Management of forearm bone loss with induced membrane technique

There are very few published studies describing the treatment of segmental bone defects of the forearm using the induced membrane technique. The objectives of this study were to evaluate the time to bone union, the function of the joints above and below the treated bone segment and the patients' quality of life over the long-term. We performed a retrospective study in all patients treated by the induced membrane for a forearm bone defect over at 13-year period. Demographics, bone union, complications, functional outcomes and occupational status were collected. Six patients were included: 2 posttraumatic injuries, 1 osteomyelitis, 1 septic arthritis, 1 aseptic nonunion, 1 tumor. The average defect length was 64mm (48-110). All defects were treated with internal fixation. Bone graft was harvested from the iliac crest in two patients, the femur (using the Reamer Irrigator Aspirator technique) in three patients and the radius in one patient. Five patients achieved bone union after a mean of 4months (3-6). Three complications were observed: 1 radioulnar instability, 1 infection of the fixation device, 1 abscess. At an average 8½ years' follow-up, the pain level on the VAS was 0.6 (0-3), the Mayo Elbow Performance Score was 98 (90-100), the Herzberg score was 108 (85.6-140) and the QuickDASH was 14.9 (2.7-35). All patients returned to work. Using the induced membrane technique avoids the complications associated with vascularized autograft and yields good functional outcome and quality of life.

Idiopathic nephrotic syndrome and rituximab: may we predict circulating B lymphocytes recovery?

BACKGROUND

Rituximab (RTX) has been shown to be an efficient treatment for steroid-dependent nephrotic syndrome (SDNS). A long B cell depletion period seems to improve the duration of remission. This study reports the duration of B cell depletion after each RTX infusion in patients with nephrotic syndrome.

METHODS

We retrospectively report the data of 22 patients with a diagnosis of a SDNS or steroid-resistant nephrotic syndrome (SRNS) and a treatment with RTX in a single center. B cell depletion duration was compared to the first B cell depletion duration and to the previous B cell depletion duration in each patient.

RESULTS

Twenty-two patients (5 girls) were included. Seventy-six periods of B cell depletions were compared to the first B cell depletion duration and to the preceding B cell depletion duration in the same patient. Total duration of B cell depletion was 26 (6-66) months. Individual post-RTX infusion B cell depletion duration was 5.1 (1.6-14) months. Median B cell depletion duration following the first RTX cure for children who had received 1 to 2 infusions at first cure was not statistically different of those who had received 3 to 4 infusions (p = 0.18). Comparing the B cell depletion induced by previous RTX courses and the following B cell depletion, 89.5% of patients had a similar duration within an open interval from 2 months.

CONCLUSION

Once the individual time interval until B cell recovery is determined, monitoring could be individualized by targeting the expected date of B cell recovery or by performing pre-emptive RTX injections.

Two-team management of vascular injuries concomitant with osteo-articular injuries in 36 patients over six years

BACKGROUND

Patients with both vascular and osteoarticular injuries require multidisciplinary management. Vascular injuries may be function- and/or life-threatening. The lower limbs are predominantly affected. Traffic, domestic, and work-related accidents contribute most of the cases. The primary objective of this study was to describe the management of patients with concomitant vascular and osteo-articular injuries, with special attention to the rates of amputation and fasciotomy. The secondary objective was to suggest a management sequence to optimise our surgical practice.

HYPOTHESIS

The management sequence is a crucial consideration in patients with both vascular and osteo-articular injuries.

MATERIAL AND METHODS

A 6-year, retrospective, observational study was conducted in patients with concomitant vascular and osteo-articular injuries.

RESULTS

The study included 36 patients with a mean age of 40.6±22.1 years. The main sources of injury were traffic accidents (n=19, 52.8%), crush injury (n=8, 22.2%), and falls (n=5, 13.9%). A compound fracture was present in 20 (55.6%) patients. Evidence of ischaemia in 25 (69.4%) patients, and bleeding in 11 (30.6%) patients. Pre-operative imaging, by ultrasonography or computed tomography, was performed in 27 (75.0%) patients. The lower limb was involved in 30 (83.3%) patients, who had osteoarticular injuries to the femur and leg combined with injury to the popliteal artery. Fasciotomy was performed in 11 (30.6%) patients and secondary amputation in 7 (19.4%) patients. The limb salvage rate was 80.6%. Median patient survival was 9.3 [0-74.8] months.

DISCUSSION

Coordinated work by two surgical teams is crucial to manage concomitant vascular and osteo-articular injuries. The management sequence must be defined clearly. Computed tomography angiography is the investigation of choice and should be performed at the slightest suspicion of vascular injury.

LEVEL OF EVIDENCE

IV, retrospective observational study.

Treatment goals for distal radius fractures in 2018: recommendations and practical advice

The goals of distal radius fracture treatment in patients above 65 years of age would not change over time if the fracture were the only factor to consider. However, people change, and fixation methods also change. Since this fracture heals in nearly every case and volar plates have eliminated the worry of malunion, we are left with two main goals. In active patients with weakened bones, the aim is to help them regain their quality of life as quickly as possible while avoiding iatrogenic conditions. This compromise is possible because of new tools-but at what price?

Inventory and vertical distribution of 137Cs, 239+240Pu and 238Pu in soil from Raivavae and Hiva Oa, two French Polynesian islands in the southern hemisphere

