Human middle longitudinal fascicle: segregation and behavioral-clinical implications of two distinct fiber connections linking temporal pole and superior temporal gyrus with the angular gyrus or superior parietal lobule using multi-tensor tractography

The middle longitudinal fascicle (MdLF) is a major fiber connection running principally between the superior temporal gyrus and the parietal lobe, neocortical regions of great biological and clinical interest. Although one of the most prominent cerebral association fiber tracts, it has only recently been discovered in humans. In this high angular resolution diffusion imaging (HARDI) MRI study, we delineated the two major fiber connections of the human MdLF, by examining morphology, topography, cortical connections, biophysical measures, volume and length in seventy-four brains. These two fiber connections course together through the dorsal temporal pole and the superior temporal gyrus maintaining a characteristic topographic relationship in the mediolateral and ventrodorsal dimensions. As these pathways course towards the parietal lobe, they split to form separate fiber pathways, one following a ventrolateral trajectory and connecting with the angular gyrus and the other following a dorsomedial route and connecting with the superior parietal lobule. Based on the functions of their cortical affiliations, we suggest that the superior temporal-angular connection of the MdLF, i.e., STG(MdLF)AG plays a role in language and attention, whereas the superior temporal-superior parietal connection of the MdLF, i.e., STG(MdLF)SPL is involved in visuospatial and integrative audiovisual functions. Furthermore, the MdLF may have clinical implications in neurodegenerative disorders such as primary progressive aphasia, frontotemporal dementia, posterior cortical atrophy, corticobulbar degeneration and Alzheimer's disease as well as attention-deficit/hyperactivity disorder and schizophrenia.

European Psychiatric Association (EPA) Guidance on Post-graduate Psychiatric Training in Europe

The European Union Free Movement Directive gives professionals the opportunity to work and live within the European Union, but does not give specific requirements regarding how the specialists in medicine have to be trained, with the exception of a required minimum of 4 years of education. Efforts have been undertaken to harmonize post-graduate training in psychiatry in Europe since the Treaty of Rome 1957, with the founding of the European Union of Medical Specialists (UEMS) and establishment of a charter outlining how psychiatrists should be trained. However, the different curricula for post-graduate training were only compared by surveys, never through a systematic review of the official national requirements. The published survey data still shows great differences between European countries and unlike other UEMS Boards, the Board of Psychiatry did not introduce a certification for specialists willing to practice in a foreign country within Europe. Such a European certification could help to keep a high qualification level for post-graduate training in psychiatry all over Europe. Moreover, it would make it easier for employers to assess the educational level of European psychiatrists applying for a job in their field.

DIFFEOMORPHIC POINT SET REGISTRATION USING NON-STATIONARY MIXTURE MODELS

This paper investigates a diffeomorphic point-set registration based on non-stationary mixture models. The goal is to improve the non-linear registration of anatomical structures by representing each point as a general non-stationary kernel that provides information about the shape of that point. Our framework generalizes work done by others that use stationary models. We achieve this by integrating the shape at each point when calculating the point-set similarity and transforming it according to the calculated deformation. We also restrict the non-rigid transform to the space of symmetric diffeomorphisms. Our algorithm is validated in synthetic and human datasets in two different applications: fiber bundle and lung airways registration. Our results shows that non-stationary mixture models are superior to Gaussian mixture models and methods that do not take into account the shape of each point.

Unsupervised white matter fiber clustering and tract probability map generation: applications of a Gaussian process framework for white matter fibers

With the increasing importance of fiber tracking in diffusion tensor images for clinical needs, there has been a growing demand for an objective mathematical framework to perform quantitative analysis of white matter fiber bundles incorporating their underlying physical significance. This article presents such a novel mathematical framework that facilitates mathematical operations between tracts using an inner product between fibres. Such inner product operation, based on Gaussian processes, spans a metric space. This metric facilitates combination of fiber tracts, rendering operations like tract membership to a bundle or bundle similarity simple. Based on this framework, we have designed an automated unsupervised atlas-based clustering method that does not require manual initialization nor an a priori knowledge of the number of clusters. Quantitative analysis can now be performed on the clustered tract volumes across subjects, thereby avoiding the need for point parameterization of these fibers, or the use of medial or envelope representations as in previous work. Experiments on synthetic data demonstrate the mathematical operations. Subsequently, the applicability of the unsupervised clustering framework has been demonstrated on a 21-subject dataset.

