New era: Prophylactic surgery for patients with multiple endocrine neoplasia-2A

Background: The surgical management of patients with multiple endocrine neoplasia-2A (MEN-2A) continues to evolve with specific genotype-phenotype correlations allowing for a more tailored approach. In this study, we report the surgical management of one of the largest MEN-2A families with a rearranged during transfection (RET) codon 804 mutation. Method: This is a cohort study comprising all at-risk kindred within a single known MEN-2A family. Prophylactic total thyroidectomy with lymph node dissection was recommended to all mutation carriers aged 5 years and older. Results: There were a total of 48 at-risk individuals in the MEN-2A kindred, with 22 patients undergoing thyroidectomy after appropriate preoperative evaluation. A total of 9 patients had medullary thyroid cancer including 5 with a normal preoperative calcitonin level. A total of 11 patients had C-cell hyperplasia and 7 showed histological evidence of parathyroid disease. Only the index case had a phaeochromocytoma. Conclusion: Genetic testing for germline mutations in the RET proto-oncogene has allowed precise identification of affected RET carriers and provided the opportunity for prophylactic or 'preclinical' surgery to treat and in fact to prevent medullary thyroid cancer. This concept of prophylactic surgery based on a genetic test is likely to be applied more widely as the tools of molecular biology advance.

Combined external-endonasal approach for complete excision of the lacrimal drainage apparatus

Purpose: The purpose of this study was to describe a new surgical technique for the complete excision of the lacrimal drainage apparatus (LDA) that combines external and endoscopic approaches. Methods: This study involved a noncomparative, retrospective chart review of the clinical and pathological findings of four patients presenting with LDA papillomas who underwent a combined open and endonasal excision of the lacrimal system. Results. Of the four patients, three were male. The mean age at referral was 41 years, and all cases were unilateral. Histopathology revealed two transitional cell papillomas, one squamous cell papilloma, and one combined transitional/squamous papilloma. Epiphora and an external lesion were the main complaints at presentation. Nasolacrimal duct obstruction was present in all four patients. Papilloma virus infection was suggested in two cases and was confirmed in the only patient who had recurrence. CT identified a solid enhancing mass in two cases. The surgical approach in all cases was performed with the patient under general anesthetic supplemented with infiltration of local anesthesia with vasoconstriction. The lacrimal sac was exposed as per an external dacryocystorhinostomy with biopsy collection from the lacrimal sac lumen to confirm the diagnosis prior LDA excision. The superior aspect of the LDA was isolated by using lacrimal probes in each canaliculus to stabilized parallel incisions and careful dissection toward the common canaliculus until they met the medial aspect of the lacrimal sac. The sac was then separated from the periosteum from the medial orbital wall, using sharp dissection. Finally, an endoscopic dissection of the lower end of the nasolacrimal duct released the most inferior aspect of the LDA, allowing the surgeon to pull and excise the complete system from the external wound. Conclusions: Extensive LDA papillomas required complete excision of the drainage system to prevent recurrence and/or malignant transformation. The use of a combined approach through an open excision of the superior part of the LDA in conjunction with the direct manipulation of the nasolacrimal duct guided by the nasal endoscope facilitates the complete excision of the system for extensive benign lesions.

Trait physiology and crop modelling to link phenotypic complexity to underlying genetic systems

New tools derived from advances in molecular biology have not been widely adopted in plant breeding because of the inability to connect information at gene level to the phenotype in a manner that is useful for selection. We explore whether a crop growth and development modelling framework can link phenotype complexity to underlying genetic systems in a way that strengthens molecular breeding strategies. We use gene-to-phenotype simulation studies on sorghum to consider the value to marker-assisted selection of intrinsically stable QTLs that might be generated by physiological dissection of complex traits. The consequences on grain yield of genetic variation in four key adaptive traits – phenology, osmotic adjustment, transpiration efficiency, and staygreen – were simulated for a diverse set of environments by placing the known extent of genetic variation in the context of the physiological determinants framework of a crop growth and development model. It was assumed that the three to five genes associated with each trait, had two alleles per locus acting in an additive manner. The effects on average simulated yield, generated by differing combinations of positive alleles for the traits incorporated, varied with environment type. The full matrix of simulated phenotypes, which consisted of 547 location-season combinations and 4235 genotypic expression states, was analysed for genetic and environmental effects. The analysis was conducted in stages with gradually increased understanding of gene-to-phenotype relationships, which would arise from physiological dissection and modelling. It was found that environmental characterisation and physiological knowledge helped to explain and unravel gene and environment context dependencies. We simulated a marker-assisted selection (MAS) breeding strategy based on the analyses of gene effects. When marker scores were allocated based on the contribution of gene effects to yield in a single environment, there was a wide divergence in rate of yield gain over all environments with breeding cycle depending on the environment chosen for the QTL analysis. It was suggested that knowledge resulting from trait physiology and modelling would overcome this dependency by identifying stable QTLs. The improved predictive power would increase the utility of the QTLs in MAS. Developing and implementing this gene-to-phenotype capability in crop improvement requires enhanced attention to phenotyping, ecophysiological modelling, and validation studies to test the stability of candidate QTLs.

