Modified latissimus dorsi and teres major transfer through a single delto-pectoral approach for external rotation deficit of the shoulder: as an isolated procedure or with a reverse arthroplasty

Definitive loss of active external rotation of the shoulder impacts an individual's ability to perform ADL's, creating severe disability. To restore active external rotation, we modified the L'Episcopo procedure by transferring both the latissimus dorsi and teres major (LD/TM) through a single delto-pectoral approach. The two tendons were rerouted and reattached laterally on the humerus to the stump of the pectoralis major which was partially transected to the posterior epiphysis. Fifteen consecutive patients who underwent this procedure; (mean age 63.2 years), have been followed for at least one year (range 14-63). The transfer was indicated alone in 7 patients with an isolated loss of active external rotation (ILER) related to an irreparable postero-superior cuff tear. It was associated with a reverse shoulder prosthesis in 8 patients with combined loss of active elevation and external rotation (CLEER): 6 cases of rotator cuff tear arthropathy and 2 of tumor reconstruction. For the series as a whole, the mean increase in active elevation was 34.7 degrees . The gain in active external rotation was +27 degrees for ILER patients and +28 degrees for CLEER patients. Constant score improved to 65.6 (range, 51-79). Subjective shoulder value (SSV) was significantly improved from 34% to 72% (P < .0009). All but one patient was satisfied or very satisfied with the result. The major contributor to their satisfaction was the ability to control the spatial positioning of the arm, eliminating the tendency of the forearm to swing in toward the trunk. One patient had a return of a lag sign after a fall. The modified tendon transfer, performed in the beach chair position through a delto-pectoral approach, is less invasive than the classic two-incisions procedure and provides good functional results in patients with absent or atrophic infraspinatus and teres minor. When the modified LD/TM transfer is associated with a reverse shoulder arthroplasty, it allows to restore both active elevation and external rotation.     

Comparison of CD8+ T Cell responses to cytomegalovirus between human fetuses and their transmitter mothers

BACKGROUND: The mechanisms responsible for the increased susceptibility of fetuses to cytomegalovirus (CMV) were studied by comparing CD8(+) T cell responses to the virus in susceptible fetuses to those in their comparatively more resistant mothers. METHODS: Included in the study were 16 transmitter mothers who underwent seroconversion during the first trimester of pregnancy as well as their fetuses, who were positive for CMV in amniotic fluid by polymerase chain reaction at 17-19 weeks of gestation. Fetal and maternal blood samples were collected between the 22nd and 39th week of gestation. Cytotoxic T lymphocytes (CTLs) that had activated (HLA-DR(+)), effector/memory (CD28(-)), and memory (CD18(high)) phenotypes; that stained with the HLA-A2/pp65 or the HLA-B7/pp65 multimer; and that secreted interferon (IFN)- gamma were enumerated by flow cytometry. Viral loads were determined simultaneously. RESULTS: The results showed (1) similar levels of activated, effector/memory, and memory CTLs in fetuses and mothers but a smaller pp65-specific CTL pool in fetuses (median, 0.015% vs. 0.99%; P=.003); (2) similar percentages of CTLs secreting IFN- gamma after stimulation with ionomycin/phorbol myristate acetate in fetuses and mothers but lower percentages of CTLs secreting IFN- gamma after stimulation with a CD3 monoclonal antibody in fetuses (median, 1% vs. 14%; P=.01); and (3) higher viral loads (mean, 17,290 vs. <250 genome equivalents/mL) in fetuses. CONCLUSION: Impaired viral clearance might be related to a defective expansion of the pp65-specific CTL pool and/or to the immaturity of IFN- gamma -secreting cells in fetuses.     

