Syndrome hypothénarien du marteau: étiologie peu connue de phénomène de Raynaud secondaire [Hypothenar hammer syndrome: little-known etiology of secondary Raynaud's phenomenon]

Hypothenar hammer syndrome is an uncommonly encountered cause of Raynaud's phenomenon associated with professional or recreational activities. We report 6 consecutive cases seen in our angiology unit between 1988 and 1990. Clinical findings include a history of repeated microtraumatisms of the dominant hand, male sex, unilaterality, sudden onset, and severe Raynaud's phenomenon of the last three fingers. Investigations reveal an aneurysm or thrombosis of the distal cubital artery or of the superficial palmar branch, associated with occlusion of digital arteries. Avoidance of the aggravating conditions or resection and/or plasty of the affected vascular segment usually leads to disappearance of the symptoms.

Conformity, upstream reciprocity and social diversity: secondary mechanisms for the evolution of cooperation

Cooperation is ubiquitous in nature: genes cooperate in genomes, cells in muti- cellular organims, and individuals in societies. In humans, division of labor and trade are key elements of most known societies, where social life is regulated by- moral systems specifying rights and duties often enforced by third party punish¬ment. Over the last decades, several primary mechanisms, such as kin selection, direct and indirect reciprocity, have been advanced to explain the evolution of cooperation from a naturalistic approach. In this thesis, I focus on the study of three secondary mechanisms which, although insufficient to allow for the evo¬lution of cooperation, have been hypothesized to further promote it when they are linked to proper primary mechanisms: conformity (the tendency to imitate common behaviors), upstream reciprocity (the tendency to help somebody once help has been received from somebody else) and social diversity (heterogeneous social contexts). I make use of mathematical and computational models in the formal framework of evolutionary game theory in order to investigate the theoret¬ical conditions under which conformity, upstream reciprocity and social diversity are able to raise the levels of cooperation attained in evolving populations. - La coopération est ubiquitaire dans la nature: les gènes coopèrent dans les génomes, les cellules dans les organismes muticellulaires, et les organismes dans les sociétés. Chez les humains, la division du travail et le commerce sont des éléments centraux de la plupart des sociétés connues, où la vie sociale est régie par des systèmes moraux établissant des droits et des devoirs, souvent renforcés par la punition. Au cours des dernières décennies, plusieurs mécanismes pri¬maires, tels que la sélection de parentèle et les réciprocités directe et indirecte, ont été avancés pour expliquer l'évolution de la coopération d'un point de vue nat¬uraliste. Dans cette thèse, nous nous concentrons sur l'étude de trois mécanismes secondaires qui, bien qu'insuffisants pour permettre l'évolution de la coopération, sont capables de la promouvoir davantage s'ils sont liés aux mécanismes primaires appropriés: la conformité (tendance à imiter des comportements en commun), la 'réciprocité en amont' (tendance à aider quelqu'un après avoir reçu l'aide de quelqu'un d'autre) et la diversité sociale (contextes sociaux hétérogènes). Nous faisons usage de modèles mathématiques et informatiques dans le cadre formel de la théorie des jeux évolutionnaires afin d'examiner les conditions théoriques dans lesquelles la conformité, la 'réciprocité en amont' et la diversité sociale sont capables d'élever le niveau de coopération des populations en évolution.

Efficacy of in-hospital multidimensional interventions of secondary prevention after acute coronary syndrome: a systematic review and meta-analysis

BACKGROUND: Secondary prevention programs for patients experiencing an acute coronary syndrome have been shown to be effective in the outpatient setting. The efficacy of in-hospital prevention interventions administered soon after acute cardiac events is unclear. We performed a systematic review and meta-analysis to determine whether in-hospital, patient-level interventions targeting multiple cardiovascular risk factors reduce all-cause mortality after an acute coronary syndrome. METHODS AND RESULTS: Using a prespecified search strategy, we included controlled clinical trials and before-after studies of secondary prevention interventions with at least a patient-level component (ie, education, counseling, or patient-specific order sets) initiated in hospital with outcomes of mortality, readmission, or reinfarction rates in acute coronary syndrome patients. We classified the interventions as patient-level interventions with or without associated healthcare provider-level interventions and/or system-level interventions. Twenty-six studies met our inclusion criteria. The summary estimate of 14 studies revealed a relative risk of all-cause mortality of 0.79 (95% CI, 0.69 to 0.92; n=37,585) at 1 year. However, the apparent benefit depended on study design and level of intervention. The before-after studies suggested reduced mortality (relative risk [RR], 0.77; 95% CI, 0.66 to 0.90; n=3680 deaths), whereas the RR was 0.96 (95% CI, 0.64 to 1.44; n=99 deaths) among the controlled clinical trials. Only interventions including a provider- or system-level intervention suggested reduced mortality compared with patient-level-only interventions. CONCLUSIONS: The evidence for in-hospital, patient-level interventions for secondary prevention is promising but not definitive because only before-after studies suggest a significant reduction in mortality. Future research should formally test which components of interventions provide the greatest benefit.

