Death and non-lethal weapons: A case of homicide by penetrating injury without projectile

Herein, we report the death of a man, approximately thirty years old, victim of a short-range shot to the thorax from a PIEXON JPX4, a hand weapon classed category D in France, said to be non-lethal. External examination of the lesion revealed characteristics similar to those of ballistic injuries. The autopsy found an intercostal wound that reached the pulmonary parenchyma and the pulmonary artery, with severe hemothorax. By the end of the autopsy, no projectile had been found in the body, nor any exit orifice. Death was caused by the effects of hemorrhagic shock. The PIEXON JPX4 has four cartridges, projecting a capsaicin gel that is designed to irritate the ENT area (ear nose throat) to incapacitate an assailant. The manufacturer recommends not to use it at distances of less than 1.5 m. Experimental shots were performed on gelatine blocks at point-blank range and at distances of 5, 10, 20, 30, 50, 100 and 150 cm to evaluate the distance necessary for the jet of gel to have a penetrating effect. Shots at 5-30 cm penetrated the structure. None of the other shots were penetrating. The autopsy and experiment data therefore show the penetrating potential of the jet of gel. Herein, we report the first death due to use of the PIEXON JPX4. From a forensic investigation viewpoint, we add a new exception to the "bullet rule". (The odd and even bullet rule states that if the number of gunshot wounds of entrance and exit found in the body is even, the presumption is that no bullet is lodged in the body. If the number of gunshot wounds of entrance and exit is odd, the presumption is that one or more bullets have been lodged in the body.).

Electroconvulsive therapy as life-saving in an acute catatonic syndrome associated with bipolar disorder: A case report

Introduction

Catatonia is a neuropsychiatric syndrome characterized by an onset of a dysfunction in psychomotor activity and/or muscle tone, which may be associated with changes in consciousness, affect, and thinking. It is characterized by negativism, wax flexibility, catalepsy, mutism echolalia, ecopraxia, or stupor. It was first described in 1874 by Kahlbaum, who characterized it as specific motor disorder associated with different psychiatric disorders. Kraepelin and Bleuler restricted catatonia to a specific subtype of schizophrenia. However, the association between catatonia and other disorders, notably mood disorders, has been reinstated, including Bipolar Disorder. Its etiology is multiple and there are two severe forms: Neuroleptic Malignant Syndrome (NMS) and Malignant Catatonia (MC). These are syndromes that present high mortality, and the health professional should be aware of its etiology, signs, symptoms, evaluation and treatment.

Objectives

The aim of this work is to present a clinical case of MC, who was sustained by literature included on scientific platforms.

Methods

Case report

Results

It is essential to recognize the different clinical presentations of catatonia, taking into account that these are psychiatric alterations in which urgent intervention is justified. In the presented case, the use of antipsychotic medication has worsened the motor function and its suspension, associated with the introduction of lorazepam, resulted in a slight improvement. The electroconvulsive therapy was the last resort, fully succeeded.

Conclusions

The relationship between SMN and Catatonia/MC remains nuclear from a psychopathological and pathophysiological point of view. Nevertheless, there is general agreement that catatonia represents a very significant risk factor for NMS.

Disclosure

No significant relationships.

Attention deficit hyperactivity disorder in adulthood and the heritability of this condition

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention and/or hyperactivity-impulsivity resulting from the interaction of genetic and environmental risk factors. Family studies shows that persistent ADHD is very familial.

Objectives

We aim to review the literature on this condition and its heritability and describe the implications that a possible misdiagnosis can have during life.

Methods

Bibliography review was performed using the databases PubMed and Cochrane, using the following keywords: “ADHD”; “Adults”; “Heretability”; “Family” and “Rater effect”.

Results

Childhood ADHD persists into adolescence and adulthood substantially, identified in some studies, as going up to 78%. The prevalence of ADHD in children and adults is between 2.5% and 5% worldwide. Family studies have shown that children of adults with ADHD are at higher risk of having ADHD. Some large-scale twin studies of adult ADHD, used self-report assessments of ADHD symptoms and estimated the heritability of this condition to be between 30 to 40%, which differs from other studies that analyse parents and teachers responses and estimates heritability to be between 60 and 90%.

