Peri-insular hemispherotomy: potential pitfalls and avoidance of complications.

Techniques for cerebral hemispherectomy have progressively evolved towards more disconnection and less excision over the last 50 years. Peri-insular hemispherotomy (PIH), as described by the senior author, has the maximal ratio of disconnection to excision among all procedures for hemispheric epilepsy. In this study, we focus on surgical complications and intraoperative anatomical observations during PIH over the last 10 years. Based on this experience, the procedure has undergone some modifications, which we detail herein.

Trypanosoma cruzi: metacyclogenesis in vitro - I. Changes in the properties of metacyclic trypomastigotes maintained in the laboratory by different methods

In this work we have studied the modifications in the biological properties of Trypanosoma cruzi when the parasite is maintained for a long time in axenic culture. The studies were done with a clone from an avirulent strain (Dm30L) and a non-cloned virulent strain (EP) of T. cruzi. Both parasiteswere maintained, for at least three years, by successive triatomine/mouse alternate passage (control condition), or by serial passage in axenic medium (culture condition), or only in the mouse (mouse condition). The comparison between parasites of culture and control condition showed that metacyclogenesis capacity was reduced in the former and that the resulting metacyclics displayed an attenuatedvirulence. In order to compare the virulence of metacyclics from the urine of the insect vector, Rhodnius prolixus were infected by artificial feeding with parasites of the control or culture condition. After three triatomine/triatomine passages, there was observed an almost identical biological behavior for these parasites, hence indicating that the maintenance of T. cruzi for a long time in axenic culture affects the differentiation capacity and the virulence of the parasite. Additionally, it was demonstrated that it is possible to maintain T. cruzi exclusively through passages in the invertebrate host.

Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel.

CONTEXT: New trial data and drug regimens that have become available in the last 2 years warrant an update to guidelines for antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected adults in resource-rich settings. OBJECTIVE: To provide current recommendations for the treatment of adult HIV infection with ART and use of laboratory-monitoring tools. Guidelines include when to start therapy and with what drugs, monitoring for response and toxic effects, special considerations in therapy, and managing antiretroviral failure. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: Data that had been published or presented in abstract form at scientific conferences in the past 2 years were systematically searched and reviewed by an International Antiviral Society-USA panel. The panel reviewed available evidence and formed recommendations by full panel consensus. DATA SYNTHESIS: Treatment is recommended for all adults with HIV infection; the strength of the recommendation and the quality of the evidence increase with decreasing CD4 cell count and the presence of certain concurrent conditions. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/lamivudine) plus a nonnucleoside reverse transcriptase inhibitor (efavirenz), a ritonavir-boosted protease inhibitor (atazanavir or darunavir), or an integrase strand transfer inhibitor (raltegravir). Alternatives in each class are recommended for patients with or at risk of certain concurrent conditions. CD4 cell count and HIV-1 RNA level should be monitored, as should engagement in care, ART adherence, HIV drug resistance, and quality-of-care indicators. Reasons for regimen switching include virologic, immunologic, or clinical failure and drug toxicity or intolerance. Confirmed treatment failure should be addressed promptly and multiple factors considered. CONCLUSION: New recommendations for HIV patient care include offering ART to all patients regardless of CD4 cell count, changes in therapeutic options, and modifications in the timing and choice of ART in the setting of opportunistic illnesses such as cryptococcal disease and tuberculosis.

Programa de introducción a la investigación y al desarrollo de las destrezas comunicativas (hablar y escribir correctamente): aplicación, desarrollo y resultados

Ante el nuevo reto que supone la adaptación al Espacio Europeo de Educación Superior (EEES) con una acción política que propone introducir importantes modificaciones en la concepción del proceso de enseñanza-aprendizaje entre las que se encuentran el replanteamiento del papel del profesor y del alumno, y el proceder metodológico en la acción docente, todos los agentes educativos deben aunar esfuerzos para articular medidas que posibiliten la adaptación a este nuevo escenario de manera óptima. Las universidades están ofreciendo a los docentes herramientas que puedan facilitar el acceso a los procesos de innovación educativa que exige el nuevo espacio de formación. En este marco es donde nace el proyecto titulado 'Programa de Introducción a la Investigación y al Desarrollo de las Destrezas Comunicativas (hablar y escribir correctamente)' que, valiéndose de los recursos tecnológicos que nos ofrece el Servicio de Innovación Educativa de la Universidad de Málaga, busca mejorar las competencias de expresión oral y escrita de los alumnos, así como la capacidad para organizar sus trabajos de investigación de manera rigurosa y ordenada, siguiendo una secuenciación razonada y científica. En la presente comunicación se detallan los objetivos del proyecto, la descripción del mismo, el modo de proceder en su desarrollo, las partes de las que ha constado y las conclusiones a las que se ha llegado.