Treatment failure of nosocomial pertussis infection in a very-low-birth-weight neonate

We describe a case of nosocomial maternal transmission of Bordetella pertussis to a very-low-birth-weight (VLBW) neonate in whom treatment was unsuccessful. This case underscores the need for rapid and sensitive PCR diagnosis in VLBW neonates and in parents with clinical signs of pertussis and suggests that standard treatment may not be appropriate for VLBW neonates.     

p38 mitogen-activated protein kinase activity commits embryonic stem cells to either neurogenesis or cardiomyogenesis

Mouse embryonic stem (ES) cells can be differentiated, in vitro into a variety of cell types including cardiac cells and neurons. This process is strictly controlled by the potent morphogen retinoic acid (RA). At a concentration of 10(-7) M, RA induces ES cell differentiation into neurons and, conversely, inhibits cardiomyogenesis. We found that p38 mitogen-activated protein kinase (p38MAPK) activity peaked spontaneously, between day 3 and day 5, during ES cell differentiation and that RA completely inhibited this peak of activity. In contrast to wild-type cells, which required RA treatment, p38alpha(-/-) ES cells differentiated spontaneously into neurons and did not form cardiomyocytes. Moreover, inhibition of the peak of p38MAPK activity by a specific inhibitor, PD169316, committed ES cells into the neuronal lineage and blocked cardiomyogenesis. By genetic and biochemical approaches, we demonstrate that, in two different ES cell lines, the control of p38MAPK activity constitutes an early switch, committing ES cells into either neurogenesis (p38 off) or cardiomyogenesis (p38 on).     

Caffeine attenuates lipopolysaccharide-induced neuroinflammation

Caffeine is an antagonist at A1 and A2A adenosine receptors and epidemiological evidence suggests that caffeine consumption reduces the risk of Alzheimer's and Parkinson's diseases. Neuroinflammation plays a role in the etiology of these diseases and caffeine may provide protection through the modulation of inflammation. Adenosine has a known role in the propagation of inflammation and caffeine may reduce microglia activation directly by blocking adenosine receptors on microglia. Chronic neuroinflammation is associated with an increase in extracellular levels of glutamate and drugs that limit the effects of glutamate at neuronal receptors have been shown to indirectly reduce the neuroinflammatory response of microglia cells. A1 and A2A receptors have been shown to regulate the pre-synaptic release of glutamate, therefore, caffeine may also reduce neuroinflammation via its ability to regulate glutamate release. Caffeine was administered at various doses to young rats with experimentally induced neuroinflammation by chronic infusion of lipopolysaccharide (LPS) over two or four weeks into the 4th ventricle and to aged rats with naturally elevated levels of microglia activation. Caffeine attenuated the number of activated microglia within the hippocampus of animals with LPS-induced and age-related inflammation.     

Autophagy and Cell Death of Purkinje Cells Overexpressing Doppel in Ngsk Prnp-deficient Mice

In Ngsk prion protein (PrP)-deficient mice ( NP^0/0 ), ectopic expression of PrP-like protein Doppel (Dpl) in central neurons induces significant Purkinje cell (PC) death resulting in late-onset ataxia. NP^0/0 PC death is partly prevented by either knocking-out the apoptotic factor BAX or overexpressing the anti-apoptotic factor BCL-2 suggesting that apoptosis is involved in Dpl-induced death. In this study, Western blotting and immunohistofluorescence show that both before and during significant PC loss, the scrapie-responsive gene 1 ( Scrg1 )—potentially associated with autophagy—and the autophagic markers LC3B and p62 increased in the NP^0/0 PCs whereas RT-PCR shows stable mRNA expression, suggesting that the degradation of autophagic products is impaired in NP^0/0 PCs. At the ultrastructural level, autophagic-like profiles accumulated in somatodendritic and axonal compartments of NP^0/0 , but not wild-type PCs. The most robust autophagy was observed in NP^0/0 PC axon compartments in the deep cerebellar nuclei suggesting that it is initiated in these axons. Our previous and present data indicate that Dpl triggers autophagy and apoptosis in NP^0/0 PCs. As observed in amyloid neurodegenerative diseases, upregulation of autophagic markers as well as extensive accumulation of autophagosomes in NP^0/0 PCs are likely to reflect a progressive dysfunction of autophagy that could trigger apoptotic cascades.     