Conclusions

Since there is a direct influence of the evaluators in estimating the extent of ADHD heritability, future studies need to clarify and describe in detail all the related characteristics of the raters. Although ADHD is widely studied, there is still a lot to learn about its etiology. The diagnosis of ADHD is clinical and complex and must be considered both in childhood and adolescence and in adulthood, with special emphasis on the family antecedents.

Disclosure

No significant relationships.

Clozapine in severe psychotic disorders: Balancing safety with efficacy

Introduction

Clozapine is a member of the dibenazepine class of antipsychotic drugs and has been designated an atypical antipsychotic drug. Clinical studies have shown that clozapine is effective in ameliorating the core symptoms, as well as the negative symptoms, in severe psychotic disorders and is therapeutically effective in treating about 30% of schizophrenic patients who are resistant to standard antipsychotic drugs.

Objectives

The goal is to review pharmacology, efficacy, and clinical use of clozapine, such as its side effects, and the benefit-to-risk ratio of this antipsychotic drug.

Methods

Non-systematic literature review based on scientific databases such as PubMed, using key words such as “clozapine”, “efficacy”, “side effects” and “resistant schizophrenia”.

Results

Clozapine was developed as the first atypical antipsychotic with activity for both the negative and positive symptoms of schizophrenia. The primary indications for clozapine are treatment-resistant psychotic disorder, defined as persistent moderate to severe delusions or hallucinations despite two or more clinical trials with other antipsychotic drugs, and patients who are at high risk for suicide. Concerns over a number of safety considerations are responsible for much of the underutilization of clozapine, such as agranulocytosis, metabolic side effects and myocarditis. These side effects can be detected, prevented, minimized and treated, but there will be a very small number of fatalities.

Conclusions

Awareness of the benefits and risks of clozapine is essential for increasing the use of this lifesaving agent.

Disclosure

No significant relationships.

Lithium in severe affective disorders: Balancing safety with efficacy

Introduction

Lithium has been one of the oldest substances used in psychiatric treatments and remains the first-line treatment for prevention of manic and depressive episodes of bipolar disorder (BD), but it has also a wide spectrum of side-effects.

Objectives

The goal is to review efficacy, and clinical use of lithium, such as its side effects, and its benefit-to-risk ratio.

Methods

Non-systematic literature review based on scientific databases such as PubMed.

Results

The first modern use of lithium was for the treatment of mania. Lithium has also proven useful in major depression, particularly for augmentation of antidepressants, for aggressive behavior and it has a specific antisuicide effect. Lithium’s prophylactic and antisuicidal effects are most unique. However, the use of lithium became problematic due to the serious toxicity since lithium also a narrow therapeutic index, with therapeutic levels between 0.6 and 1.5 mEq/L.

Conclusions

Awareness of the benefits and risks of lithium is essential for the use of this lifesaving agent. Lithium levels must be carefully monitored and lithium dosage adjusted as necessary.

Disclosure

No significant relationships.

Visualization of Urban Mobility Data from Intelligent Transportation Systems

Intelligent Transportation Systems are an important enabler for the smart cities paradigm. Currently, such systems generate massive amounts of granular data that can be analyzed to better understand people’s dynamics. To address the multivariate nature of spatiotemporal urban mobility data, researchers and practitioners have developed an extensive body of research and interactive visualization tools. Data visualization provides multiple perspectives on data and supports the analytical tasks of domain experts. This article surveys related studies to analyze which topics of urban mobility were addressed and their related phenomena, and to identify the adopted visualization techniques and sensors data types. We highlight research opportunities based on our findings.