Mathematical methods for diffusion MRI processing

In this article, we review recent mathematical models and computational methods for the processing of diffusion Magnetic Resonance Images, including state-of-the-art reconstruction of diffusion models, cerebral white matter connectivity analysis, and segmentation techniques. We focus on Diffusion Tensor Images (DTI) and Q-Ball Images (QBI).

Case report: cytomegalovirus primoinfection may be associated with severe outcome in burns

We report two cases of severe cytomegalovirus (CMV) primoinfection in seriously burned patients. The infection may have contributed to both patients' fatal outcome. This underlines the importance of research in viral aetiology, especially with regard to CMV, when immunodeficient patients - as burn patients are - develop unexplained fever. We propose a monitoring and a prevention strategy for CMV in the most severely burned patients. The prevention strategy involves the use of skin allografts and blood products in seronegative patients. CMV infection should not be underestimated in severely burned patients.

A silver sulphadiazine-impregnated lipidocolloid wound dressing to treat second-degree burns

OBJECTIVE

To evaluate the efficacy and tolerance of Urgotul SSD dressing (Laboratoires Urgo) in the treatment of second-degree burns.

METHOD

This was a national multicentre phase III non-comparative open-label prospective study involving 10 burns units. The 41 subjects were non-immunosuppressed adults with second-degree thermal burn(s), which were clinically non-infected, less than 24 hours old, had a surface area less than 500 cm2 and warranted the local use of silver sulphadiazine. For four weeks, subjects were followed up weekly with a clinical assessment, bacteriological swabs and photographic recording.

RESULTS

Of the 41 patients, 24 healed within a mean of 10.8 days and 13 had a skin graft on the study burn within a mean of 11.5 days. There were four premature study withdrawals. The total number of cumulative treatment days was 445, and 298 treatments were performed (including 257 dressing changes). Mean dressing wear time was 1.73 days. None of the subjects acquired a secondary infection. Researchers took 121 bacteriological samples, and wound colonisation with Staphylococcus aureus was found in only one patient. At follow-up nursing staff reported that dressing acceptability was good.

CONCLUSION

Use of Urgotul SSD led to a good wound outcome--wounds healed or were grafted.

[Criteria for burn severity. Epidemiology. prevention, organization of management]

Total body surface area burned and deep of the skin injury are the main determinants of the burn severity. Other factors like age of the patient, pathological conditions, pulmonary injury by smoke inhalation, wound localizations play also a major role. 500,000 cases of burn injuries occurred each year in France. Ten hundred are hospitalized among witch 3,000 are hospitalized in burn units. Burns by flames are the most common in adult severely burned patients. In children, for all type of injuries, and in adult patients suffering of light or medium injuries, hot liquids are the most frequent encountered agents. Obviously, prevention programs should markedly decrease the occurrence of burn injuries. Regulation modifications are probably more potent than information campaigns. There is 25 burn units in France. Unfortunately, these units take care of less than one third of all the burned hospitalized patients. The organization of a national network binding regional burn centers and local specialized units would probably improve the efficiency of burn therapy in our country.

[Systemic complications of extended burns]

Burns covering more than 10% of the total body surface area (TBSA) are responsible for systemic perturbations which, in very severe cases, can represent a vital risk and, in all cases, affect the wound evolution. Among these general perturbations, fluid volume and electrolyte changes, leading eventually to burn shock, have the most dramatic consequences. Burn shock is, still to day, a vital risk and can also, in case of inadequate early fluid resuscitation, results in secondary morbidity and mortality. Fluid replacement during the very first hours after injury represents certainly a key point of the management of severe burn cases. Estimation of resuscitation fluid needs during this period is frequently underestimated. For adult, we recommend, during the first hour, a minimum of one liter for all severe injuries and two liters if the injury exceeds 50% of TBSA. Pulmonary injuries due to smoke inhalation are frequent, about 25% of patients hospitalized in burn units, and responsible for numerous death at site of house fires. In burn units, about 25% of hospitalized patients have pulmonary injuries in relation with smoke inhalation. This population has a high mortality rate increasing with the area of the skin injury and with age. Patients with inhalation injury need more resuscitation fluids, are subject to pneumonia and necessitate frequently mechanical ventilation. Parameters of the mechanical ventilation have to be choice to avoid barotrauma. Severe burn patients are submitted to a very high metabolic level. This can leads to a deep nutritional deficit responsible for an immunological suppression. It is then of major importance to provide an adequate nutritional support. It is also necessary to fight against the stress and to put the patient in a warm environment. Finally, infection is the most frequent and the most severe complication of burn injuries. Everything have to be done to avoid bacteriological contamination including architecture, equipment's, care procedure, nutritional support, types of wound dressing and most importantly surgery. Surgical procedures have to be done as earliest as possible to excise necrosis and cover the wound.