QUALIDADE DE VIDA E ESTRATÉGIAS DE ENFRENTAMENTO DE MULHERES COM E SEM LINFEDEMA APÓS CÂNCER DE MAMA

O linfedema no membro superior é uma complicação inerente ao tratamento de câncer de mama. Caracterizado pelo aumento do volume do membro, leva às limitações físicas e funcionais, e impacto negativo no âmbito psicológico e social. O objetivo deste estudo foi investigar a qualidade de vida e seus domínios, as estratégias de enfrentamento frente ao câncer de mama, e a correlação entre essas variáveis. Este estudo foi realizado em um centro de saúde dedicado às mulheres, por quatro meses. Os instrumentos de avaliação foram: questionário de caracterização geral e específico do câncer de mama, perimetria dos membros superiores; questionários de qualidade de vida da Organização Européia de Pesquisa e Tratamento do Câncer, EORTC QLQ-30 e BR-23; e Inventário de Estratégias de Coping. Foram entrevistadas 82 mulheres, idade média de 57,4 anos (DV12,3), submetidas a tratamento cirúrgico de mama unilateral e esvaziamento axilar, sem metástase. O linfedema apresentou-se em 39,03% (32) e parece não interferir muito na qualidade de vida das mulheres pós-câncer de mama, sendo a função social a mais prejudicada. Sintomas relacionados à quimioterapia e a mama incomodam as mulheres de ambos grupos, porém os sintomas relacionados aos braços foram estatisticamente maiores nas portadoras de linfedema. As estratégias mais utilizadas pelas entrevistadas para enfrentar o câncer foram a reavaliação, resolução de problemas, fuga, suporte social e autocontrole, somente o autocontrole foi estatisticamente maior nas mulheres com linfedema. As estratégias de resolução de problemas, autocontrole e baixo suporte social podem ter colaborado para o desencadeamento do linfedema. Conclui-se que o uso de estratégias ativas e positivas para enfrentar o câncer de mama parece resultar na boa adaptação psicossocial

Genetic and environmentally derived variation in the cell wall composition of miscanthus and implications for thermo-chemical conversion

Fifteen Miscanthus genotypes grown in five locations across Europe were analysed to investigate the influence of genetic and environmental factors on cell wall composition. Chemometric techniques combining near infrared reflectance spectroscopy and conventional chemical analyses were used to construct calibration models for determination of acid detergent lignin, acid detergent fibre, and neutral detergent fibre from sample spectra. The developed equations were shown to predict cell wall components with a good degree of accuracy and significant genetic and environmental variation was identified. The influence of nitrogen and potassium fertiliser on the dry matter yield and cell wall composition of M. x giganteus was investigated. A detrimental affect on feedstock quality was observed to result from application of these inputs which resulted in an overall reduction in concentrations of cell wall components and increased accumulation of ash within the biomass. Pyrolysis-gas chromatography-mass spectrometry and thermo-gravimetric analysis indicates that genotypes other than the commercially cultivated M. x giganteus have potential for use in energy conversion processes and in the bio-refining. The yields and quality parameters of the pyrolysis liquids produced from Miscanthus compared favourably with that produced from SRC willow and produced a more stable pyrolysis liquid with a higher lower heating value. Overall, genotype had a more significant effect on cell wall composition than environment. This indicates good potential for dissection of this trait by QTL analysis and also for plant breeding to produce new genotypes with improved feedstock characteristics for energy conversion.