Atmospheric nuclear weapons tests carried out by the United States, the former Soviet Union, the United Kingdom, France and China between 1945 and 1980 resulted in radioactive fallout over the earth's surface of long-lived radionuclides, such as ¹³⁷Cs, ^239+240Pu and ²³⁸Pu that could be detected more than 50 years after their production. In addition, the burnup in the upper atmosphere of a thermoelectric generator fueled by ²³⁸Pu, SNAP-9A, contributed to the inventory of ²³⁸Pu deposited on the ground. In order to estimate the deposition densities of ¹³⁷Cs, ^239+240Pu and ²³⁸Pu in French Polynesia, we collected undisturbed soil samples up to 30 cm deep at eight sites in two islands (Hiva Oa, 139°W - 10°S and Raivavae, 148°W - 24°S) in 2015-2016. The top 0-10 cm of the soil cores were sliced into five 2-cm layers and the bottom 10-30 cm into four 5-cm layers for gamma spectrometry and alpha spectrometry measurements. We found that more than 50% of the radioactive inventories are still contained within the first 10 cm and that the average vertical migration velocities of ¹³⁷Cs and Pu are less than 0.2 cm y^-1. The average accumulated depositions, deduced from the profile measurements, are 236 ± 11 Bq.m^-2 and 313 ± 39 Bq.m^-2 for ¹³⁷Cs, 12.1 ± 1.5 Bq.m^-2 and 22.1 ± 1.7 Bq.m^-2 for ^239+240Pu, and 1.23 ± 0.46 Bq.m^-2 and 1.58 ± 0.60 Bq.m^-2 for ²³⁸Pu, in Hiva Oa and Raivavae, respectively. The ²³⁸Pu/^239+240Pu ratios are 0.102 ± 0.050 at Hiva Oa and 0.072 ± 0.033 at Raivavae. Both values are higher than the ratio in nuclear weapons tests fallout estimated to be 0.016 in 2016 (Hardy et al., 1973), because of the contribution of ²³⁸Pu fallout from SNAP-9A, which is latitude dependent. The ¹³⁷Cs/^239+240Pu ratios, 19.5 ± 3.2 at Hiva Oa and 14.2 ± 2.8 at Raivavae are in the lower part of the range of values observed in other regions of the world.

A novel "pro-healing" approach: the COMBO™ dual therapy stent from a pathological view

Current generations of monotherapy drug-eluting stents only inhibit neointimal hyperplasia. However, these stent designs have other drawbacks such as delayed arterial healing, hypersensitivity, late stent thrombosis, and neoatherosclerosis, creating a need for a new generation of safer devices. The novel 'pro-healing' COMBOTM dual therapy stent aims to address these issues by reducing neointimal hyperplasia via an abluminal bioabsorbable polymer eluting sirolimus, and by simultaneously capturing circulating endothelial progenitor cells via luminally immobilized anti-CD34+ antibodies. Short-term preclinical data shows promising results as compared to 1st generation and 2nd generation drug-eluting stents; however long-term literature remains unavailable until now. This review aims to evaluate, histopathologically, drawbacks of the current era of stents at autopsy, review short-term preclinical and clinical data from the REMEDEE trial, and present original long-term preclinical data. To date, preclinical data shows good performance of the COMBOTM stent comparable with the safety profile of bare metal stents with minimal inflammation, increased endothelialization, and acceptable neointimal hyperplasia with no statistical evidence of late catch-up. Clinical data from the REMEDEE trial at 12 months shows non-inferiority to paclitaxel drug-eluting stents, no evidence of late stent thrombosis, and a low rate of adverse clinical events.

[Anatomy and biomechanics of distal radius fractures: a literature review]

Distal radius fractures remain the most frequent fractures in the adult. Associated osteoporosis increases morbidity risk (secondary displacement is the most frequent) and mortality risk (in women older than 60). Severity of the fracture and functional results are related to the bone mineral density. Anatomy has been recently revisited with better description of palmar and dorsal aspects in order to avoid material-related complications. Standard postero-anterior, lateral and oblique radiographs of the wrist show the fracture and the displacement. CT scan is warranted if conventional X-rays are insufficient to show the articular surface. The involvement of the metaphysis (comminution), the epiphysis (articular fracture) and the ulna is different in each case and each fracture is an association of these three components. The MEU classification describes the fracture with sufficient inter-observer reliability and intra-observer reproducibility to be a useful tool for treatment and prognosis. The PAF system is used to propose the most appropriate treatment for each patient. Anatomical reduction and stable fixation are associated with good functional results but in high demanding patients.

[Fanconi anemia in 2012: diagnosis, pediatric follow-up and treatment]

Fanconi anemia (FA) is a rare genetic disease, transmitted in an autosomal recessive mode. The clinical phenotype is very broad and heterogeneous, related to the wide range of genes involved in this pathology. The classical triad of short height, physical abnormalities, and bone marrow failure is suggestive. The main physical abnormalities found involve the limbs, spinal column, skin, kidneys and urinary tract, and the ORL zone. Recent progress in molecular biology has identified 15 genes whose mutation causes FA chromosomal instability. FA is diagnosed by cytogenetic examination, then specified by molecular analysis. As FA patients may present multiorgan abnormalities and a high risk for neoplasia development, their medical follow-up has to be multidisciplinary and prolonged throughout life. The main challenges of the follow-up are patient information and education. Bone marrow failure, appearing during the first decade, requires close hematological monitoring and for severe cases requires hematopoietic stem cell transplantation, major and specific care with frequent serious complications and high mortality, but this is the only curative treatment in FA. Extrahematological care consists in screening for organ abnormalities and defects as well as monitoring precancerous lesions and tumors.

Proximal ulna comminuted fractures: fixation using a double-plating technique

INTRODUCTION

Comminuted fractures of the proximal ulna are severe injuries often associated with bone and ligament injuries of the elbow joint (Monteggia lesion, radial head fractures, dislocation of the elbow). The treatment of these fractures is very demanding and the functional results often fairly mediocre due to associated injuries. Based on a single-center retrospective study, we report the results of the treatment of these fractures fixed using a double-plate technique. The aim was to evaluate the feasibility and reliability of this fixation mode and to compare it with other fractures series using a single plate fixation (in terms of bone union, elbow joint function, and complications stemming from the plates).

PATIENTS AND METHODS

Eighteen patients sustained a comminuted proximal ulna fracture between 2002 and 2006. The fractures were associated in five cases with a Monteggia type lesion, in two cases with elbow dislocation, and in four cases with a Mason 3 radial head fracture. Four patients had an open fracture. These comminuted ulna fractures included nine Mayo Clinic IIIB fractures. Bone fixation was performed with two third-cylinder tubular plates, one plate on each side of the proximal ulna. This allows more versatile solutions for screw insertion. Functional assessment (according to Broberg and Morrey) and radiological evaluation (bone healing) were provided at 6 months and at the longest follow-up by an independent surgeon.