Estimation of daily mean temperatures: an accurate method for the Douro Valley

Air temperature data from many locations worldwide are only available as series of daily minima and maxima temperatures. Historically, several different approaches have been used to estimate the actual daily mean temperature, as only in the last two or three decades automatic thermometers are able to compute its actual value. The most common approach is to estimate it by averaging the daily minima and maxima. When only daily minima and maxima are available, an alternative approach, proposed by Dall’Amico and Hornsteiner in 2006, uses the two daily extremes together with next day minima temperature and a coefficient related to the local daily astronomical sunset time. Additionally, the method uses two optimizable coefficients related to the region’s temperature profile. In order to use this approach it is necessary to optimize the region’s unknown parameters. For this optimization, it is necessary a dataset containing the maxima, minima, and the actual daily mean temperatures for at least one year. In this research, for the period 2007-2014, we used three datasets of minima, maxima and actual mean temperatures obtained at three automatic meteorological stations located in the Douro Valley to optimize the two unknown parameters in the Dall’Amico and Hornsteiner approach. Moreover, we compared the actual mean daily temperatures available from the three datasets with the correspondent values estimated by using i) the usual approach of averaging the daily maxima and minima temperatures and ii) the Dall’Amico and Hornsteiner approach. Results show that the former approach overestimates, on average, the daily mean temperatures by 0.5ºC. The Dall’Amico and Hornsteiner approach showed to be a better approximation of mean temperatures for the three meteorological stations used in this research, being unbiased relative to the actual mean values of daily temperatures. In conclusion, this research confirms that the Dall’Amico and Hornsteiner is a better approach to estimate the mean daily temperatures and provides the optimized parameters for three sites located at each of the three sub-regions of the Douro Valley (Baixo Corgo, Cima Corgo and Douro Superior).

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update

BACKGROUND

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.

METHODS

SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.

RESULTS

The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Effect of Comedication With Conventional Synthetic Disease-Modifying Antirheumatic Drugs on Retention of Tumor Necrosis Factor Inhibitors in Patients With Spondyloarthritis: A Prospective Cohort Study

OBJECTIVE

To evaluate whether use of comedication with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) influences the retention of tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA).

METHODS

Patients with SpA from the Rheumatic Diseases Portuguese Register who started treatment with their first TNFi between 2001 and 2014 were included in this study. Cox regression analysis was used to estimate the effect of comedication with csDMARDs on TNFi retention in 2 types of models: a model in which baseline (time-fixed) variables were included, and a second model incorporating time-varying variables, including sociodemographic features, measures of disease activity, measures of physical function, and cotreatment with other drugs (nonsteroidal antiinflammatory drugs and oral steroids). To control for possible confounding by indication, the effect of csDMARD comedication on TNFi retention was also tested after adjustment for the treatment propensity score.

RESULTS

In total, 954 patients were included in the study, of whom 289 (30.3%) discontinued treatment with their first TNFi after a median follow-up time of 2.5 years (range 0.08-13 years). Inefficacy was the most common reason for TNFi discontinuation (55.7% of patients). In the multivariable analyses, comedication with csDMARDs had no measurable effect on TNFi retention, neither in the baseline model (hazard ratio [HR] 0.83, 95% confidence interval [95% CI] 0.59-1.16) nor during follow-up in the model adjusted for time-varying covariates (HR 1.07, 95% CI 0.68-1.68). The effect of csDMARD comedication remained nonsignificant after propensity score adjustment.

CONCLUSION

Comedication with csDMARDs does not prolong TNFi retention in patients with SpA in clinical practice, suggesting that there is no benefit conferred by the concomitant use of these drugs.

Depression across DSM and ICD editions: Psychiatric nosology's ‘Black Dog’

Introduction

The diagnosis of depressive disorders has suffered important modifications throughout DSM and ICD editions. The history of those modifications is an important subject to fully understand the current diagnostic criteria and classification, with milestones often set not by scientific or theoretical data but rather by political decision and conflicting interests.

Objective

The authors propose a review of how the concept of major depression has evolved along the several DSM and ICD editions.

Methods

The results were obtained searching literature included on the platforms PubMed, Google Scholar, PsycINFO and Psychology and Behavioral Sciences Collection.

Results

The current diagnostic entity lacks validity and utility and that is an obstacle to both scientific research and clinical practice.

Conclusion

The authors also discuss alternative models which may contribute to a paradigm shift more suitable to clinical reality and to provide a useful framework for all levels of research.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Regret Anticipation Failures Scale (RAFS): Validation of the Portuguese version

Introduction

Failures in regret anticipation undermine regret avoidance, increasing regret frequency and ultimately the risk of regret-related problems. The Regret Anticipation Failures Scale (RAFS; Schmidt and Linden, 2011) was developed to evaluate interindividual differences in regret anticipation.

