clinical outcomes in osteoporosis, to serve as a background to discussions about how to define MCID for both individuals and groups. The outcomes assessed were bone density, fractures, quality of life, and function. We conducted a systematic literature search in MEDLINE, EMBASE, and Current Contents for articles that discussed responsiveness, detectable difference, improvement criteria, and clinical importance. We used the Beaton cube to classify the studies depending on whether they compared differences between or changes within individuals or groups. Although a number of studies were identified that presented data on detectable differences beyond error and observed differences, few studies presented data on how to define clinically important differences. A key priority for future research is to define minimally clinical important differences for clinically important osteoporosis outcomes using a consensus based approach that will be accepted by the osteoporosis community at large. Furthermore, these MCID will likely be different for individual patients seen in clinical practice than for individuals in a clinical trial.

Engraftment of autologous retrovirally transduced hepatocytes after intraportal transplantation into nonhuman primates: implication for ex vivo gene therapy

The main impediment to effective ex vivo liver gene therapy of metabolic diseases is the lack of experimental work on large animals to resolve such important issues as effective gene delivery, cell-processing techniques, and the development of appropriate vectors. We have used a nonhuman primate, as a preclinical model, to analyze the limiting steps of this approach using recombinant retroviruses. Seven monkeys (Macaca fascicularis) underwent the complete protocol: their left liver lobe was resected, a catheter was placed in the inferior mesenteric vein and connected to an infusion chamber, and the hepatocytes were isolated, cultured, and transduced with a retroviral vector containing the beta-galactosidase gene. The hepatocytes were harvested and returned to the host via the infusion chamber. Biopsies were taken 4-40 days later. No animal was killed in the course of the experiments. They all tolerated the procedure well. We have developed and defined conditions that permit the proliferation and transduction of up to 90% of the plated hepatocytes. A significant proportion of genetically modified cells, representing up to 3% of the liver mass, were safely delivered to the liver via the chamber. Polymerase chain reaction analysis detected integrated viral DNA sequences and quantitative analysis of the in situ beta-Gal-expressing hepatocytes indicated that a significant amount of transduced hepatocytes, up to 2%, had become integrated into the liver and were functional. These results represent substantial advances in the development of the ex vivo approach and suggest that this approach is of clinical relevance for liver-directed gene therapy.

[Reflex sympathetic dystrophy: psychological and psychopathologic features]

It has traditionally been accepted that a predisposing psychological field exists with the appearance of the reflex sympathetic dystrophy. Nevertheless, there is no unanimous agreement in this interpretation, since surveys exist unanimous are in favour the reactive character of the psychological effect on reflex sympathetic dystrophy. In this study, we revise literature already published on the subject, present arguments on the psychological evaluation tests carried out to date and propose the possibility of using other test unanimous are easier to manage and to interpret.

[Treatment with danaparoid during pregnancy for a woman with a cutenous allergy to low-molecular-weight heparin]

The authors describe a case of heparin-induced skin reaction due to two preparations of low molecular weight heparin in a pregnant woman. The main characteristics of heparin-related cutaneous allergy are reported. The use of an heparinoid, usually indicated for patients with heparin-induced thrombocytopenia, appeared to be efficient and safe for the mother and her fetus. An epidural analgesia was performed for labor analgesia, 24 hours after the last injection of danaparid of sodium.

[Nosocomial infections in mother and child: specific risks in the labour ward]

Nosocomial infection is a frequent and potentially lethal complication in obstetrics. The incidence of this complication may be underscored and an accurate surveillance system must be used in each obstetrics unit for infection control. This surveillance system should also identify the patients at risk for infection in order to improve prevention efforts. beta-lactam-sensitive streptococcus is often involved in obstetrical infections and a short antibio-prophylaxis is indicated in most obstetrical procedures. Disinfection strategy, guidelines for clinical practice and control charts should be established in each obstetrics unit to prevent nosocomial infections.

(R)-tert-Butoxycarbonylamino-fluorenylmethoxycarbonyl-glycine from (S)-benzyloxycarbonyl-serine or from papain resolution of the corresponding amide or methyl ester

The enantiospecific synthesis of (R)-Boc-(Fmoc)-aminoglycine 7 was achieved. (S)-Cbz-serine 1 was reacted with diphenylphosphoryl azide in the presence of triethylamine to yield cyclic (S) carbamate 2. The ring nitrogen of 2 was protected with a Boc group (3). The cyclic carbamate of 3 was hydrolyzed with benzyltrimethylammonium hydroxide to yield the (R)-enantiomer of alcohol 4. The oxidation of 4 with pyridinium dichromate yielded the enantiomerically pure (97% ee) (R)-Boc-(Cbz)-aminoglycine 5, which was converted to 7 with retention of optical purity. Similarly, starting from (S)-Boc-serine 9, cyclic (S) carbamate 10 was obtained. The ring nitrogen of 10 was protected with a Cbz group (11) with retention of configuration. The cyclic carbamate of 11 was base hydrolyzed to yield 12, the (S)-enantiomer alcohol. Independently, Boc-(Fmoc)-aminoglycine amide 13 and Boc-(Fmoc)-aminoglycine methyl ester 14 were resolved using papain. The stereochemistry of the isolated acid was determined to be (R) by coelution on HPLC of its derivative with Marfey's reagent and that of an authentic sample (7) obtained by enantiospecific synthesis.