RESULTS

Sixteen of 18 patients achieved bone union. No septic complications occurred and no hardware removal was required on patient request. In 67% of the cases, the Morrey score indicated excellent or good results with a mean score of 82.

DISCUSSION

There are no reports in the literature on the technical point of fixation concerning complex fractures of the ulna. Two plates mean the possibility of twice the number of screw insertions for epiphyseal reconstruction . This fixation remains easy to perform and provides stable anatomic reconstruction of the ulna.

LEVEL OF EVIDENCE

Level IV. Retrospective study.

[Fractures of the distal radius in patients over 70 years old: Volar plates or K-wires?]

In a growing elderly osteoporotic population, the management of distal radius fractures remains without consensus as to volar distal plate versus K-wires. The goal of this retrospective study was to evaluate these treatments in elderly people. In a series of 38 patients over 70 years, 21 were treated by a volar plate and 17 by percutaneous K-wire fixation. Follow-up was at least 6 months. Results were analyzed using the disabilities of the arm, shoulder and hand (DASH), patient-rated wrist evaluation (PRWE) and Herzberg score by an independent operator. Radiological parameters were radio-ulnar variance, radial inclination and palmar or dorsal tilt. Radio-ulnar variance was better for the plate group (-0.7mm versus -0.1mm in K-wires). Mean functional outcomes were good but there were more satisfied patients in the plate group (67% versus 39% for the K-wire group). Secondary displacements were frequent in both groups but more with K-wires (50% versus 37% in case of plates). Six articles about surgical treatment of elderly radius distal fractures were published up to 2009 showing similar results. However, they analyze only global mean scores. Volar plates give more stability and a higher rate of satisfaction, with similar results of wrist mobility and grasp strength. The main advantage of the plates is earlier return to daily activities.

Efficacy of a support group programme for care-givers of demented patients in the community: a randomized controlled trial

Dementia induces morbidity not only in the patients but also in the families taking care of them. Many studies described the impact of care-giving on physical and psychological health. Support groups were designed to alleviate the burden of care-givers. The objective of this study was to measure the efficacy of a support group programme for care-givers of demented patients in the community. Forty-one primary care-givers were randomly assigned to a study (n=23) or a control group (n=18). Subjects of the study group attended a structured programme of eight 2-h sessions. These weekly sessions consisted of information on the disease, role-playing on management of behavior problems, discussion on emotional impact of care-giving, and learning of stress management techniques. Subjects of the control group were referred to informal monthly meetings of the Alzheimer's Society. Subjects of both groups were evaluated at the entry (T1), after 8 weeks (T2) and after 8 months (T3). The outcome variables were the Burden Interview, the Revised Memory and Behavior Problems Checklist, the Brief Symptoms Inventory, the Alzheimer's Disease Knowledge Test and a questionnaire on health care utilization. Compared with the control group, subjects of the study group yielded only a significant increase in knowledge about the disease (p<0.0001) but no significant difference on the other outcome variables. It is concluded that this type of support group programme seems to have only a minimal impact on morbidity and on the burden of care-givers. These results are similar with two other studies examining the same issue.

Fractures comminutives du radius distal traitées par ostéosynthèse et substitut osseux injectable

PURPOSE OF THE STUDY

Comminution is often neglected in patients presenting fractures of the distal radius. Use of injectable bone substitutes can fill the gap left by comminution, avoiding radial shortening and loss of prono-supination.

MATERIAL AND METHODS

Forty-eight patients with a distal fracture of the radius were treated by osteosynthesis and injectable cement between 1998 and 2001. These patients were reviewed at mean follow-up of 46 months (36-56). Dorsal displacement was present in all cases and the AO classification was A (n=26), B (n=15), C (n=7). Fixation was achieved with pins (n=32), posterior plate (n=14), and external fixator (n=2) before injection of the bone substitute. Outcome was evaluated with the Herzberg score, the Gartland and Werley score and DASH by an independent operator.

RESULTS

Four patients were lost to follow-up and five who developed a deformed callus after the initial osteosynthesis were excluded from the analysis. The Herzberg functional score reached 84 (range 54-100) and the Gartland and Werley radioclinical score was 4.6 (0-11) with 89% excellent and good outcomes. DASH was 23.6 (5.8-62.7). Ulnar variance was unchanged or changed less than 2 mm between the immediate postoperative period and last follow-up in 88% of patients. There was one carpal tunnel syndrome related to anterior cement leakage. Three biopsies were performed and revealed a "humid sand" aspect six months after injection as well as presence of osteoblasts within the bone substitute. There was no or very little resorption.

DISCUSSION

Several authors have demonstrated the biomechanical and functional effects of filling the comminution gap to avoid radial shortening. The first reported cases, then later prospective series, favored the use of injectable cements for patients with comminution. Cement used in our patients allowed preservation enables preservation of normal ulnar variance in addition to filling the gap. Like any bone substitute, it is an attractive alternative to other filling methods (ceramic graft) offering two advantages: adaptation to the bone defect and primary stability. This easy-to-use cement is resorbed slowly. Because of high cost, it may be reserved for patients with important functional needs.

In situ metrology of 85Kr plumes released by the COGEMA La Hague nuclear reprocessing plant

The IRSN (Institut de Radioprotection et de Sûreté Nucléaire, France) has started an in situ study of the behaviour of atmospheric releases close-by the COGEMA La Hague nuclear reprocessing plant. The study is designed to improve information on the dispersion of radioactive pollutants very close to the emission point--a 100 m height chimney. In this situation, close to the emission and height of the emission, Gaussian models generally used to predict the behaviour of atmospheric releases are not well adapted. The study is based on the characterisation of the 85Kr emitted during normal operations of the reprocessing process. Temporal and spatial variations of the plume shape were investigated with intensive in situ measurements. Live in situ techniques to measure the electrons and the photons emitted by the 85Kr have been implemented and will be described. Preliminary results showing the interest of the techniques were presented. Variations of the dose rates created by the photon flux of a plume were directly measured and correlated to other quantities.