Differences between burns in rural and in urban areas: implications for prevention

This study aimed to identify typical features of burns in rural areas and to improve their prevention by comparing the characteristics of burnt patients and their burns in rural and urban areas. A cross-sectional survey was conducted in 19 of the 23 French burns units over one year, using a structured questionnaire. We analysed the resulting database. Of the 1422 patients, excluding 188 burnt in unclassified areas, 420 (34%) were burnt in rural areas. Burns were more frequent in rural than in urban areas. Occupational burns were more frequent in rural than in urban areas. The characteristics of patients and burns did not differ between the areas. Patients burnt during everyday activities were older and more frequently had predisposing factors in rural than in urban areas. Burns occurred outdoors more often in rural than in urban areas and were frequently due to flames or explosions or to the use of barbecues or open fires. The hands and perineum were burnt more frequently in rural than in urban areas. Rural burns were more severe than urban burns: they were deeper, involved a larger body surface area and caused more deaths. Preventive measures in rural areas should take into account occupation and everyday activities. They should be specifically adapted to the profiles of burnt patients.

A decade of change in clinical waste treatment and disposal in Scotland

Ten years ago there were over 150 small incinerators located on hospital premises throughout Scotland. The majority were operated by portering staff, had poor combustion and no gas cleaning equipment. At that time alternatives to incineration were in their infancy and relatively expensive. Funding for major capital projects lay with the Government, and a strategic study suggested the installation of 12 centralised modern incinerators on the mainland and three on the islands: one per Scottish Health Board. Some health boards proceeded with new installations well ahead of dead-lines for closure of old plant. Others adopted a 'wait and see' policy and were overtaken by political changes. These resulted in a cutback in government-funded capital investment and a shift of non-core services to the private sector. Clinical waste disposal was contracted out as a service contract and some private sector companies offered alternative low-temperature technologies for clinical waste treatment. As a result there is now the opportunity to compare the advantages and disadvantages of incineration, sterilization, dry heat disinfection and other techniques. Technological change has also required revised waste segregation methods within the hospitals. In parallel with this there has been an overall reduction in waste quantities. The remaining incinerator operators are now faced with more stringent emission limits to be implemented by June 2000. This is resulting in closures of incinerators that have been operating for a few years. The situation continues to change.

Inhibiteur de rejet de greffe alpha2-macroglobulin in burn injury: a suppressive activity on complement

A subform of alpha2-macroglobulin, (inhibiteur de rejet de greffe (IRG), present at a low rate in healthy rat, increased with rate-related suppressive activity on complement during inflammatory processes. In human serum, a molecule with such properties was described. Serum and blister IRG from burn patients belonging to a selected population was purified under gentle conditions. Serum IRG increased quickly within the first day after hospitalization and continued to increase until day 6. Although absent in whole serum, the rate-related activity of IRG varied according to the surface area and the degree of burns. A rate-related activity was also revealed in whole blister fluid and in purified blister IRG. We report a new site and a new suppressive activity of IRG in its native form from serum and blister fluid during inflammatory processes of burned patients. The suppressive activity of IRG on complement is discussed, and it appears to play a role in the development of inflammatory processes.