Criteria for the Evaluation and Disposition of Low-Traffic-Count Secondary Roads, HR-139, 1969

The State of Iowa has too many roads. Although ranking thirty-fourth in population, twenty-fifth in area, and twentieth in motor vehicle registration, it ranks seventh in the nation in miles of rural roads. In 1920 when Iowa's rural population was 1,528,000, there were 97,440 miles of secondary roads. In 1960 with rural population down 56 percent to 662,000, there were 91,000 miles of secondary roads--a 7 percent decrease. The question has been asked: "Who are these 'service roads' serving?" This excess mileage tends to dissipate road funds at a critical time of increasing public demand for better and safer roads.

Capturing epidermal stemness for regenerative medicine.

The skin is privileged because several skin-derived stem cells (epithelial stem cells from epidermis and its appendages, mesenchymal stem cells from dermis and subcutis, melanocyte stem cells) can be efficiently captured for therapeutic use. Main indications remain the permanent coverage of extensive third degree burns and healing of chronic cutaneous wounds, but recent advances in gene therapy technology open the door to the treatment of disabling inherited skin diseases with genetically corrected keratinocyte stem cells. Therapeutic skin stem cells that were initially cultured in research or hospital laboratories must be produced according strict regulatory guidelines, which ensure patients and medical teams that the medicinal cell products are safe, of constant quality and manufactured according to state-of-the art technology. Nonetheless, it does not warrant clinical efficacy and permanent engraftment of autologous stem cells remains variable. There are many challenges ahead to improve efficacy among which to keep telomere-dependent senescence and telomere-independent senescence (clonal conversion) to a minimum in cell culture and to understand the cellular and molecular mechanisms implicated in engraftment. Finally, medicinal stem cells are expansive to produce and reimbursement of costs by health insurances is a major concern in many countries.

Human epidermal cultures screened for residual murine feeder cells-No contaminants found

Rationale: Human keratinocytes used for transplants are cultivated on a feeder layer which may be composed of autologous human fibroblasts or 3T3 murine fibroblasts. Using the latter method spares 15 additional days of preparation. In this study we investigate the potential presence of residual murine feeder cell contaminants in epidermal cultures prepared for transplantation. Methods: Monolayers of cultured 3T3-J2 murine fibroblasts were treated with 4 μg/mL of mitomycin C (MMC) for 2 h and used to track cell survival kinetics. Using similar 3T3 cells, human keratinocyte cultures were grown following a modified protocol based on the method described by Rheinwald and Green. Cell sheets were mechanically detached and rinsed 4 times following the same procedure used for transplant preparation. The elimination of 3T3 cells during culture was visually tracked using phase contrast microscopy. Epidermal cultures were then dissociated to produce cell suspensions and analyzed by flow cytometry using a murine-specific antibody, CD90, conjugated to a fluorescein isothiocyanate (FITC) marker. Dead cells were identified using 7-amino-actinomysin D (7-AAD) which binds to DNA in permeabilized cells. Results: 3T3 cells treated with MMC display clear morphological signs of apoptosis, disappearing completely in 9-10 days following kinetics similar to 30 Gy gamma irradiated 3T3 cells. Histological analysis of cultured epidermal sheets revealed homogenous keratinocytic tissue with no 3T3 cells. MMC treated and untreated 3T3 cells displayed strong CD90 expression. Cell suspensions obtained from epidermal cultures were, however, negative for that marker. Conclusion: Results obtained demonstrate the absence of contaminating murine 3T3 feeder cells in human keratinocyte cultures. These findings highlight our success in developing cultured human epidermal autografts.

Necrotrophic fungi associated with epidermal microcracking caused by chilling injury in pickling cucumber fruit

The objective of this work was to visualize the association between microcracking and other epidermal chilling injury symptoms, and to identify rots in cucumber fruit (Cucumis sativus L.) by scanning electron microscopy (SEM). Depressed epidermal areas and surface cracking due to damages of subepidermal cells characterized the onset of pitting in cucumber fruit. The germination of conidia of Alternaria alternata, with some of them evident on the fractures in the cultivar Trópico, occurred after damaging on the epidermis. Before, the chilling injury symptoms became visible, Stemphylium herbarum conidia germinated, and mycelium penetrated through the hypodermis using the microcracks as pathway. In the cultivar Perichán 121 the fungus was identified as Botrytis cinerea.

Cell death-induced activation of epidermal growth factor receptor in keratinocytes: implications for restricting epidermal damage in dermatitis.