New series of N-substituted phenyl ketone oxime ethers: synthesis and bovine beta3-adrenergic agonistic activities

A series of ten novel phenyl ketone oxime ethers substituted on the terminal nitrogen by either 1,3 benzodioxole, alkyl, aralkyl or aryl moiety were synthesized and tested for their activity at bovine beta3-adrenoceptors. The best compound, which was the benzodioxole dicarboxylate derivative, showed potent beta3-adrenergic agonistic activities in Chinese hamster ovary cells expressing the bovine beta3-adrenoceptors with Kact and Ki values better than compound CL 316,243 used as reference (14 +/- 6 nM and 203 +/- 71 nM, respectively). In this series three compounds showed an antagonistic activity. Structure-activity relationships in these ketone oxime ethers are discussed.

Concentration and distribution of 210Po in the tissues of the scallop Chlamys varia and the mussel Mytilus edulis from the coasts of Charente-Maritime (France)

Polonium-210 (210Po) has been analysed in the soft parts of two bivalves species, the scallop Chlamys varia and the common mussel Mytilus edulis, from the Bay of La Rochelle and Ré Island, on the French Atlantic coast. Between those sites, the highest 210Po concentrations have been found in whole scallop soft parts from La Rochelle, reaching 1,181 +/- 29 Bq kg(-1) dry weight (dwt), a size effect being related to the highest 210Po concentration in the smallest scallops. The results show a significant difference in concentrations for similar size individuals between species in each site (C. varia > M. edulis) and between sites for each species (Ré Island > Bay of La Rochelle). Very high 210Po concentrations have been found in the digestive gland of C varia, ranging 3,150-4,637 Bq kg(-1) dwt. Thus, the digestive gland contains up to 60% of the radionuclide. Subcellular investigations have shown that approximately 40% of the 210Po contained in the digestive gland is in the cytosolic fraction, suggesting a high bioavailability of the 210Po from this fraction to the trophic upper level. Calculations will show that approximately 4 kg of scallops flesh intake would be necessary to reach the annual incorporation limit of 1 mSv.

Synthesis and bovine beta 3-adrenergic agonistic activities of a novel series of aryloxypropanolamines

We synthesized a novel series of 21 aryloxypropanolamine compounds characterized by N-alkyl, aralkyl, and aryl substituents. The compounds showed potent beta 3-adrenergic agonistic activities in Chinese hamster ovary cells expressing the bovine beta 3-adrenoceptors with Kact and Ki values of 4.2 +/- 3.0 nM and 459 +/- 169 nM respectively, for the ligand with the best compromise between potency and affinity. Structure-activity relationships are discussed.

Effect of ionizing radiation on thymidine uptake, differentiation, and VEGFR2 receptor expression in endothelial cells: the role of VEGF(165)

PURPOSE

Late thrombosis of irradiated vascular segments may be the consequence of endothelial cell (EC) dysfunction after radiation therapy. We investigated the effects of beta ionizing radiation on human EC viability, thymidine uptake, and differentiation.

METHODS AND MATERIALS

Endothelial cells were exposed to (32)P-labeled DNA oligonucleotides in incremental doses of 2, 6, and 10 Gy. The modulation of the VEGFR2 receptor expression after irradiation and the overall potential radioprotective effect of VEGF(165) on these functions were assayed.

RESULTS

A dose-dependent inhibitory effect of beta irradiation on ECs' thymidine uptake and differentiation was observed. EC viability, however, was not affected at levels of radiation up to 10 Gy. VEGF(165) proved to have a radioprotective effect as ECs' thymidine uptake, after radiation doses of 2, 6, and 10 Gy, was increased by 1.5-, 2-, and 4-fold, respectively, in the presence of 10 ng/ml of VEGF(165) (p < 0.05 vs. LacZ). This concentration of VEGF(165) also proved beneficial in maintaining cell differentiation at 16 h postirradiation when compared to controls. These biologic effects were in direct correlation with the upregulation of VEGFR2 receptor expression in irradiated ECs.

CONCLUSIONS

beta irradiation interacts directly with EC functions by significantly reducing their ability to differentiate and proliferate, associated with upregulation of VEGFR2. These effects can be prevented in part by pretreating cells with VEGF(165), an effect potentially favored by the upregulation of VEGFR2 receptor expression after irradiation.

Effects of radiation therapy on vascular responsiveness

The use of radiation therapy to inhibit vascular proliferative diseases has produced encouraging results in several clinical trials. However, little is known about the possible side effects of radiation on vascular responsiveness. Our goal was to study the in vitro vascular responses of the rabbit aorta to various agonists immediately after several regimens of radiation therapy administered at doses prescribed in clinical protocols and at two different dose rates. High-dose-rate radiation was administered either by brachytherapy, using a gamma source, iridium 192, or an external electron beam producing beta radiation. Low-dose-rate radiation was administered by brachytherapy using a liquid-filled balloon with the beta emitter 32P. Vascular reactivity after the various regimens of irradiation was determined using the organ bath pharmacology assay. Various agonists were applied to the rabbit aorta to produce full cumulative concentration-response curves. Radiation, administered using an external electron beam, did not alter endothelium-dependent relaxation of the aorta induced by acetylcholine. However, the use of a catheter-based system to deliver radiation disrupted the endothelial cell lining of the vessel, causing a lack of relaxation by acetylcholine. Therefore, to compare all modalities of radiation therapy on vascular responsiveness, the agonists used in this study are known to act directly on the smooth muscle. Radiation therapy had no effect on the contractile responses induced by the following agonists: phenylephrine and potassium chloride. Vascular dilatation induced by nitroglycerin, a nitric oxide donor, was unaffected by radiation therapy. The contractile response induced by des-Arg9-bradykinin, a kinin B1 receptor agonist, was significantly increased twofold to threefold by all types of irradiation under study. This enhanced response is attributable to an increase of mRNA levels coding for this receptor. In all cases, radiation therapy did not alter the effective concentration producing 50% of maximal responsiveness (EC50) and did not reduce the vascular responsiveness induced by agonists. Taken together, we conclude that radiation therapy does not hinder endothelium-independent vascular responsiveness and increases the kinin B1 receptor-mediated vasoconstriction.