Distinct subcellular localization of beta-tubulin epitopes in the adult mouse brain.

A panel of monoclonal antibodies specific of alpha-tubulin (TU-01, TU-09) and beta-tubulin (TU-06, TU-13) subunits was used to study the location of N-terminal structural domains of tubulin in adult mouse brain. The specificity of antibodies was confirmed b immunoblotting experiments. Immunohistochemical staining of vibratome sections from cerebral cortex, cerebellum, hippocampus, and corpus callosum showed that antibodies TU-01, TU-09, and TU-13 reacted with neuronal and glial cells and their processes, whereas the TU-06 antibody stained only the perikarya. Dendrites and axons were either unstained or their staining was very weak. As the TU-06 epitope is located on the N-terminal structural domain of beta-tubulin, the observed staining pattern cannot be interpreted as evidence of a distinct subcellular localization of beta-tubulin isotypes or known post-translational modifications. The limited distribution of the epitope could, rather, reflect differences between the conformations of tubulin molecules in microtubules of somata and neurites or, alternatively, a specific masking of the corresponding region on the N-terminal domain of beta-tubulin by interacting protein(s) in dendrites and axons.

Involvement of PPARβ/δ in mesenchymal-epidermal interactions during skin wound healing

SUMMARY : Skin wound repair is a complex and highly coordinated process, where a variety of cell types unite to regenerate the damaged tissue. Several works have elucidated cellular and molecular mechanisms, in which mesenchymal-epidermal interactions play an essential role for the regulation of skin homeostasis and repair. Peroxisome Proliferator-Activated Receptors (PPARs) are ligand-activated transcription factors that belong to the nuclear receptor superfamily. Three related isotypes (PPARα, PPARß/δ and PPARγ) have been found, which exhibit distinct tissue distribution and specific physiological functions. PPARß/δ was identified as a crucial player of skin homeostasis. In the mouse skin, PPARß/δ has been described to control proliferation-differentiation state, adhesion and migration, and survival of the keratinocytes during healing. PPARß/δ has been implicated as well in the development of the hair follicles, in which mesenchymal-secreted hepatocyte growth factor (HGF) is involved. These data suggest that the biological activity of PPARß/δ is modulated by mesenchymal-epidermal interactions and that, in turn, PPARß/δ also modulates some of these signals. The aim of the present work was to elucidate the nature of the signals exchanged between the epidermis and dermis compartments, and more particularly those which are under the control of PPARß/δ. In the first part of the study, we showed that PPARß/8 in dermal fibroblasts down-regulates the mitotic activity of keratinocytes by inhibiting the IL-1 signalling pathway via the production of secreted IL-1 receptor antagonist (sIL-1Ra), a natural antagonist of this signalling. The regulation of IL-1 signalling by PPARß/δ is required for anon-pathological skin wound repair. These findings provide evidence for a novel homeostatic control of keratinocyte proliferation and differentiation mediated by the regulation of IL-1 signalling via dermal PPARß/δ fibroblasts. Proteolysis of the extracellular matrix (ECM) is a key process involved in wound repair and modifications in its activity are often associated with an alteration óf the wound closure. This process implies specific proteinases, as matrix metalloproteinases (MMPs), which are finely modulated by IL-1 signalling. In line with the first results, the second part of the work showed that MMP8 and MMP13, which are two important collagenases involved in mouse skin wound repair, are regulated by PPARß/δ. Their expression is indirectly down-regulated by dermal PPARß/δ, via the production of sIL-1Ra, resulting in the inhibition of IL-1 signalling, known to regulate the expression of numerous MMPs. We suggest that, in absence of PPARß/δ, the positive regulation of these two collagenases could participate to the delay of skin wound healing, which has been observed in mice deleted for PPARßlS. The potential therapeutic