Classification of bacterial strains based on DNA profiles

The analysis of bacterial genomes for epidemiological purposes often results in the production of a banding profile of DNA fragments characteristic of the genome under investigation. These may be produced using various methods, many of which involve the cutting or amplification of DNA into defined and reproducible characteristic fragments. It is frequently of interest to enquire whether the bacterial isolates are naturally classifiable into distinct groups based on their DNA profiles. A major problem with this approach is whether classification or clustering of the data is even appropriate. It is always possible to classify such data but it does not follow that the strains they represent are ‘actually’ classifiable into well-defined separate parts. Hence, the act of classification does not in itself answer the question: do the strains consist of a number of different distinct groups or species or do they merge imperceptibly into one another because DNA profiles vary continuously? Nevertheless, we may still wish to classify the data for ‘convenience’ even though strains may vary continuously, and such a classification has been called a ‘dissection’. This Statnote discusses the use of classificatory methods in analyzing the DNA profiles from a sample of bacterial isolates.

Niederdeutsch im Internet. Möglichkeiten und Grenzen computervermittelter Kommunikation für den Spracherhalt:possibilities and limitations of computer-mediated communication for language preservation

Der vorliegende Beitrag untersucht die Frage, in welchem Maße sich Institutionen, die niederdeutsche Kulturszene und individuelle Sprecher des Niederdeutschen moderne Kommunikationstechnologien wie das Internet zunutze machen und ob computervermittelte Kommunikation helfen kann, dem Rückgang des Niederdeutschen Einhalt zu gebieten. Die grundsätzliche Herangehensweise ist eine soziolinguistische, die das Internet als sozialen Handlungsraum versteht, in dem Individuen und Institutionen kommunizieren. Für eine derartige Perspektive stehen weniger das Medium oder das Genre im Mittelpunkt des Interesses als vielmehr das kommunizierende Individuum und die Sprachgemeinschaft, in diesem Fall die virtuelle Sprachgemeinschaft. Based on studies that analyse the potential of computer-mediated communication (cmc) to help fight language shift in lesser-used languages, this paper discusses the situation of Low German in Northern Germany. Over the last three decades, Low German has lost more than half of its active speakers. The article raises the question of whether and, if so, how Low German speakers make use of cmc to stem this tide. Following a sociolinguistic approach focussed on the individual speakers who use the Internet as a space for social interaction, it gives an overview of the discursive field of Low German on the internet and analyses in detail the most popular Low German discussion board. It shows that one of the main obstacles to a more successful use of cmc can be found in speakers' complex attitude toward written Low German. © Franz Steiner Verlag Stuttgart.

On the 'classification' of neurodegenerative disorders:discrete entities, overlap or continuum?

The traditional method of classifying neurodegenerative diseases is based on the original clinico-pathological concept supported by 'consensus' criteria and data from molecular pathological studies. This review discusses first, current problems in classification resulting from the coexistence of different classificatory schemes, the presence of disease heterogeneity and multiple pathologies, the use of 'signature' brain lesions in diagnosis, and the existence of pathological processes common to different diseases. Second, three models of neurodegenerative disease are proposed: (1) that distinct diseases exist ('discrete' model), (2) that relatively distinct diseases exist but exhibit overlapping features ('overlap' model), and (3) that distinct diseases do not exist and neurodegenerative disease is a 'continuum' in which there is continuous variation in clinical/pathological features from one case to another ('continuum' model). Third, to distinguish between models, the distribution of the most important molecular 'signature' lesions across the different diseases is reviewed. Such lesions often have poor 'fidelity', i.e., they are not unique to individual disorders but are distributed across many diseases consistent with the overlap or continuum models. Fourth, the question of whether the current classificatory system should be rejected is considered and three alternatives are proposed, viz., objective classification, classification for convenience (a 'dissection'), or analysis as a continuum.

Cognitive Approach to e-Learning in Sciences and Technologies

This article describes the approach adopted and the results obtained by the international team developing WBLST (Web Based Learning in Sciences and Technologies) a Web-based application for e-learning, developed for the students of “UVPL: Université Virtuelle des Pays de la Loire”. The developed e-learning system covers three levels of learning activities - content, exercises, and laboratory. The delivery model is designed to operate with domain concepts as relevant providers of semantic links. The aim is to facilitate the overview and to help the establishment of a mental map of the learning material. The implemented system is strongly based on the organization of the instruction in virtual classes. The obtained quality of the system is evaluated on the bases of feedback form students and professors.