Effects of repeated infliximab therapy on serum lipid profile in patients with refractory rheumatoid arthritis

BACKGROUND: Patients with rheumatoid arthritis (RA) frequently display an atherogenic lipid profile which has been linked with inflammation. Tumor necrosis factor-alpha (TNF-alpha), a pivotal pro-inflammatory cytokine in RA may be involved in the development of the disturbed lipid metabolism. We investigated whether infliximab, an anti-TNF-alpha therapy, may modify the lipid profile. METHODS: 56 consecutive RA patients were treated with infliximab (3 mg/kg at weeks 0, 2, 6, 14, 22, 30). Lipid profile and CRP were assayed at baseline and before infusion at weeks 6 and 30. Baseline values were compared with those in 56 healthy volunteers. RESULTS: At baseline, the concentrations of HDL-cholesterol were lower in RA patients than in the controls (1.3+/-0.4 vs. 1.5+/-0.2 mmol/L; p<0.01). The triglyceride concentrations (1.6+/-0.8 vs. 1.3+/-0.4 mmol/L, p<0.01), the ratio of total cholesterol/HDL-cholesterol (4.3+/-1.6 vs. 3.2+/-0.5, p<0.001) and LDL-cholesterol/HDL-cholesterol (2.6+/-1.2 vs. 1.7+/-0.5, p<0.001) were significantly higher in RA patients than in controls. After 6 weeks of infliximab therapy, the mean total cholesterol concentration increased by 25% (p<0.001), LDL-cholesterol by 24% (p<0.001) and HDL-cholesterol by 30% (p<0.001). The decrease in CRP levels to 30 week inversely correlated with the increase in HDL-cholesterol (r=-0.47, p=0.005). CONCLUSIONS: Infliximab administration is associated with important increases in cholesterol levels in all its forms but as no significant beneficial effect on the atherogenic ratio.     

The detection and quantification of a digenean infection in the snail host with special emphasis on <Emphasis Type="Italic">Fasciola</Emphasis> sp.

In this review, ten methods used to study digenean infections in their intermediate hosts were compared to determine which one should be used either in the field or in the lab to establish the prevalence and intensity of infections in snails. Snail crushing and snail dissection allow quick establishing of prevalence in natural or experimental infections, whereas histology is considered as the most accurate approach to assess the intensity of infection. The follow-up of cercarial shedding only gave an idea on cercarial production. Among recently developed techniques, polymerase chain reaction (PCR) brings the most accurate information and shows high sensitivity and specificity levels when compared to blotting techniques. The easiness and relatively low cost of the basic PCR protocol make it interesting to investigate the epidemiology of the liver fluke in a lab with limited financial resources. Nevertheless, if this technique allows a relatively good estimation of the prevalence, information concerning the intensity of infection is best obtained through real time PCR. However, at the time being this technique is too expensive to be used routinely in the field. The choice between classical or new techniques is usually based on a compromise, as each technique has its advantages and drawbacks.     

Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma

OBJECTIVE: To evaluate the effect of a regular oropharyngeal application of povidone-iodine on the prevalence of ventilator-associated pneumonia in patients with severe head trauma. DESIGN: Prospective randomized study. SETTING: A surgical intensive care unit of a university hospital. INTERVENTIONS: Patients with severe head trauma (Glasgow Coma Score of < or =8) expected to need ventilation for > or =2 days were prospectively randomized into three groups: those receiving nasopharynx and oropharynx rinsing with 20 mL of a 10% povidone-iodine aqueous solution, reconstituted in a 60-mL solution with sterile water (povidone-iodine group); those receiving nasopharynx and oropharynx rinsing with 60 mL of saline solution (saline group); or those undergoing a standard regimen without any instillation but with aspiration of oropharyngeal secretions (control group). MEASUREMENTS AND MAIN RESULTS: The prevalence of ventilator-associated pneumonia was compared among the three groups. A total of 98 patients were analyzed (povidone-iodine group, n = 36; saline group, n = 31; and control group, n = 31). A total of 28 cases of ventilator-associated pneumonia were diagnosed. There was a significant decrease in the rate of ventilator-associated pneumonia in the povidone-iodine group when compared with the saline and control groups (3 of 36 patients [8%] vs. 12 of 31 patients [39%] and 13 of 31 patients [42%], respectively; p = .003 and .001, respectively). The length of stay and mortality in the surgical intensive care unit were not statistically different between the three groups. CONCLUSIONS: The regular administration of povidone-iodine may be an effective strategy for decreasing the prevalence of ventilator-associated pneumonia in patients with severe head trauma.