Use of random amplified polymorphic DNA as a typing method for Candida albicans in epidemiological surveillance of a burn unit

Burn patients are particularly exposed to deep-seated nosocomial infections caused by Candida species. Superficial carriage of C. albicans is a potential source of infection and dissemination, and typing methods could be useful to trace the different isolates. We report the use of random amplified polymorphic DNA to type isolates of C. albicans in the Hôpital Cochin burn unit. This molecular typing method, which is based on PCR with arbitrary short primers, was evaluated on a panel of 32 C. albicans strains isolated from various anatomical sites of unrelated patients, and the strains showed 22 different patterns. Random amplified polymorphic DNA was then used in the epidemiological surveillance of the patients in the burn unit over a 9-month period. Seven patterns were identified among 84 isolates from 18 patients. One pattern (pattern A) corresponding to isolates from 7 of the 18 patients (68% of isolates) predominated throughout the 9-month study, while some strains with other profiles were isolated only once. Some profiles appeared to show a particular geographic pattern within the unit, suggesting transmission from room to room. These results underline the importance of fungal surveillance in such patients and the need to inform nursing staff of measures to prevent the spread of Candida spp. from patient to patient.

[Child victims of house fires in France. Mortality, morbidity, prevention]

Children injuries by house fires in France are the cause of a severe mortality (sixty deaths in average each year) and of a morbidity for the survival due to smoke toxicity (oxygen deprivation and inhalation of toxic gases--CO and HCN) and to thermal burns. Epidemiological studies show that young children (0 to 4) are specially concerned by this threat and that the deaths occurred more often in some part of France (Nord-Pas-de-Calais Region). A special strategy for this prevention should be applied in France, the same available in USA, Sweden and UK, including information on the behavior one should have with children: never leave them alone and escape with them as soon as possible out of the smoke. The usefulness of smoke detectors should be confirmed by French administration and recommended to the public, since they have had effective results in other countries.

Use of topically applied silver sulphadiazine plus cerium nitrate in major burns

All patients hospitalized between May 1987 and June 1988 suffering from burns covering over 50 per cent of the body surface area were treated by topical application of a cream containing cerium nitrate (0.05 M) and silver sulphadiazine (0.03 M) (CN + SSD). Eleven patients were included in this series, with a mean age of 35 years (range 22-65), a mean total burn size of 78 per cent (range 50-96 per cent) and full skin thickness covering a mean of 48 per cent (range 10-91 per cent). Eight patients survived (73 per cent) (mean age 36 years; mean total burn surface 73 per cent; mean full skin thickness burn surface, 38 per cent). These results are far better than those obtained in our Unit where a survival rate of 34 per cent was obtained in a comparable series of patients treated before 1987. Sixty positive blood cultures were obtained, which included a large variety of organisms with a slight predominance of Staph. aureus, Candida albicans and Ps. aeruginosa. Wound cultures were positive in 72 per cent of swabs and showed a predominance of Ps. aeruginosa (59 per cent of all the strains isolated). Even if CN + SSD appears in this series not to be very efficient in preventing wound colonization and septic complications, it permitted a very high survival rate in the treated patients, taking into account the extreme severity of the injuries. This beneficial effect is probably the consequence of the protective action of the yellow-green eschar formed by CN + SSD.(ABSTRACT TRUNCATED AT 250 WORDS)

Survival rates of patients hospitalized in French burns units during 1985

This survey analyses data from 17 French burn units with respect to age, severity of injury and survival of patients admitted to hospital during 1985. Of the 2398 patients treated, more than half were between 15 and 50 years old. About 90 per cent of the patients had burns covering less than 50 per cent of the body surface area. The overall mortality rate was 11.8 per cent. The LD50 for the 2398 patients was a burned surface area of approximately 60 per cent of the total body surface area. The LD50 for patients less than 30 years old was a burn covering just over 80 per cent of the total body surface. The survival rate as a function of the Baux index was also analysed.

Preliminary clinical studies of a biological skin equivalent in burned patients

The possibility of covering large areas of full thickness skin loss with 'living skin equivalent' produced by a modification of Bell's method was studied. Living skin equivalents, composed of a dermal equivalent (fibroblasts plus collagen) covered by epithelial cells were grafted, meshed or non-meshed, onto granulation tissue and, in one patient, onto fascia. Eight patients with full skin thickness burn wounds covering over 15 per cent of the body surface area were thus partially covered. The graft 'take' was evaluated every 48 h. In every patient grafted, an extensive lysis (60-90 per cent) of the skin equivalent graft was observed at the first dressing (48 h). In one patient only, a significant percentage of 'take' (40 per cent) was observed 14 days after grafting. These disappointing results were probably related to the presence of collagenases or proteases produced on the wound bed either by bacteria or by surrounding human cells. It appears that at the present time the biochemical nature of the dermal equivalent used is not yet completely appropriate to serve routinely as a substitute for human skin.