Recent findings have implicated Fas/Fas ligand (FasL) in mediating the death of keratinocytes in spongiotic lesions. We asked whether dying keratinocytes could potentially initiate a protective response of the skin to limit the destruction of the epidermis in the spongiotic areas. In addition to apoptosis, treatment of keratinocyte cultures in vitro with FasL triggers a profound phoshorylation of the epidermal growth factor receptor (EGFR) and of its downstream effectors ERK and protein kinase B (PKB/Akt). Using a variety of inhibitors and blocking antibodies, we demonstrated that: (i) apoptosis is required for the generation of the signal(s) leading to the activation of EGFR, ERK, and Akt; (ii) the activation of EGFR, ERK, and Akt by FasL is indeed mediated by its bona fide receptor Fas; (iii) the activation of EGFR is essential for the subsequent activation of ERK and Akt; and (iv) apoptotic keratinocytes secrete soluble EGFR ligands (including amphiregulin) that are processed from membrane-bound proligand forms by metalloproteinase(s). Our findings demonstrate a potential mechanism for the restriction and repair of spongiotic damage in eczemas.

A critical evaluation of secondary cancer risk models applied to Monte Carlo dose distributions of 2-dimensional, 3-dimensional conformal and hybrid intensity-modulated radiation therapy for breast cancer.

The comparison of radiotherapy techniques regarding secondary cancer risk has yielded contradictory results possibly stemming from the many different approaches used to estimate risk. The purpose of this study was to make a comprehensive evaluation of different available risk models applied to detailed whole-body dose distributions computed by Monte Carlo for various breast radiotherapy techniques including conventional open tangents, 3D conformal wedged tangents and hybrid intensity modulated radiation therapy (IMRT). First, organ-specific linear risk models developed by the International Commission on Radiological Protection (ICRP) and the Biological Effects of Ionizing Radiation (BEIR) VII committee were applied to mean doses for remote organs only and all solid organs. Then, different general non-linear risk models were applied to the whole body dose distribution. Finally, organ-specific non-linear risk models for the lung and breast were used to assess the secondary cancer risk for these two specific organs. A total of 32 different calculated absolute risks resulted in a broad range of values (between 0.1% and 48.5%) underlying the large uncertainties in absolute risk calculation. The ratio of risk between two techniques has often been proposed as a more robust assessment of risk than the absolute risk. We found that the ratio of risk between two techniques could also vary substantially considering the different approaches to risk estimation. Sometimes the ratio of risk between two techniques would range between values smaller and larger than one, which then translates into inconsistent results on the potential higher risk of one technique compared to another. We found however that the hybrid IMRT technique resulted in a systematic reduction of risk compared to the other techniques investigated even though the magnitude of this reduction varied substantially with the different approaches investigated. Based on the epidemiological data available, a reasonable approach to risk estimation would be to use organ-specific non-linear risk models applied to the dose distributions of organs within or near the treatment fields (lungs and contralateral breast in the case of breast radiotherapy) as the majority of radiation-induced secondary cancers are found in the beam-bordering regions.

Recent advances in the epidermal growth factor receptor/ligand system biology on skin homeostasis and keratinocyte stem cell regulation.

The epidermal growth factor (EGF) receptor/ligand system stimulates multiple pathways of signal transduction, and is activated by various extracellular stimuli and inter-receptor crosstalk signaling. Aberrant activation of EGF receptor (EGFR) signaling is found in many tumor cells, and humanized neutralizing antibodies and synthetic small compounds against EGFR are in clinical use today. However, these drugs are known to cause a variety of skin toxicities such as inflammatory rash, skin dryness, and hair abnormalities. These side effects demonstrate the multiple EGFR-dependent homeostatic functions in human skin. The epidermis and hair follicles are self-renewing tissues, and keratinocyte stem cells are crucial for maintaining these homeostasis. A variety of molecules associated with the EGF receptor/ligand system are involved in epidermal homeostasis and hair follicle development, and the modulation of EGFR signaling impacts the behavior of keratinocyte stem cells. Understanding the roles of the EGF receptor/ligand system in skin homeostasis is an emerging issue in dermatology to improve the current therapy for skin disorders, and the EGFR inhibitor-associated skin toxicities. Besides, controlling of keratinocyte stem cells by modulating the EGF receptor/ligand system assures advances in regenerative medicine of the skin. We present an overview of the recent progress in the field of the EGF receptor/ligand system on skin homeostasis and regulation of keratinocyte stem cells.

Factors affecting the snow and wind induced damage of a montane secondary forest in northeastern China

Abstract

Aggregate material formulated with MSWI bottom ash and APC fly ash for use as secondary building material

The main goal of this paper is to obtain a granular material formulated with Municipal Solid Waste Incinerarion (MSWI) bottom ash (BA) and air pollution control (APC) ash to be used as secondary building material. Previously, an optimum concrete mixture using both MSWI residues as aggregates was formulated. A compromise between the environmental behaviour and the economy of the process was considered. Unconfined compressive strength and abrasion resistance values were measured in order to evaluate the mechanical properties. From these results, the granular mixture was not suited for certain applications owing to the high BA/APC content and low cement percentages used to reduce the costs of the final product. Nevertheless, the leaching test performed showed that the concentrations of all heavy metals were below the limits established by the current Catalan legislation for their reutilization. Therefore, the material studied might be mainly used in embankments, where high mechanical properties are not needed and environmental safety is assured.