role of PPARß/b could be as well extending to inflammatory and hyperproliferative skin diseases involving IL-1 signalling, such as psoriasis or skin cancers. Quite interestingly, MMP1 (analogue of mouse MMP13) plays an essential role in human photoaging, suggesting that PPARß/δ could as well be an attractive target for photoprotection. RESUME : La cicatrisation est un processus complexe et extrêmement organisé, impliquant un grand nombre de cellules qui s'unissent pour régénérer le tissu endommagé. De nombreux travaux nous ont éclairés sur les mécanismes cellulaires et moléculaires, dans lesquels les interactions épidermo-mésenchymateuses détiennent un rôle capital à la fois dans la régulation de l'homéostasie et dans la réparation de la peau. PPAR (Peroxisome proliferatar-activated receptor), qui appartient à la superfamille des récepteurs nucléaires, se définit comme un facteur de transcription activé par des ligands très spécifiques. Trois isotypes (PPARa, PPARß/δ et PPARy) ont été décrits et sont caractérisés par une distribution tissulaire et des fonctions physiologiques clairement définies. PPARß/δ a été identifié comme étant un important acteur dans l'homéostasie de la peau. Chez la souris, il a été décrit comme contrôlant l'état de prolifération et de différenciation, le processus d'adhésion et de migration, ainsi que la survie des kératinocytes au cours de la cicatrisation. PPARßIS a également été défini comme contrôlant le développement des follicules pileux, impliquant la sécrétion par le mésenchyme du facteur de croissance HGF. Ces données suggèrent que l'activité biologique de PPARß/δ est modulée par des interactions épidermo-mésenchymateuses, et qu'en retour, il possède la capacité de moduler certains de ces signaux. L`objectif de ce travail a été d'élucider la nature des signaux échangés entre les compartiments épidermique et dermique, et plus particulièrement ceux qui sont sous le contrôle de PPARß/δ. Dans la première partie de l'étude, nous avons montré que les fibroblastes exprimant PPARß/δ réduisent l'activité mitotique des kératinocytes en inhibant la voie de signalisation IL-1, via la production de sIL-1Ra (secreted IL-1 receptor antagonist), défini comme un antagoniste naturel de cette voie de signalisation. La régulation de cette dernière par PPARß/δ est donc nécessaire pour une cicatrisation de type non pathologique. Ces résultats offrent donc une nouvelle preuve du contrôle de l'homéostasie et de l'état de prolifération/différenciation des kératinocytes par les fibroblastes exprimant PPARß/δ, en régulant la voie de signalisation IL-1. Le mécanisme de dégradation de la matrice extracellulaire (MEC) est une étape essentielle lors du processus de cicatrisation. Ainsi des modifications de cette activité protéolytïque sont souvent associées à une altération de la fermeture de la plaie. Ce processus implique des protéinases, comme les MMPs, qui sont finement modulés par la voie de signalisation IL-1. En accord avec les premiers résultats, la seconde partie des nos travaux a montré que les collagénases MMP8 et MMP13, connues pour être d'importantes molécules impliquées lors de la réparation tissulaire chez la souris, sont modulées par l'activité de PPARß/δ. Leurs expressions sont indirectement régulées par PPARß/δ, via la production. de sIL-1 Ra, entraînant ainsi l'inhibition de la voie de signalisation IL-1, décrite pour réguler l'expression de nombreuses MMPs, Nous suggérons donc qu'en absence de PPARß/δ, la régulation de ces deux collagénases pourrait être impliquée dans le retard de cicatrisation, observé chez les souris déficientes pour PPARß/δ. L'activité biologique de PPARß/δ pourrait être ainsi étendue à des maladies hyperproliferatives et inflammatoires de la peau, impliquant la voie de signalisation IL-1, comme le psoriasis ou certains cancers de la peau, et ce à des fins thérapeutiques. Il est aussi intéressant de relever que chez l'homme, MMP1 (présenté comme l'analogue de MMP13 de la souris} joue un rôle primordial dans le photo-vieillissement, nous suggérons donc que PPARß/δ pourrait ainsi être une cible attrayante concernant la photoprotection.

Early broncoconstriction in anesthetized sheep: a simplified experimental model of asthma