Plasma fibronectin time course in burned patients: influence of sepsis

Plasma fibronectin time course was studied in 30 patients versus clinical criteria: body surface area burn (BSA), unit burn standard (UBS), and infection state. The mean value for all the population was lowest within days 1-3. No correlation was observed between fibronectin concentration and clinical criteria, either at admission or subsequently. Fibronectin levels of nonseptic patients (Group 1) did not differ significantly during the first days from those of patients who, at any time of their hospitalization, would become moderately infected (Group 2) or septic (Group 3). Afterwards, protein concentration of Group 1 increased regularly and hyperopsonization was observed from day 17 until the end of the study, day 35. In contrast, protein levels of Groups 2 and 3 remained low with a further improvement for moderately infected patients. A marked and significant difference was observed between nonseptic patients and septic patients, from the 6th postburn day. Variation of Groups 2 and 3 may be related to the infectious period, whatever the BSA or UBS index evolution. Since infection was related to low fibronectin level in the three deaths observed, it appears that opsonic protein cryoprecipitate would be of value in the treatment of burn victims.

Serum levels of polychlorinated biphenyls and some organochlorine insecticides in women with recent and former missed abortions

Polychlorinated biphenyls and some organochlorine insecticides (DDT isomers and their metabolites, lindane (gamma-BHC), dieldrin, heptachlor epoxide) were assessed in the serum of 17 women with recent missed abortions, 7 women who experienced one or several missed abortions in their past, and 7 women with normal, second trimester pregnancy. Fifty-three percent of the cases of recent missed abortion had PCB serum levels higher than the mean plus two standard deviations of the control group. The mean PCB serum level in women with recent missed abortion and relatively high PCB serum levels was significantly different from that of the control group (103.04 versus 20.69 ppb, P less than 0.001). The mean PCB serum level of the former missed abortions group was also significantly different from that of the control group (82.00 versus 20.69 ppb, P less than 0.001). The quantity of the higher chlorinated biphenyl homologues (penta- and hexachlorobiphenyls) was increased in the high PCB level, missed abortion group and in the former missed abortion group, while the lower chlorinated biphenyl homologues were decreased in these groups in comparison with the control group. The percentage of total o,p'-DDT serum level, as related to total DDT, showed an increase in the high PCB level, recent missed abortion and in the former missed abortion groups, in comparison with the control group (36.18 and 48.98 versus 25.57, respectively). The fact that the former missed abortion group showed increased PCB serum levels similar to those found in the high PCB level, recent missed abortion group confirms the existence of an association between relatively high PCB serum levels and the occurrence of missed abortion. The possible role of PCBs in the occurrence of missed abortion is discussed.

Behavioural changes in burned adult patients during their stay in hospital

Using regular weekly interviews and entries on special record cards, the authors were able to study behavioural changes and psychological disorders in 53 adults patients with moderately severe burns admitted to a burns unit in a large Paris hospital. The changes observed followed a distinctive pattern and could be divided into four phases corresponding to admission, stabilization, recovery, and pre-discharge. The results of these studies may help to institute timely chemotherapy or psychotherapy and to provide the nursing staff with a better understanding of these patients.

World PCBs map: storage and effects in man and his biologic environment in the 1970s

PCB residues are found in biota all over the world. A biologic magnification of PCBs has been demonstrated in the food chain: plankton-fish-fish eating birds. A world map of the PCBs residues in biota and some of their biologic effects are given in this study. The biologic effects of PCBs are varied and may generally be explained by the induction or inhibition of the activity of a large number of enzymes, which upsets quantitatively, normal biochemical processes. Harm to reproduction, growth, development, defense systems, tissues, and organs appeared in susceptible organisms as a result of such changes or as a chain reaction to heterostases. The adverse health effects, observed in persons occupationally exposed and in those accidentally poisoned, point to the risk for the general population of an ever-increasing environmental pollution by PCBs. There is need for an integrated approach, consisting of epidemiologic studies on high risk groups in the general population and in persons occupationally exposed, as well as periodic assessment of PCB residues in man, his food, and feed supplies.