Objective

To investigate the psychometric properties of the RAFS Portuguese version.

Methods

A community sample composed of 108 university students and 79 employees (78.1% females; mean age = 33.16 ± 13.175; range: 17–62) answered the Portuguese preliminary version of the RAFS. To study the temporal stability, 31 participants (83.9% females; mean age = 26.54 ± 18.761) answered the RAFS again after approximately 6 weeks.

Results

The RAFS Cronbach alpha was “very good” (a = 0.81). All the items presented significant correlations with the total (excluding the item; > 0.20); only item 2 (Even when I’m stressed, I can foresee the regrets that certain behaviors could evoke in me) had the effect of lowering the internal consistency if deleted. The test-retest correlation coefficient was high, positive and significant (0.61; P < 0.001); there was not significant difference between test and re-test scores [14.26 ± 5.170 vs. 13.06 ± 4.761, t (30) = 1.532, P = 0.136]. Following Kaiser and Cattel Scree Plot criteria, only one factor was extracted, meaning that the scale is unidimensional.

Conclusions

The Portuguese version of RAFS has good reliability and construct validity. It could be very useful both in clinical and research contexts, namely in an ongoing project on the relationship between regret, personality and psychological distress.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Partitioning the grapevine growing season in the Douro Valley of Portugal: accumulated heat better than calendar dates

Temperature and water status profiles during the growing season are the most important factors influencing the ripening of wine grapes. To model weather influences on the quality and productivity of the vintages, it is necessary to partition the growing season into smaller growth intervals in which weather variables are evaluated. A significant part of past and ongoing research on the relationships between weather and wine quality uses calendar-defined intervals to partition the growing season. The phenology of grapevines is not determined by calendar dates but by several factors such as accumulated heat. To examine the accuracy of different approaches, this work analyzed the difference in average temperature and accumulated precipitation using growth intervals with boundaries defined by means of estimated historical phenological dates and intervals defined by means of accumulated heat or average calendar dates of the Douro Valley of Portugal. The results show that in situations where there is an absence of historical phenological dates and/or no available data that makes the estimation of those dates possible, it is more accurate to use grapevine heat requirements than calendar dates to define growth interval boundaries. Additionally, we analyzed the ability of the length of growth intervals with boundaries based on grapevine heat requirements to differentiate the best from the worst vintage years with the results showing that vintage quality is strongly related to the phenological events. Finally, we analyzed the variability of growth interval lengths in the Douro Valley during 1980-2009 with the results showing a tendency for earlier grapevine physiology.

Characterization of damage in Portuguese lupus patients: analysis of a national lupus registry

Background: Although the survival rate has considerably improved, many patients with systemic lupus erythematosus (SLE) develop irreversible organ damage. Objectives: The objectives of this paper are to characterize cumulative damage in SLE patients and identify variables associated with its presence and severity. Methods: A cross-sectional analysis of SLE patients from the Portuguese Lupus register Reuma.pt/SLE in whom damage assessment using the SLICC/ACR-Disability Index (SDI) was available was performed. Predictor factors for damage, defined as SDI ≥ 1, were determined by logistic regression analyses. A sub-analysis of patients with severe damage (SDI ≥ 3) was also performed. Results: In total, 976 patients were included. SDI was ≥1 in 365 patients, of whom 89 had severe damage. Musculoskeletal (24.4%), neuropsychiatric (24.1%) and ocular (17.2%) domains were the most commonly affected. Older age, longer disease duration, renal involvement, presence of antiphospholipid antibodies and current therapy with steroids were independently associated with SDI ≥ 1. The subpopulation with severe damage had, in addition, a greater interval between the first manifestation attributable to SLE and the clinical diagnosis as well as and more frequently early retirement due to SLE. Conclusions: This large lupus cohort confirmed that demographic and clinical characteristics as well as medication are independently associated with damage. Additionally, premature retirement occurs more often in patients with SDI ≥ 3. Diagnosis delay might contribute to damage accrual.