Sequences and antimycoplasmic properties of longibrachins LGB II and LGB III, two novel 20-residue peptaibols from Trichoderma longibrachiatum

Longibrachins are members of the class of natural Aib-containing peptides designated as peptaibols. Six longibrachins, LGA I-IV and LGB II and III, were purified from a Trichoderma longibrachiatum strain by a procedure employing several chromatography steps including reversed-phase HPLC. The amino acid sequence determination was based on a combination of liquid secondary ion mass spectrometry (LSIMS) and two-dimensional 1H and 13C NMR spectroscopy. Longibrachins are 20-residue peptaibols with a C-terminal phenylalaninol and either neutral (LGA; Gln18) or acidic (LGB; Glu18) character. Longibrachins LGB II and III have novel sequences. Both longibrachins LGA and LGB show significant bactericidal activity against mycoplasmas (Acholeplasma, Mycoplasma, and Spiroplasma), with minimal inhibitory concentrations in the range 1.56-12.5 microM (3-25 micrograms/mL), and also perturb the permeability of membrane bilayers. Longibrachin LGA IV is the most potent of the presently known 18-20-residue peptaibols. The antimicrobial and membrane-perturbing properties of longibrachins, which are described here for the first time, were shown to be correlated.

[Psychosocial resources, transitory events and quality of life of aging people.]

Based on data of the Québec longitudinal study on aging, this article examines crosswise the relation between psychosocial resources of elderly people and their quality of life. The sample of 781 subjects includes three groups of elderly people selected according to their age and their experience or not of a major transitory event: retirement (60-65), widowed (70-75) and functional incapacity (80-85). The results confirm that respondents with a high level of psychosocial resources obtain better performances in the various indexes of quality of life. However, in regards to events, the protective effect of psychosocial resources on quality of life is only shown with those people in retirement. We notice that with people with functional incapacity, social support seem to slightly contribute in maintaining quality of life. Finally, the authors propose certain explanations.

Allergic contact dermatitis to epoxy resin in microscopy immersion oil: cases from Canada

The presence of epoxy resin in a reformulated immersion oil for microscopy has caused an epidemic of occupational contact dermatitis in laboratory technicians from some European centers. We report 6 additional cases, the mode of presentation of which was similar to the European patients. All patients were patch tested to the undiluted oil, and some were tested to the European or North American standard series and to an extensive series of glues and adhesives allergens. At 96 hours, all 6 patients displayed a strong 2+ to 3+ reaction to the undiluted oil. Two patients were not further tested, but in the remaining 4, positive reactions were seen to epoxy resin from the standard tray. One patient reacted to cycloaliphatic epoxy resin, and 2 displayed positive tests to the reactive diluents phenyl glycidyl ether and cresyl glycidyl ether. These further cases confirm the strong sensitizing properties of this particular immersion oil. The product, manufactured by Leica Microsystems (Wetzlar, Germany), since has been withdrawn from sale.

[Incidence of the onset of disability and recovery of functional autonomy among the very old after one year]

BACKGROUND

This article measures the survival rate and explores the changes in functional autonomy among both men and women over a one-year period in a sample of 272 subjects aged 80-85.

METHODS

Data were taken from the Quebec Longitudinal Study on Aging, a multi-cohort prospective study focusing on health and quality of life. The sample comprises two sub-groups, namely disabled and autonomous subjects. Eligible participants were selected from the Quebec Health Insurance Plan (QHIP) file. However, to obtain the required number of participants, the sample was completed from eligible subjects who volunteered in response to TV, billboard and newspaper advertising about the project. The Functional Autonomy Measurement System (SMAF) was used to assess disability. The SMAF assesses functional disability in 5 domains: activities of daily living (ADL), mobility, instrumental activities (IADL), communication, and mental functioning.

RESULTS

After one year, nearly 5% of the subjects had died and 72.5% were still autonomous, i.e., they had a score under 4.5 on the SMAF. The annual incidence of the onset of disability (including death, lengthy hospitalization, functional incapacities and cognitive deficits) was 20%. However, no difference was found between the sexes in regard to the risk of losing autonomy. The main areas where disability occurred among the previously autonomous subjects were, in order of importance, domestic tasks, mobility and communication. The study confirmed that it is possible to recover autonomy, even at this advanced age, particularly for women (11.2%), but less so for men (3.6%).

CONCLUSION

This phenomenon of recovering functional autonomy suggests that octogenarians have a residual potential and confirms the effectiveness of preventive and curative measures and the benefits of interventions by community and family networks.

Criterion validity of a new measure of self-actualization

Many authors have questioned the validity of the major existing measures of self-actualization (the Personal Orientation Inventory, the Personal Orientation Dimensions, and the Short Index of Self-actualization), given their serious theoretical and methodological limitations. A new inventory was developed, the Measure of Actualization of Potential, and various studies were conducted to assess its theoretical and empirical content as well as its construct validity, internal consistency, and temporal reliability. The present aim was to estimate the criterion validity of the new measure using humanistic clinical psychologists' assessments as the criterion. The results show that eight clinical psychologists' rankings of 73 individuals are positively and highly correlated with the scores obtained by the same individuals on the Measure of Actualization of Potential.

Specific nonpeptide photoprobes as tools for the structural study of the angiotensin II AT(1) receptor

The aim of this work was to obtain photoactivatable nonpeptide antagonists of the angiotensin II AT(1) receptor. Based on structure-function relationships, two chemical structures as well as appropriate synthetic schemes were chosen as a frame for the design of radiolabeled azido probes. The feasibility of the strategy was first assessed by the synthesis of two tritiated ligands 21 and 22 possessing a high affinity for the AT(1) receptor and a low nonspecific binding to membrane or cell preparations. We then prepared two unlabeled azido derivatives 7 and 14 which retained a fairly high affinity for the AT(1) receptor. The latter compound proved to be suitable for receptor irreversible labeling and was prepared in its tritiated form 28. This tritiated azido nonpeptide probe displayed a K(d) value of 11.8 nM and a low nonspecific binding. It was suitable for specific and efficient covalent labeling of the recombinant AT(1A) receptor stably expressed in CHO cells. The electrophoretic pattern of the specifically labeled entity was strictly identical to that of purified receptor photolabeled with a biotinylated peptidic photoactivatable probe. This new tool should be useful for the mapping of the nonpeptide receptor binding site. These potential applications are discussed in light of the current knowledge of molecular mechanisms of G-protein coupled receptor activation and inactivation.