Systematic utilization of an antipseudomonas aeruginosa vaccine in a severe burn unit

The biological and clinical results of vaccination against pseudomonas aeruginosa infection have been analyzed for a group of 287 burned patients having over 25% surface burnt. The vaccine used was a cellular one inactivated by heat and containing 10 different strains. The effectiveness has been judged on the one hand by the increase in the antipseudomonas antibody count and on the other by comparing a group of vaccinated patients with a non-vaccinated group. After vaccination, the antipseudomonas aeruginosa antibodies increased from the 4th-5th day and reached an impressive increase after the 10th day. Clinically, protection is almost complete if one considers that pseudomonas aeruginosa positive blood cultures appear 15 days after vaccination, and above all the prognosis of these late infections. Both locally and generally, this vaccine has always been perfectly tolerated.

Polychlorinated biphenyls induced rat liver adenomas

Multiple liver adenomas were found in 30 month old female rats which had received for 28 months, 200 ppm polychlorinated biphenyls (Arochlor 1254) in their drinking water. No lung metastases were detected. The examination of fragments of these adenomas under the electron microscope showed group polymorphism of the hyperplastic liver cells. The ultrastructural changes were considered to be as a result of chemical lesions induced by polychlorinated biphenyls and as adaptive morphological responses to the long term exposure to toxic chemical compounds. The group polymorphism was seen in the light of the clonal theory, to be the result of inherited biochemical lesions occurring in cells of hyperplastic liver nodules.

[Evolution of blood fatty acid levels in severe burns]

During the first ten days following the burn, there is no significant increase in serum FFA for the surviving patients. This shows a good balance between production and use by the cells. The glucose that is brought allows their oxydation in tricarboxylic Kreb's cycle and the albumine allows for them transport in the circulating liquids, probably helping to maintain this good balance. On the other hand for 70 p. 100 of the patients who died this equilibrium does not exist and the serum FFA increased significantly. Later on and in all cases, the value of serum FFA decrease significantly below that of the control group. This fact can be explained by the exhaustion of the lipidic reserves and/or a decrease of serum proteines particularly albumin, and consequently of transport in the blood of the fatty acids.

Organochlorine compounds in human blood plasma and milk

Organochlorine insecticides and polychlorinated biphenyls (PCB's were assessed in human blood and milk collected from Israeli mothers 2-4 days ater childbirth during 1975. The concentration of total DDT (sigma DDT) was similar in whole plasma and milk (74 ppb versus 72 ppb) and higher in plasma-extracted lipids than in milk-extracted lipids: 15.12 ppm versus 5.77 ppm. Levels of gemma-BHC, dieldrin, and heptachlor epoxide were higher in whole plasma and plasma-extracted lipids than in whole milk or in milk-extracted lipids. PCB's had similar concentrations in extracted lipids of plasma and milk but were significantly higher in whole milk than in whole plasma. Higher percentages of organochlorine insecticides and PCBs were excreted in milk from mothers between 20 and 29 than between 30 and 39, although the younger group had lower levels of these compounds in plasma. Overweight women excreted lower quantities of organochlorine insecticides and PCB's than did women of normal weight

Multiple rough endoplasmic cisternae in "C" cells

Multiple rough endoplasmic cisternae were found in "C" cells of the adult rat, at interphase. They are considered to be normal constituents of "C" cells. Their morphological relation to rough endoplasmic reticulum and their close proximity to mitochondria, Golgi dictyosomes and secretory granules suggest that they may have a role in the secretory activity of this endocrine cells.

Multiple rough endoplasmic cisternae in the endocrine pancreas of the adult rat

Multiple rough endoplasmic cisternae were found in the parenchymatous cells of the endocrine pancreas of the adult rat (alpha, beta, D and intermediary cells) and were especially developed in beta cells. They are considered to be normal constituents of the parenchymatous cells of the endocrine pancreas. Their close proximity to Golgi dictyosomes and the accumulation of secretory material sometimes seen at the extremities of such cisternae, suggest that they may have a role in the secretory activity of these endocrine cells.