An Extended Kernel Density Two-Step Floating Catchment Area Method to Analyze Access to Health Care

In Portugal the distribution of physicians is considered an appropriate proxy for the distribution of the actual hospital resources and additional information on hospital supply is mostly unavailable, while health care utilization data are also usually absent. A suitable method that can be used to analyze patients' access to hospital health care in countries with such characteristics is the two-step floating catchment area (2SFCA) method, since it requires only the number of physicians to represent supply and the population size to estimate demand. An improved version of the 2SFCA method is the kernel density 2SFCA (KD2SFCA) method. However, this method was not developed to analyze access to health care and it computes scores that express only the spatial access dimensions of proximity and availability. In this paper we present a new method, based on the KD2SFCA method, which improves health care access analysis and better identifies populations that are less empowered to use health care. We adapt the KD2SFCA method for the context of health care access analysis and extend it to capture additional access dimensions. We applied the extended method to the Portuguese hospital health care sector in a case study, and compared its results with those obtained with the KD2SFCA method. Our method was able to improve the identification of the less empowered populations and discovered that they represent 8.1% of the total population, instead of 4.6%, and reside in sixteen of the eighteen Portuguese districts, instead of in thirteen, as identified by the original KD2SFCA method. By improving the KD2SFCA method for the identification of the less empowered populations, our method can be a first step in an endeavor to identify opportunities to increase the health care supply or to redistribute supply resources, with the objective of increasing the access of those deprived populations.

Synergic antitumoral effect of an IGF-IR inhibitor and trastuzumab on HER2-overexpressing breast cancer cells

BACKGROUND

Receptor tyrosine kinases play an important role in breast cancer. One of them, the type I insulin-like growth factor, has been linked to resistance to trastuzumab (Herceptin), an agent that targets human epidermal growth factor receptor 2. Here, we show that the insulin-like growth factor-I receptor (IGF-IR) antagonist NVP-AEW541 inhibits proliferation of breast cancer cells and synergizes with trastuzumab.

PATIENTS AND METHODS

Patient samples and breast cancer cell lines were evaluated for IGF-IR expression or activation by western blotting. 1-(4,5-Dimethylthiazol-2-yl)-3,5-diphenylformazan (MTT) uptake assays and Annexin V staining were used for the analyses of cell proliferation/apoptosis. Biochemical and genomic studies were carried out to gain insights into the mechanism of action of NVP-AEW541.

RESULTS

The IGF-IR was expressed above normal levels in a number of breast cancer samples. Activation of this receptor was inhibited by NVP-AEW541 that also decreased cell proliferation and increased apoptosis. NVP-AEW541 decreased the amount of pAkt and increased the level of p27. Combination studies with several drugs used in the breast cancer clinic showed that NVP-AEW541 synergistically increased the action of trastuzumab.

CONCLUSIONS

Our results show the anti-breast cancer action of NVP-AEW541 and support the clinical development of anti-IGF-IR agents, especially in combination with trastuzumab.

Insulin-like growth factor-I receptor kinase inhibitor NVP-AEW541 is active in breast cancer cells and enhances growth inhibition by herceptin through an increase in cell cycle arrest

21077

Background: Targeting ErbB2 with the monoclonal antibody trastuzumab (Herceptin) has shown to be active in breast cancer. However, a proportion of patients do not benefit from this treatment due to primary resistance. Mechanisms proposed for this resistance include activation of other receptors involved in proliferation as is the case of the insulin-like growth factor receptor (IGF-1R).Different strategies have been proposed for the inhibition of IGF-1R such as antibodies or small tyrosine-kinase inhibitors. In this study we analyzed the mechanism of action and the antiproliferative activity of an specific IGF-1R tyrosine-kinase inhibitor termed NVP-AEW541 alone and in combination with Herceptin. Methods: MCF7, SKBR3, BT474, and MDA-MB-231 breast cancer cells were used for this study. Proliferation and apoptosis were analyzed by MTT uptake assays or Annexin-V-FITC, respectively. The levels of different signalling proteins were analyzed by Western blotting. Microarray studies were performed using the HU-133A oligonucleotide arrays (Affymetrix, Santa Clara, CA). Real time quantitative PCR was used to confirm the differentially regulated genes. Results: The IGF-1R was expressed in all the cell lines studied. Exogenous addition of IGF-1 increased the tyrosine phosphorylation of IGF-1R, and this was prevented by preincubation with NVP- AEW541. The latter also decreased MTT uptake, and provoked a slight increase in apoptosis of BT474 cells. Combination of NVP-AEW541 and Herceptin had a synergistic effect on the inhibition of BT474 proliferation. Cell cycle analyses indicated that the combined addition of NVP- AEW541 and Herceptin increased the number of cells in the G0/G1 phases. These data were complemented with an increase in p27 levels upon treatment with both compounds. Microarray analyses identified several genes whose expression was modified by each agent alone and by the combination. Conclusions: Our results indicate that the combined targeting of two receptor tyrosine kinases known to play important roles in tumor cell proliferation may be more efficient than individual targeting of these receptors.