New calcium antagonists: synthesis, X-ray analysis, and smooth muscle relaxing effect of 3-[O-(benzyl-substituted)-oximino-ethers]-hexahydroazepin-2,3- diones

A series of new Z and E 3-[O-(benzyl-substituted)-oximino-ether]-hexahydroazepin-2,3 -diones was prepared from the corresponding hexahydroazepin-2,3-diones and examined as smooth muscle relaxants. E and Z structures were assigned by NMR analysis and confirmed for 16 (E and Z) by an X-ray diffraction using synchrotron radiations. The nitrobenzyl derivative 16 was the most potent in vitro as relaxant of rat trachea precontracted with acetylcholine. The E isomer 16b was more potent than the Z isomer 16a. E isomer 16b is more potent than aminophylline to relax both rat trachea and human bronchus. This derivative acts mainly by inhibiting cellular influx of extracellular calcium since it inhibits potently and dose-dependently the contractions of rat trachea to high concentrations of KCI and to CaCl2 in a depolarizing medium. It appears to act weakly by inducing cGMP and cAMP synthesis. Moreover, its relaxing activity is not related to an inhibition of phosphodiesterases, to opening of potassium channels or to induction of prostaglandin synthesis. Therefore, 16b appears to work mainly as a potent calcium antagonist.

Preparation and pharmacological evaluation of the R- and S-enantiomers of 3-(2-butylamino)-4H- and 3-(3-methyl-2-butylamino)-4H-pyrido[4,3-e]-1,2,4-thiadiazine 1,1-dioxide, two tissue selective ATP-sensitive potassium channel openers

The preparation and the pharmacological evaluation of the R- and S-isomers of 3-(2-butylamino)-4H-pyrido[4,3-e]-1,2,4-thiadiazine 1,1-dioxide (BPDZ 42) and 3-(3-methyl-2-butylamino)-4H-pyrido[4,3-e]-1,2,4-thiadiazine 1,1-dioxide (BPDZ 44), two potassium channel openers, is described. Their optical purity was estimated by means of capillary electrophoresis (R- and S-BPDZ 42) and chiral HPLC (R- and S-BPDZ 44). The absolute configuration of each isomer of BPDZ 44 was deduced from crystallographic data. Pharmacological assays performed with the R- and S-isomers of BPDZ 44 revealed only slight differences in their activity on pancreatic B-cells but significant differences in their activity on vascular smooth muscle cells: the R-isomer being sixfold more potent than its corresponding S-isomer. The R-isomer of BPDZ 42 was shown to be more potent than its corresponding S-isomer on the endocrine pancreas. S-BPDZ 44 as well as R- and S-BPDZ 42 were found to exhibit tissue selectivity for the pancreatic versus the vascular smooth muscle tissue.

Healing of experimental aneurysms. II: Platelet extracts can increase the thickness of the neointima at the neck of treated aneurysms

PURPOSE

To assess the effect of platelet extracts (PE) on neointima formation following gelfoam packing of experimental porcine aneurysms. A strategy involving the local delivery of platelet growth factors may potentially improve long term results of endovascular treatment of aneurysms.

METHODS

Bilateral lateral wall common carotid aneurysms were constructed on 30 pigs. A collagen sponge containing a PE rich in growth factors was used to pack one aneurysm with the controlateral lesion being embolized with a sponge containing NaCl 0.9% (22 animals). In 8 animals, a control sponge was used on both sides. Animals were sacrificed at 1, 2, 3, 4 and 9 weeks and the thickness of the neointima covering the neck of PE-treated aneurysms was measured in 5 locations for each lesion at 2 and 3 weeks and compared with the control aneurysm of the same animal. Morphometric data was analysed using the paired Student's t-test.

RESULTS

The thickness of the neointima was significantly increased in lesions treated with PE as compared to control lesions at 2 weeks (p = 0.008, n = 9). There was no significant difference at 3 weeks (p = 0.99, n = 9). There was no significant difference between lesions of control animals (p = 0.95, n = 8).

CONCLUSION

PE rich in growth factors can increase the thickness of the neointima at the neck of treated experimental porcine aneurysms at 2 weeks, but had no effect at 3 weeks. This accelerated neointimal formation may have some value in improving healing following endovascular treatment. This hypothesis could not be supported with this experimental model which has a spontaneous tendency to heal. Further studies using an animal model which reproduces the clinical problem of recurrences may help to define the role of the local delivery of growth factors in combination with coils in a strategy designed to improve results of endovascular treatment.

Cellular effects of beta-particle delivery on vascular smooth muscle cells and endothelial cells: a dose-response study

BACKGROUND

Although endovascular radiotherapy inhibits neointimal hyperplasia, the exact cellular alterations induced by beta irradiation remain to be elucidated.

METHODS AND RESULTS

We investigated in vitro the ability of 32P-labeled oligonucleotides to alter (1) proliferation of human and porcine vascular smooth muscle cells (VSMCs) and human coronary artery endothelial cells (ECs), (2) cell cycle progression, (3) cell viability and apoptosis, (4) cell migration, and (5) cell phenotype and morphological features. beta radiation significantly reduced proliferation of VSMCs (ED50 1.10 Gy) and ECs (ED50 2.15 Gy) in a dose-dependent manner. Exposure to beta emission interfered with cell cycle progression, with induction of G0/G1 arrest in VSMCs, without evidence of cell viability alteration, apoptosis, or ultrastructural changes. This strategy also proved to efficiently inhibit VSMC migration by 80% and induce contractile phenotype appearance, as shown by the predominance of alpha-actin immunostaining in beta-irradiated cells compared with control cells.