In vivo biocompatibility evaluation of composite polymeric materials for use in a novel artificial heart valve

A novel trileaflet polymer valve is a composite design of a biostable polymer poly(styrene-isobutylene-styrene) (SIBS) with a reinforcement polyethylene terephthalate (PET) fabric. Surface roughness and hydrophilicity vary with fabrication methods and influence leaflet biocompatibility. The purpose of this study was to investigate the biocompatibility of this composite material using both small animal (nonfunctional mode) and large animal (functional mode) models. Composite samples were manufactured using dip coating and solvent casting with different coating thickness (251μm and 50μm). Sample's surface was characterized through qualitative SEM observation and quantitative surface roughness analysis. A novel rat abdominal aorta model was developed to test the composite samples in a similar pulsatile flow condition as its intended use. The sample's tissue response was characterized by histological examination. Among the samples tested, the 25μm solvent-cast sample exhibited the smoothest surface and best biocompatibility in terms of tissue capsulation thickness, and was chosen as the method for fabrication of the SIBS valve. Phosphocholine was used to create a hydrophilic surface on selected composite samples, which resulted in improved blood compatibility. Four SIBS valves (two with phosphocholine modification) were implanted into sheep. Echocardiography, blood chemistry, and system pathology were conducted to evaluate the valve's performance and biocompatibility. No adverse response was identified following implantation. The average survival time was 76 days, and one sheep with the phosphocholine modified valve passed the FDA minimum requirement of 140 days with approximately 20 million cycles of valve activity. The explanted valves were observed under the aid of a dissection microscope, and evaluated via histology, SEM and X-ray. Surface cracks and calcified tissue deposition were found on the leaflets. In conclusion, we demonstrated the applicability of using a new rat abdominal aorta model for biocompatibility assessment of polymeric materials. A smooth and complete coating surface is essential for the biocompatibility of PET/SIBS composite, and surface modification using phosphocholine improves blood compatibility. Extrinsic calcification was identified on the leaflets and was associated with regions of surface cracks.

Elaboração de ferramenta computacional para aprendizado da anatomia do pescoço

The teaching-learning process requires a constant search on the part of educators for didatic innovations aimed at improving learning. Among these are technological innovations our students are familiar with. In human anatomy teaching, these innovations are increasingly important, since the need for “mechanizing” many structures may make learning tiresome and nonstimulating for students. The search for new technologies may make this process simpler. Another important issue is the need to constantly emphasize applying the knowledge in question, in order for students to better understand the meaning of learning. Accordingly, this project aims to develop an interactive tablet application for neck anatomy. This application will function as a guide to dissection, containing text, photographs, drawings and videos, distributed systematically, with a script emphasizing the clinical and surgical importance of neck anatomy.

Étude descriptive de l'environnement des écoliers à l'heure des leçons et des devoirs à la maison

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Proposition d'un modèle d'environnement multimédiatisé pour l'apprentissage de concepts abstraits en science

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Expertise sportive et entraînement perceptivo-cognitif de l’athlète