No significant financial relationships to disclose.

Endoskopische Verfahren in der ästhetischen Mammachirurgie

During the last decades, numerous surgical techniques have been described for breast augmentation. In addition to the very popular inframammary and the periareolar approaches, the transaxillary technique provides an elegant means of conducting a safe and accurate implant placement without producing visible scars on the breast mound. Due to a questionable lack of intraoperative visualisation with resultant higher complication rates,we conducted a retrospective analysis comparing the endoscopy-assisted transaxillary approach with the inframammary technique. A retrospective analysis was conducted comparing the endoscopy-assisted transaxillary approach with the more commonly chosen inframammary aditus. Patients undergoing breast augmentation from 1997 to 2005 were analysed retrospectively. The analysis was conducted in patients undergoing this procedure for aesthetic reasons only. Underlying breast pathology as well as previously performed breast surgery were among the exclusion criteria. The Client Satisfaction Questionnaire (CSQ-8) was applied for assessment of patient satisfaction. From 1997 to 2005, 96 patients underwent breast augmentation at our institution. Implant volumes ranged from 150 to 400 ml.62.5% preferred the transaxillary technique vs. 37.5% who chose the inframammary route. Complication rates were low in both patient subsets, the statistics revealing no differences. Assessment of patient satisfaction displayed high levels of satisfaction in both groups without any significant differences. The endoscopy-assisted transaxillary breast augmentation is a safe technique which generates high levels of patient satisfaction. Predictable results can be achieved by this approach which is preferred by the majority of patients when offered.

Untersuchung der Angiogenese im Tissue Engineering

INTRODUCTION

Tissue engineering (TE) applications include the isolation, culture, and seeding of cells into a suitable matrix or scaffold prior to in vivo transplantation. After transplantation, vascularization of the scaffold is a principal factor limiting cell viability for the first 6-8 days post transplantation. A model has been developed for systematic analysis of this process.

METHODS

Fertilized white Leghorn eggs were incubated and opened at day 3 of incubation. Preadipocyte-seeded fibrin constructs were implanted in a specially designed plastic cylinder and placed through the opening onto the surface of the chorioallantoic membrane (CAM) at day 8 of incubation. Vascularization of the constructs by chorioallantoic blood vessels was assessed for up to 8 days post transplantation.

RESULTS

The survival rate for embryos receiving constructs was about 90%. Histology confirmed transplant cell viability at day 4 post transplantation, and vascularization of the constructs by avian endothelial cells progressively increased thereafter.

CONCLUSION

A new in vivo model to study the effect of angiogenesis in TE constructs including assessments of viability, proliferation, and differentiation of transplanted cells and biomaterial properties is presented. Advantages include easy access to the CAM vascular network, lack of immunocompetence, low cost, and avoidance of animal experiments.

Activity profile in multiple sclerosis: an integrative approach. A preliminary report

In order to define an activity profile in patients with multiple sclerosis (MS), T-cell subpopulations and proliferative responses to myelin basic protein (MBP) associated with anti-MBP antibodies, nitrotyrosine levels in serum and cerebrospinal fluid (CSF), and serum CD40L (sCD154) were simultaneously assessed in 29 consecutive and untreated MS patients. When compared to controls, patients in secondary progressive stable (SP/I), or in full remission (RR/I) stages, individuals with secondary progressive active disease (SPIA) or in acute relapse (RR/A) showed a significant decrease of CD4/CD45RA+ T cells associated with an increase of absolute numbers of CD4/45R0+ T cells (p < 0.001). In addition, in vitro-specific T-cell proliferative responses against MBP (SP/A, RR/A, SP/I: p < 0.001 versus controls) in association with augmented sCD154 serum levels (SP/A, RR/A, versus controls p < 0.001) and a significant increase of both CSF and serum levels of anti-MBP antibodies and nitrotyrosine levels (p < 0.001) were also found. Thus, the simultaneous evaluation of antibody and cell-mediated immunopathological parameters, along with the effector mediators of inflammation such as the nitric oxide products, offers a new integrative approach to characterize markers of clinical activity in MS patients, which may be used at the moment of the initial diagnosis and during an apparent recurrences of the disease to monitor therapeutic protocols and to determine whether immune-based nerve destruction mechanisms are still operating in patients with few clinical findings.