CONCLUSIONS

32P-labeled oligonucleotide was highly effective in inhibiting proliferation of both VSMCs and ECs in a dose-dependent fashion, with ECs showing a higher resistance to these effects. beta irradiation-induced G1 arrest was not associated with cytotoxicity and apoptosis, thus demonstrating a potent cytostatic effect of beta-based therapy. This effect, coupled to that on VSMC migration inhibition and the appearance of a contractile phenotype, reinforced the potential of ionizing radiation to prevent neointima formation after angioplasty.

Healing mechanisms in experimental aneurysms. I. Vascular smooth muscle cells and neointima formation

PURPOSE

The purpose of this work is to better define healing phenomena in this model, in an effort to find strategies to improve long term results of endovascular treatment.

METHODS

Lateral wall venous pouch aneurysms were constructed on both carotid arteries in 30 pigs. The aneurysms were packed with collagen sponges per-operatively in 25 animals. Angiography, serial histological studies and immuno-histochemistry tests were used to study healing phenomena and measure neointima formation at various time intervals from 1 day to 9 weeks after surgery. GDC embolization was performed in 5 other pigs for comparison with the collagen sponge model. Explants from the neointima at the neck of aneurysms as well as from the parent artery of 8 pigs were prepared in an attempt to grow and to characterize in vitro cells responsible for healing porcine aneurysms using immunocytochemistry and enzymatic assays. To confirm the hypothesis that an analogy exists between cells involved in aneurysmal healing and neointimal cells found in restenosis, explant outgrowths were scored and compared to explants from intact carotid arteries and carotid arteries subjected to angioplasty in 3 other animals. In addition, to test the value of neointima measurements in quantifying results, 6 dogs were analysed to correlate the thickness of the neointima formed at the neck of aneurysms with angiographic results in animals prone to recurrences.

RESULTS

Histopathological findings with collagen sponge packing were similar to the ones following coil embolization. Porcine aneurysms had a strong tendency to heal with a thick neointima primarily composed of vascular smooth muscle cells (VSMCs). Aneurysms in dogs did not heal as well and the neointima at the neck of treated lesions was thin. Cells responsible for healing of experimental porcine aneurysms could be cultured in vitro, and are activated VSMCs. These cells, similar to those harvested following balloon injury, had a higher colony forming capacity and an accelerated explant outgrowth rate as compared to cells derived from the parent artery.

CONCLUSION

Animals which heal poorly harbor a thin or deficient neointima at the neck of treated aneurysms. Favorable healing in porcine aneurysms involves VSMCs which form a thick neointima. These VSMCs can be cultured in vitro. They share similar outgrowth characteristics with VSMCs recovered after balloon angioplasty. The collagen sponge model may be useful to harvest cells for in vitro experimentation and in the in vivo evaluation of the local delivery of potential therapeutic molecules thought to improve healing following embolization of aneurysms.

Synthesis, activity, and molecular modeling of new 2, 4-dioxo-5-(naphthylmethylene)-3-thiazolidineacetic acids and 2-thioxo analogues as potent aldose reductase inhibitors

A series of 2,4-dioxo-5-(2-naphthylmethylene)-3-thiazolidineacetic acids and 2-thioxo analogues have been prepared as aldose reductase inhibitors. In vitro inhibitory activities of bovine lens aldose reductase were determined by a conventional method. 1-Naphthyl-substituted derivatives of the 2-thioxo series were the more potent inhibitors (IC50 congruent with 10 nM) with similar activity to that of Epalrestat. Structural analysis, especially by X-ray crystallography of two selected compounds, and molecular modeling comparisons with Zopolrestat were performed. These results provide explanations of the good activity of the inhibitor, the preference for 1-naphthyl-substituted compounds, and the nature of molecular interactions in these systems.

A new class of Caulobacter crescentus flagellar genes

Eight Caulobacter crescentus flagellar genes, flmA, flmB, flmC, flmD, flmE, flmF, flmG, and flmH, have been cloned and characterized. These eight genes are clustered in pairs (flmAB, flmCD, flmEF, and flmGH) that appear to be structurally organized as operons. Homology comparisons suggest that the proteins encoded by the flm genes may be involved in posttranslational modification of flagellins or proteins that interact with flagellin monomers prior to their assembly into a flagellar filament. Expression of the flmAB, flmEF, and flmGH operons was shown to occur primarily in predivisional cells. In contrast, the flmCD operon was expressed throughout the cell cycle, with only a twofold increase in predivisional cells. The expression of the three temporally regulated operons was subject to positive regulation by the CtrA response regulator protein. Mutations in class II and III flagellar genes had no significant effect on the expression of the flm genes. Furthermore, the flm genes did not affect the expression of class II or class III flagellar genes. However, mutations in the flm genes did result in reduced synthesis of the class IV flagellin proteins. Taken together, these data indicate that the flm operons belong to a new class of flagellar genes.

Synthesis and adrenergic activity of a new series of N-aryl dicyclopropyl ketone oxime ethers: SAR and stereochemical aspects

A novel series of 31 N-aryl dicyclopropyl ketone oxime ethers were synthesized and tested for their activity at alpha- and beta-adrenergic receptors. All of the compounds showed greater affinity for beta-than for alpha1-receptor sites. Some compounds had pure antagonist effects whereas some were partial agonists. Several compounds had an antagonist effect matching that of propranolol in in vitro (binding data and pA2 values on rat heart ventricle homogenates and guinea pig spontaneously beating right and electrically driven left atrial isolated preparations, respectively) and in in vivo tests (measurement of antagonism toward isoprenaline-induced tachycardia in anesthetized rats). Furthermore, all of the compounds showed a beta1-adrenergic selectivity (beta2-affinity > 1500 nM).

[Twenty practical questions about prenatal corticosteroid therapy]

Since Liggins and Howie first published their work, numerous studies have shown that corticosteroids significantly decrease perinatal mortality and morbidity, without complication for the mothers and child. Corticosteroids should be prescribed in case of threatening premature birth. Imminent delivery premature rupture of the membranes and gestationnal age over 34 weeks are not contraindications to prescription, as corticosteroids can be safely given all in these circumstances. Theoretically, more than half of premature neonates should have been treated with corticosteroids. Actually, only 20% or less are currently treated. The cost-effectiveness ratio of an antenatal corticosteroid policy would be extremely positive: more than 1,500 prenatal deaths could theoretically be avoided in France annually and the overall cost of neonatal care would decrease by 10%.