Vesicle-mediated transfer of virulence genes from Escherichia coli O157:H7 to other enteric bacteria

Membrane vesicles are released from the surfaces of many gram-negative bacteria during growth. Vesicles consist of proteins, lipopolysaccharide, phospholipids, RNA, and DNA. Results of the present study demonstrate that membrane vesicles isolated from the food-borne pathogen Escherichia coli O157:H7 facilitate the transfer of genes, which are then expressed by recipient Salmonella enterica serovar Enteritidis or E. coli JM109. Electron micrographs of purified DNA from E. coli O157:H7 vesicles showed large rosette-like structures, linear DNA fragments, and small open-circle plasmids. PCR analysis of vesicle DNA demonstrated the presence of specific genes from host and recombinant plasmids (hly, L7095, mobA, and gfp), chromosomal DNA (uidA and eaeA), and phage DNA (stx1 and stx2). The results of PCR and the Vero cell assay demonstrate that genetic material, including virulence genes, is transferred to recipient bacteria and subsequently expressed. The cytotoxicity of the transformed enteric bacteria was sixfold higher than that of the parent isolate (E. coli JM109). Utilization of the nonhost plasmid (pGFP) permitted the evaluation of transformation efficiency (ca. 10(3) transformants microg of DNA(-1)) and demonstrated that vesicles can deliver antibiotic resistance. Transformed E. coli JM109 cells were resistant to ampicillin and fluoresced a brilliant green. The role vesicles play in genetic exchange between different species in the environment or host has yet to be defined.

[RS3PE syndrome: report of 11 cases]

The RS3P syndrome or remitting seronegative symmetrical synovitis with pitting oedema, was described in 1985 by McCarty. The description refers to a rheumatologic set of symptoms with an acute commence, with no erosive lesions, with seronegativity, affecting more frequently to elderly males and showing an excellent prognosis. These characteristics make it possible to difference from the rheumatoid arthritis and from the rheumatic polymyalgia. We present eleven cases which confirm the good prognosis already described, but we suggest the possibility of this syndrome could be a manifestation or the beginning of other possible diseases.

Morphometric analysis of dendritic tree of cerebellar Purkinje-cells

Basic neural processes of sensorimotor adaptation can be observed by cellular-level studies on cerebellar cortex, both by electrophysiological and morphological means. In earlier studies we demonstrated double (sometimes triple or quadruple) rhythmic prespike activity patterns in dendritic microelectrode records taken from cerebellar Pc. By their active and passive interactions, the actual input pattern will turn into an arrhythmic output spiking, realizing a nonlinear and phase-sensitive integration. This curious complex spike-generating process can give rise to novel cerebellar functional models. The acting membrane dynamics rely not just upon the ionic current machinery but also upon the specific micromorphology of the dendritic tree, especially that of the branching areas. Although, statistical analyses on Pc dendrites generally followed the graph-theory, elaborated abstract parameters for complexity and hierarchy, and denied realistic geometry. Thus a novel specific morphometric study should be carried out, first applied to the main branching sites.

Red laser-induced fluorescence energy transfer in an immunosystem

We describe two near-infrared fluorescent squaraine dyes (Sq635 and Sq660), their spectra, their covalent linkage to proteins, and their use as donor and acceptor, respectively, in a fluorescence resonance energy transfer (FRET) immunoassay based on the use of red lasers. The dyes show quantum yields of around 10% in the free form and up to 68% when bound to proteins. If converted into their N-hydroxysuccinimide esters, they can be linked to free amino groups of proteins. To improve water solubility, two sulfo groups were introduced. The emission spectrum of Sq635 overlaps the absorption spectrum of Sq660, a fact that makes them a useful pair of dyes for use in FRET immunoassay which is demonstrated for human serum albumin/anti-human serum albumin.

Effect of injection rate on hypotension associated with spinal anesthesia for cesarean section

Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated in a prospective observational study the influence of injection speed on maternal hypotension. Hyperbaric bupivacaine 10 mg, sufentanil 2 microg and morphine 200 microg (total volume 4 mL) were injected either quickly (<15 s) or slowly (=120 s) in 50 women scheduled for elective cesarean section. Hypotension (systolic arterial pressure (SAP) <100 mmHg or <70% of baseline) was promptly treated with 5 mg ephedrine boluses. Slow injection significantly reduced the incidence of hypotension (68% in the 120 s group and 92% in the other, P =0.03). In addition, onset of hypotension was delayed, had a shorter duration and required less ephedrine for hypotension in the 120 s group (11.6 mg vs. 19.6 mg, P =0.019). Anesthesia was satisfactory for all women. We conclude that a 2 mL/min injection rate may be a simple and effective way to reduce the incidence and severity of hypotension during cesarean section under spinal anesthesia.