Pour être performant au plus haut niveau, les athlètes doivent posséder une capacité perceptivo-cognitive supérieure à la moyenne. Cette faculté, reflétée sur le terrain par la vision et l’intelligence de jeu des sportifs, permet d’extraire l’information clé de la scène visuelle. La science du sport a depuis longtemps observé l’expertise perceptivo-cognitive au sein de l’environnement sportif propre aux athlètes. Récemment, des études ont rapporté que l’expertise pouvait également se refléter hors de ce contexte, lors d’activités du quotidien par exemple. De plus, les récentes théories entourant la capacité plastique du cerveau ont amené les chercheurs à développer des outils pour entraîner les capacités perceptivo-cognitives des athlètes afin de les rendre plus performants sur le terrain. Ces méthodes sont la plupart du temps contextuelles à la discipline visée. Cependant, un nouvel outil d’entraînement perceptivo-cognitif, nommé 3-Dimensional Multiple Object Tracking (3D-MOT) et dénué de contexte sportif, a récemment vu le jour et a fait l’objet de nos recherches. Un de nos objectifs visait à mettre en évidence l’expertise perceptivo-cognitive spécifique et non-spécifique chez des athlètes lors d’une même étude. Nous avons évalué la perception du mouvement biologique chez des joueurs de soccer et des non-athlètes dans une salle de réalité virtuelle. Les sportifs étaient systématiquement plus performants en termes d’efficacité et de temps de réaction que les novices pour discriminer la direction du mouvement biologique lors d’un exercice spécifique de soccer (tir) mais également lors d’une action issue du quotidien (marche). Ces résultats signifient que les athlètes possèdent une meilleure capacité à percevoir les mouvements biologiques humains effectués par les autres. La pratique du soccer semble donc conférer un avantage fondamental qui va au-delà des fonctions spécifiques à la pratique d’un sport. Ces découvertes sont à mettre en parallèle avec la performance exceptionnelle des athlètes dans le traitement de scènes visuelles dynamiques et également dénuées de contexte sportif. Des joueurs de soccer ont surpassé des novices dans le test de 3D-MOT qui consiste à suivre des cibles en mouvement et stimule les capacités perceptivo-cognitives. Leur vitesse de suivi visuel ainsi que leur faculté d’apprentissage étaient supérieures. Ces résultats confirmaient des données obtenues précédemment chez des sportifs. Le 3D-MOT est un test de poursuite attentionnelle qui stimule le traitement actif de l’information visuelle dynamique. En particulier, l’attention sélective, dynamique et soutenue ainsi que la mémoire de travail. Cet outil peut être utilisé pour entraîner les fonctions perceptivo-cognitives des athlètes. Des joueurs de soccer entraînés au 3D-MOT durant 30 sessions ont montré une amélioration de la prise de décision dans les passes de 15% sur le terrain comparés à des joueurs de groupes contrôles. Ces données démontrent pour la première fois un transfert perceptivo-cognitif du laboratoire au terrain suivant un entraînement perceptivo-cognitif non-contextuel au sport de l’athlète ciblé. Nos recherches aident à comprendre l’expertise des athlètes par l’approche spécifique et non-spécifique et présentent également les outils d’entraînements perceptivo-cognitifs, en particulier le 3D-MOT, pour améliorer la performance dans le sport de haut-niveau.

Interpreting Human Genetic Variation through Genomics and In Vivo Models

Improvements in genomic technology, both in the increased speed and reduced cost of sequencing, have expanded the appreciation of the abundance of human genetic variation. However the sheer amount of variation, as well as the varying type and genomic content of variation, poses a challenge in understanding the clinical consequence of a single mutation. This work uses several methodologies to interpret the observed variation in the human genome, and presents novel strategies for the prediction of allele pathogenicity.

Using the zebrafish model system as an in vivo assay of allele function, we identified a novel driver of Bardet-Biedl Syndrome (BBS) in CEP76. A combination of targeted sequencing of 785 cilia-associated genes in a cohort of BBS patients and subsequent in vivo functional assays recapitulating the human phenotype gave strong evidence for the role of CEP76 mutations in the pathology of an affected family. This portion of the work demonstrated the necessity of functional testing in validating disease-associated mutations, and added to the catalogue of known BBS disease genes.

Further study into the role of copy-number variations (CNVs) in a cohort of BBS patients showed the significant contribution of CNVs to disease pathology. Using high-density array comparative genomic hybridization (aCGH) we were able to identify pathogenic CNVs as small as several hundred bp. Dissection of constituent gene and in vivo experiments investigating epistatic interactions between affected genes allowed for an appreciation of several paradigms by which CNVs can contribute to disease. This study revealed that the contribution of CNVs to disease in BBS patients is much higher than previously expected, and demonstrated the necessity of consideration of CNV contribution in future (and retrospective) investigations of human genetic disease.

Finally, we used a combination of comparative genomics and in vivo complementation assays to identify second-site compensatory modification of pathogenic alleles. These pathogenic alleles, which are found compensated in other species (termed compensated pathogenic deviations [CPDs]), represent a significant fraction (from 3 – 10%) of human disease-associated alleles. In silico pathogenicity prediction algorithms, a valuable method of allele prioritization, often misrepresent these alleles as benign, leading to omission of possibly informative variants in studies of human genetic disease. We created a mathematical model that was able to predict CPDs and putative compensatory sites, and functionally showed in vivo that second-site mutation can mitigate the pathogenicity of disease alleles. Additionally, we made publically available an in silico module for the prediction of CPDs and modifier sites.

These studies have advanced the ability to interpret the pathogenicity of multiple types of human variation, as well as made available tools for others to do so as well.