Directed biosynthesis of peptaibol antibiotics in two Trichoderma strains. II. Structure elucidation

Alpha-aminoisobutyric acid-directed biosynthesis in two Trichoderma strains has been shown to lead to the simplification of the natural peptaibol microheterogeneous mixtures and to the production of new analogues. Hence, two new peptides originating from T. harzianum, trichorzin PA(U) 4 and harzianin PCU 4, were isolated by HPLC. Their sequences were determined by positive liquid secondary-ion mass spectrometry (LSI MS). Trichorzin PA(U) 4 and harzianin PC(U) 4 are 18- and 14-residue peptaibols, respectively, both containing a high proportion of alpha-aminoisobutyric acid (Aib). LSI MS performed with lithium cationized peptides, allowed to assign the relative position of leucine/isoleucine isomeric residues, even without the use of tandem mass spectrometry.

Directed biosynthesis of peptaibol antibiotics in two Trichoderma strains. I. Fermentation and isolation

Peptaibols are linear alpha-aminoisobutyric acid-containing peptide antibiotics originating from soil fungi mainly of the genus Trichoderma and biosynthesized in complex mixtures of closely related analogues by a polyenzymatic pathway. Addition of amino acids such as alpha-aminoisobutyric acid (Aib), glutamic acid or arginine, to the fermentation medium of two Trichoderma strains, T. harzianum and T. longibrachiatum, has been shown to result in the simplification of the natural peptaibol mixtures, leading in each case to the almost exclusive biosynthesis of a single peptide. Surprisingly, the obtained peptides are Aib-enriched, whether the added amino acid is Aib, Glu or Arg. By adding Aib to the fermentation medium of T. harzianum, two new Aib-rich peptaibols were isolated. Moreover, adding glutamic acid to the culture medium of T. longibrachiatum, which produces both neutral and acidic 20-residue peptaibols with either glutamine or glutamic acid at position 18, increases the production of the acidic peptides. However, arginine which is a positively charged amino acid generally absent from peptaibol sequences, is not incorporated in trichorzins when added to the fermentation medium of T. harzianum.

Extra-pulmonary effects of inhaled nitric oxide in swine with and without phenylephrine

We have compared the effects of inhaled nitric oxide (iNO) and i.v. nitroglycerin (ivGTN) on the haemodynamic response to phenylephrine-induced hypertension (PEHT) in anaesthetized pigs. PEHT did not change either pulmonary vascular resistance or gas exchange throughout all experiments. Both treatments lowered pulmonary arterial pressure to the same extent (-12.4% iNO; -13.7% ivGTN) and passively via an effect on left atrial pressure (-26.3% iNO; -31.4% ivGTN). Both treatments failed to reverse the decrease in renal blood flow (RBFc) induced by PEHT, but both increased urinary flow (UF) (+128% iNO; +148% ivGTN). IvGTN significantly increased plasma concentrations of nitrite and nitrate during (+22.7% arterial blood; +26.2% venous blood) and beyond the period of infusion (iNO: +6.4% and +4.9%, respectively). In four control pigs (no PEHT), iNO markedly increased RBFc (+109%), glomerular filtration rate (+72.5%) and UF (+68.7%). We conclude that iNO may have direct cardiac and renal effects, probably via intervention of NO carrier forms such as S-nitroso compounds.

[The effect of family and social relations on the consumption of psychotropic drugs by the aged]

Psychotropic drugs are the second most commonly used medication by Quebec's elderly. The objective of this study is to test a theoretical model of psychotropic drug use in the elderly. The principal hypothesis is that the quality of relationships the elderly person has with others, particularly with his or her children, has a direct influence on his or her psychological well-being, which, in turn, directly affects the consumption of psychotropic agents. A survey was conducted on a sample of 500 elderly people, aged 65-84 years, living at home. 31.8% of the respondents used psychotropic drugs during the three-month period preceding the interview. Path analysis led to the elaboration of a modified model for the consumption of psychotropic drugs by the elderly which indicates that the best predictors of consumption are both the psychological well-being and the state of health of the individual. More elevated is the psychological well-being, less is the consumption of psychotropic drugs, whereas poor health condition increases it. The quality of an individual's social relationships has a direct influence on his or her psychological well-being, whereas family relationships are of lesser importance. Our model accounts for 13% of the predictors of psychotropic consumption by the elderly.

Differential expression of nonmuscle myosin II isoforms in human atherosclerotic plaque

Intimal proliferation and functional changes involving vascular smooth muscle cells are key events in the development of atherosclerosis, including restenosis after percutaneous transluminal angioplasty. Nonmuscle myosin (NMM) is required for cytokinesis and has been shown in cultures of vascular smooth muscle cells to undergo changes of isoform expression depending on the stage of proliferation and differentiation. The purpose of this study was to examine the differential expression of the two most recently identified nonmuscle myosin heavy chain isoform II (NMMHC-II) isoforms A and B in atherosclerotic plaque. Primary atherosclerotic and restenotic atherectomy specimens and non-atherosclerotic controls, were analyzed by Western Blot analysis, immunohistochemistry and in situ hybridization. Nonmuscle myosin heavy chain isoform IIA (NMMHC-IIA) was equally expressed in all types of tissue specimens both at the protein and mRNA levels. In contrast, NMMHC-IIB protein was found in restenotic specimens and normal artery but was at very low levels in primary atherosclerotic plaque. By in situ hybridization NMMHC-IIB mRNA levels were significantly greater in restenotic versus primary atherosclerotic lesions. NMMHC-IIB expression is associated with vascular restenosis but is downregulated in stable atherosclerotic lesions, whereas NMMHC-IIA is expressed in both. These results indicate that these new myosin isoforms have different functions and should be regarded separately with respect to smooth muscle proliferation and restenosis. They should prove to be useful molecular markers for the study of atherosclerosis and restenosis.