Plasmid gene delivery to human keratinocytes through a fibrin-mediated transfection system

We have developed a matrix-mediated transfection system to deliver plasmids to human keratinocytes. The matrix is a soluble, self-hardening fibrin matrix (Tissucol), Baxter) that has been used clinically. Recently it has been shown that full thickness burn wounds can be successfully treated with a keratinocyte fibrin glue suspension. Further, it has been demonstrated that hEGF transfected cells accelerate wound healing. In this study, we inoculated the matrix with the hEGF expression plasmid and resuspended the matrix with either cultured or noncultured human keratinocytes. We obtained successful transfection rates of these cells (up to a 100-fold increase compared to controls containing no EGF expression plasmid) in vitro. After transplantation to full thickness wounds on athymic mice we were able to show a 180-fold increase in EGF concentration compared to controls, which persisted over the entire 7-day monitored period, decreasing from 180 to 20 pg/mL at day seven. This unique approach indicates the possible utility to combine a matrix for cell transplantation with a transfection system to release therapeutic proteins in vitro and in vivo.

A reversible abnormal form of myelin: an X-ray scattering study of human sural and rat sciatic nerves

A sural nerve dissected from a recently dead patient displayed an unusual X-ray diffraction pattern, suggesting that in situ and at the time of the patient's death the myelin sheaths were in a swollen state. Diffraction patterns of the swollen type were also recorded from: (1) a sural nerve from the corpse of a neurologically healthy person after soaking the nerve with Ringer solution at pH 5.5; (2) sciatic nerves dissected from rat cadavers at increasing time after death. In all the cases the swollen patterns reversed to the native type upon superfusion with Ringer solution at pH 7.3. The postmortem effect is to decrease the pH of the fluids surrounding the nerves in the cadavers. Our experiments show that the early postmortem processes have the effect of acidifying PNS nerves and that as a consequence of acidification the myelin sheaths swell.

Malnutrition and myelin structure: an X-ray scattering study of rat sciatic and optic nerves

Taking advantage of the fast and accurate X-ray scattering techniques recently developed in our laboratory, we tackled the study of the structural alterations induced in myelin by malnutrition. Our work was performed on sciatic and optic nerves dissected from rats fed with either a normal or a low-protein caloric diet, as a function of age (from birth to 60 days). By way of electrophysiological controls we also measured (on the sciatic nerves) the height and velocity of the compound action potential. Malnutrition was found to decrease the amount of myelin and to impair the packing order of the membranes in the sheaths.

Clinical comparative study between cryotherapy and local dermabrasion for the treatment of solar lentigo on the back of the hands

BACKGROUND

Solar lentigo is a common and unsightly dermatosis that has a variety of proposed treatments.

OBJECTIVE

This study was done to assess the efficacy and the effectiveness of localized dermabrasion compared with cryotherapy with liquid nitrogen on solar lentigo on the back of the hands.

METHODS

Ten female patients aged 64-96 years with solar lentigo on the back of the hands were treated with dermabrasion or cryotherapy and observed over a 6-month period.

RESULTS

The postsurgery signs and symptoms were less intense and better tolerated with localized dermabrasion. More than 50% of the patients treated with cryotherapy still had hypochromia in the treated areas 6 months after treatment, compared with 11% of the patients treated with dermabrasion. The percentage of recurrence was the same with the both treatments (55.55%).

CONCLUSION

Localized dermabrasion is an efficacious and effective technique comparable to cryotherapy for the treatment of solar lentigo on the back of the hands.