Résumé Cette étude décrit un modèle expérimental de bronchoconstriction précoce induite par aérosolisation d'un extrait d'Ascaris suum chez des moutons anesthésiés par de l'isoflurane et ventilés mécaniquement. Dix moutons adultes ont été anesthésiés et ventilés mécaniquement puis ont été exposés à un stimulus bronchoconstrictif sous forme d'un aérosol d'extrait d'Ascaris suum durant 25 minutes. Tous les moutons ont été exposés deux fois à huit semaines d'intervalle à ce même stimulus. Les échanges gazeux ainsi que les paramètres respiratoires ont été mesurés régulièrement durant la période d'aérosolisation ainsi que durant les 60 minutes suivantes. A la fin de la période d'aérosolisation, une augmentation significative (p<0.05) des pressions de crête (+114%) et de plateau (+148%), de la résistance expiratoire (+93%) et de la pression partielle artérielle de gaz carbonique PaCO2 (+25%) a été constatée, de même qu'une diminution significative (p<0.05) de la compliance respiratoire (-41 %) et de la pression partielle artérielle d'oxygène PaO2 (-49%). Ces modifications sont restées stables durant toute la période d'observation. Ce modèle expérimental animal de bronchoconstriction offre de nombreux avantages : la stabilité hémodynamique et le confort de l'animal sont améliorés et la réaction de stress est inhibée. Il permet de plus une distribution optimale de l'antigène respiratoire et finalement évite l'utilisation d'un pléthysmographe corporel. Abstract This study describes a simplified experimental model of early bronchoconstriction induced by aerosolization of Ascaris suum extract in isoflurane-anesthetized and mechanically ventilated sheep. Ten adult sheep were anesthetized, mechanically ventilated and then challenged with an aerosol of Ascaris suum extract during 25 minutes. All of them were challenged twice at eight weeks intervals. During the bronchoconstrictive challenges and the following sixty minutes, gas exchange was measured and respiratory mechanics parameters computed from a lung mechanics calculator. At the end of the challenge, a significant increase (p<0.05) was observed in peak (+114%) and plateau (+148%) pressures, expiratory resistance (+93%) and PaCO2 (+25%) along with a significant decrease (p<0.05) in respiratory compliance (-41 %) and PaO2 (-49%). These changes remained stable throughout the 60 minutes study period. This model offers several advantages: hemodynamic stability and animal welfare are improved and the stress response is blunted. It allows an optimal distribution of the antigen and finally avoids the need of a body plethysmograph.

White matter maturation reshapes structural connectivity in the late developing human brain.

From toddler to late teenager, the macroscopic pattern of axonal projections in the human brain remains largely unchanged while undergoing dramatic functional modifications that lead to network refinement. These functional modifications are mediated by increasing myelination and changes in axonal diameter and synaptic density, as well as changes in neurochemical mediators. Here we explore the contribution of white matter maturation to the development of connectivity between ages 2 and 18 y using high b-value diffusion MRI tractography and connectivity analysis. We measured changes in connection efficacy as the inverse of the average diffusivity along a fiber tract. We observed significant refinement in specific metrics of network topology, including a significant increase in node strength and efficiency along with a decrease in clustering. Major structural modules and hubs were in place by 2 y of age, and they continued to strengthen their profile during subsequent development. Recording resting-state functional MRI from a subset of subjects, we confirmed a positive correlation between structural and functional connectivity, and in addition observed that this relationship strengthened with age. Continuously increasing integration and decreasing segregation of structural connectivity with age suggests that network refinement mediated by white matter maturation promotes increased global efficiency. In addition, the strengthening of the correlation between structural and functional connectivity with age suggests that white matter connectivity in combination with other factors, such as differential modulation of axonal diameter and myelin thickness, that are partially captured by inverse average diffusivity, play an increasingly important role in creating brain-wide coherence and synchrony.

Non-covalent and covalent protein labeling in two-dimensional gel electrophoresis.

Over the past decades, several sensitive post-electrophoretic stains have been developed for an identification of proteins in general, or for a specific detection of post-translational modifications such as phosphorylation, glycosylation or oxidation. Yet, for a visualization and quantification of protein differences, the differential two-dimensional gel electrophoresis, termed DIGE, has become the method of choice for a detection of differences in two sets of proteomes. The goal of this review is to evaluate the use of the most common non-covalent and covalent staining techniques in 2D electrophoresis gels, in order to obtain maximal information per electrophoresis gel and for an identification of potential biomarkers. We will also discuss the use of detergents during covalent labeling, the identification of oxidative modifications and review influence of detergents on finger prints analysis and MS/MS identification in relation to 2D electrophoresis.

Poumon et grossesse [Lung and pregnancy].

During pregnancy several adaptations develop in response to the enhanced maternal and fetal metabolic needs. This review summarizes the major cardiorespiratory modifications of pregnancy as well as their consequences in chronic respiratory diseases such as restrictive ventilatory defects (post-tuberculosis pneumonectomy, kyphoscoliosis, neuromuscular disorders), asthma, cystic fibrosis, and pulmonary hypertension. It is important to recognize early the cardiorespiratory situations for which pregnancy is contraindicated or associated with a high risk of respiratory complications. Clinical management by an expert and often pluridisciplinary team is recommended.

A protocol for preparing GFP-labeled neurons previously imaged in vivo and in slice preparations for light and electron microscopic analysis.