Central venous catheter placement in children: evaluation of electrocardiography using J-wire

Misplacement of a central venous catheter may lead to myocardial perforation and dysrhythmia. Atrial electrocardiography (ECG) through a saline column is an effective but complex method to determine the accurate location of catheters. We evaluated a simplified variant of this technique using the guidewire as an internal electrode in 23 children (5-16 years old) undergoing spinal surgery. Catheters were placed using a Seldinger technique after jugular or subclavian venous puncture. Each time the operator recognized the atrial signal, the catheter was found to be correctly placed on the chest radiograph (20/23). In three patients, the atrial signal was not obtained. A technical error was responsible in one case whereas the two others were related to aberrant migrations of the catheter either into a subclavian vein or into the pleura. In this latter case, the complication was unrecognized on the first radiograph despite malposition having been predicted by atrial ECG. We conclude that a method using atrial ECG guidance is sensitive and specific, and may be an alternative to the classical chest radiograph to detect accurate placement of central venous catheters in children.

Stereotypes and terror management: evidence that mortality salience enhances stereotypic thinking and preferences

If stereotypes function to protect people against death-related concerns, then mortality salience should increase stereotypic thinking and preferences for stereotype-confirming individuals. Study 1 demonstrated that mortality salience increased stereotyping of Germans. In Study 2, it increased participants' tendency to generate more explanations for stereotype-inconsistent than stereotype-consistent gender role behavior. In Study 3, mortality salience increased participants' liking for a stereotype-consistent African American and decreased their liking for a stereotype-inconsistent African American; control participants exhibited the opposite preference. Study 4 replicated this pattern with evaluations of stereotype-confirming or stereotype-disconfirming men and women. Study 5 showed that, among participants high in need for closure, mortality salience led to decreased liking for a stereotype-inconsistent gay man.

Stereotypes and terror management: evidence that mortality salience enhances stereotypic thinking and preferences

If stereotypes function to protect people against death-related concerns, then mortality salience should increase stereotypic thinking and preferences for stereotype-confirming individuals. Study 1 demonstrated that mortality salience increased stereotyping of Germans. In Study 2, it increased participants' tendency to generate more explanations for stereotype-inconsistent than stereotype-consistent gender role behavior. In Study 3, mortality salience increased participants' liking for a stereotype-consistent African American and decreased their liking for a stereotype-inconsistent African American; control participants exhibited the opposite preference. Study 4 replicated this pattern with evaluations of stereotype-confirming or stereotype-disconfirming men and women. Study 5 showed that, among participants high in need for closure, mortality salience led to decreased liking for a stereotype-inconsistent gay man.

[Dural taps in peridural analgesia for labor: management by French anesthesiologists in 1997]

OBJECTIVES

To assess prophylactic and curative managements of dural taps occurring during the setting of epidural analgesia (EA) for labour.

STUDY DESIGN

Nationwide French retrospective survey.

PATIENTS AND METHODS

From April to July 1997, a questionnaire was sent to 799 French obstetrical units located in both teaching and non-teaching public hospitals and private institutions.

RESULTS

Answers were obtained from 267 units (response rate of 33%). Although management of dural taps was similar in 52% of the institutions, only 8% had produced a written protocol. After a dural puncture, EA was still performed in 95% of the units, but usually in another interspace (87%). Large oral fluid intake was the most frequent prophylactic measure (81%). To prevent postdural puncture headache (PDPH), bed rest was largely used (76%) and lasted 24 hours in 46% of the institutions. Prophylactic epidural blood patch (EBP) was performed in 14% of the units. To treat PDPH, a majority of anaesthesiologists performed an EBP (92%) and most of them after a delay of 48 hours (62%). Intravenous and oral caffeine was used in 31 and 24% of the units respectively. Prior to EBP, coagulation status was assessed in about 20% of the units and blood culture in less than 3%. In 65% of the units the injection of EBP was discontinued when the patients felt backache. A large range of volumes were injected, but usually less than 20 mL were administered (81%). In 60% of the units the patients were discharged home after an overnight stay in the hospital. If the first EBP failed, a second one was performed in 61% of the cases.

CONCLUSION

Management of dural taps occurring after EA for pain relief in labour differs widely from one French obstetrical unit to another.

Sound propagation in urban areas: a periodic disposition of buildings

A numerical simulation of background noise propagation is performed for a network of hexagonal buildings. The obtained results suggest that the prediction of background noise in urban spaces is possible by means of a modified diffusion equation using two parameters: the diffusion coefficient that expresses the spreading out of noise resulting from diffuse scattering and multiple reflections by buildings, and an attenuation term accounting for the wall absorption, atmospheric attenuation, and absorption by the open top. The dependence of the diffusion coefficient with geometrical shapes and the diffusive nature of the buildings are investigated in the case of a periodic disposition of hexagonal buildings.