In vivo imaging of green fluorescent protein (GFP)-labeled neurons in the intact brain is being used increasingly to study neuronal plasticity. However, interpreting the observed changes as modifications in neuronal connectivity needs information about synapses. We show here that axons and dendrites of GFP-labeled neurons imaged previously in the live mouse or in slice preparations using 2-photon laser microscopy can be analyzed using light and electron microscopy, allowing morphological reconstruction of the synapses both on the imaged neurons, as well as those in the surrounding neuropil. We describe how, over a 2-day period, the imaged tissue is fixed, sliced and immuno-labeled to localize the neurons of interest. Once embedded in epoxy resin, the entire neuron can then be drawn in three dimensions (3D) for detailed morphological analysis using light microscopy. Specific dendrites and axons can be further serially thin sectioned, imaged in the electron microscope (EM) and then the ultrastructure analyzed on the serial images.

Cytochemical and immunocytochemical characterization of nuclear bodies during hibernation.

Brown adipose tissue and liver of hibernating, arousing and euthermic individuals of the dormouse Muscardinus avellanarius were studies using ultrastructural cytochemistry and immunocytochemistry with the aim to investigate possible fine structural modifications of the cell nucleus during the seasonal cycle. The general morphology of brown adipocyte and hepatocyte nuclei was similar in the three experimental groups. However, three nuclear structural constituents were identified only in hibernating individuals: coiled bodies (CBs) and amorphous bodies (ABs) were observed in hepatocytes and, together with bundles of nucleoplasmic fibrils (NF), were present in brown adipocytes of hibernating dormice. In arousing animals only some structural constituents suggestive of poorly structured CBs were found. The latter showed the same immunocytochemical features as CBs of hibernating individuals, suggesting that they are disappearing CBs. A possible involvement of CBs in storing and/or processing RNA which must be rapidly and abundantly released upon arousal is discussed. ABs similarly to CBs contain RNA and nucleoplasmic ribonucleoproteins (RNPs) and could also be involved in mRNA pathways. NF do not contain nucleic acids or RNPs and seem to be composed of protein-aceous material; their functional role in the nuclear metabolism of hibernating brown adipocytes remains unclear.

Biocompatibility of an x-shaped zirconium implant in deep sclerectomy in rabbits.

BACKGROUND: The aim of this study was to evaluate the mid-term biocompatibility of a new x-shaped implant made of zirconium in an animal model of glaucoma surgery. METHODS: Preoperatively, ultrasound biomicroscopy (UBM), intraocular pressure (IOP) and outflow facility (OF) data were acquired. Upon surgery, one eye was chosen randomly to receive an implant, while the other received none. Ten rabbits went through a 1-, 2-, 3-, 4- and 6-month follow-up. IOP was measured regularly, UBM performed at 1, 3 and 6 months after surgery. At the end of the follow-up, OF was again measured. Histology sections were analyzed. RESULTS: For both groups IOP control was satisfactory, while OF initially increased at month 1 to resume preoperative values thereafter. Eyes with implants had larger filtration blebs which decreased faster than in eyes without the implant. Drainage vessel density, inflammatory cell number and fibrosis were higher in tissues near the implant. CONCLUSIONS: The zirconium implant initially promoted the positive effects of the surgery (IOP control, OF increase). Nevertheless, after several months, foreign body reactions and fibrosis had occurred on some implants that restrained the early benefit of such a procedure. Modifications of the zirconium implant geometry could enhance the overall success rate.

Identification of Novel Membrane Structures in Plasmodium falciparum Infected Erythrocytes

Little is known about the molecular mechanisms underlying the release of merozoites from malaria infected erythrocytes. In this study membranous structures present in the culture medium at the time of merozoite release have been characterized. Biochemical and ultrastructural evidence indicate that membranous structures consist of the infected erythrocyte membrane, the parasitophorous vacuolar membrane and a residual body containing electron dense material. These are subcellular compartments expected in a structure that arises as a consequence of merozoite release from the infected cell. Ultrastructural studies show that a novel structure extends from the former parasite compartment to the surface membrane. Since these membrane modifications are detected only after merozoites have been released from the infected erythrocyte, it is proposed that they might play a role in the release of merozoites from the host cell

Impending status epilepticus and anxiety in a pregnant woman treated with levetiracetam.

Levetiracetam (LEV) has been considered to undergo no significant change in bioavailability during pregnancy; however, it was recently demonstrated to display modifications leading to a drop in its serum level. We describe a patient who displayed impending status epilepticus following a fall in her LEV level during the first trimester. The oral LEV dosage was increased, and phenytoin and benzodiazepines were transiently prescribed. She experienced severe anxiety and an unbearable fear over the deleterious consequences for her baby despite repeated, reassuring explanations. Her anxiety was so strong that she aborted electively shortly after leaving the hospital. This observation emphasizes the need for LEV level monitoring during pregnancy to prevent unexpected seizure relapses. The rapid increase in levetiracetam dosage in parallel with the loss of seizure control is suspected of facilitating the induction of significant psychiatric changes.