X chromosome gene methylation in peripheral lymphocytes from monozygotic twins discordant for scleroderma.

Scleroderma (SSc) is a rare connective tissue disease characterized by fibrosis, microvasculopathy and autoimmune features. The role of genetics is limited in SSc, as suggested by similar concordance rates in monozygotic and dizygotic twin pairs, while environmental factors may act through epigenetic changes, as demonstrated for specific genes. Further, sex chromosome changes have been reported in SSc and may explain the female preponderance. In the present study we compared the methylation profile of all X chromosome genes in peripheral blood mononuclear cells from monozygotic twins discordant (n=7) and concordant (n=1) for SSc. Methylated DNA immunoprecipitations from each discordant twin pair were hybridized to a custom-designed array included 998 sites encompassing promoters of all X chromosome genes and randomly chosen autosomal genes. Biostatistical tools identified sites with an elevated probability to be consistently hypermethylated (n=18) or hypomethylated (n=25) in affected twins. Identified genes include transcription factors (ARX, HSFX1, ZBED1, ZNF41) and surface antigens (IL1RAPL2, PGRMC1), and pathway analysis suggests their involvement in cell proliferation (PGK1, SMS, UTP14A, SSR4), apoptosis (MTM1), inflammation (ARAF) and oxidative stress (ENOX2). In conclusion, we propose that X chromosome genes with different methylation profiles in monozygotic twin pairs may constitute candidates for SSc susceptibility.

Scientific basis for selecting surgical needles and needle holders for wound closure.

Standardized reproducible tests have been devised to determine surgical needle sharpness, resistance to bending, and ductility. Three comparable groups of reverse cutting edge needles were selected from different manufacturers for measurement of these needle performance parameters. This testing demonstrated that needle diameter, manufacturing process, needle material composition, cross-sectional design, and the manufacturer were all important determinants of surgical needle performance. In addition, the biomechanics of curved surgical needle bending has been related to the clamping moment of surgical needle holders. This relationship identifies the surgical needle holder that can be used with surgical needles without deformation. The results of these studies provide a scientific basis for the selection of surgical needles and needle holders for use in surgery.

Multiple sclerosis and asymptomatic urinary tract infection.

Multiple sclerosis patients with bladder dysfunction are prone to have an asymptomatic urinary tract infection. Because bladder function abnormalities occur at some time in 70% to 90% of multiple sclerosis patients, a quantitative estimate of the bacterial concentration in the urine as well as a culture is mandatory. Treatment of bladder dysfunction or infection will vary according to the post-voiding residual volume. A patient with multiple sclerosis and asymptomatic urinary tract infection is reported that highlights strategies for the diagnosis and treatment of the urinary tract infection.

Needle holder damage to surgical needles.

Clamping surgical needles between the jaws of needle holders with teeth markedly weaken the needles, making them prone to breakage. In contrast, clamping surgical needles between either smooth needle holder jaws or jaws embedded with tungsten carbide particles did not alter the ductility of surgical needles.

Emergency physician's needle holder.

A new needle holder is described that has jaws metallurgically bonded with tungsten carbide particles that enhance needle holding security without causing sutural damage during instrument ties. Scissors have also been incorporated into the needle holder to cut sutures. One ringlet on a handle has been offset to facilitate retrieval of the needle holder from a flat surface.

Evaluation of flotation devices for deep-water exercise.

Jogging and running in deep water (greater than or equal to 7 feet) appears to be a more efficient and safer means of aerobic exercise than jogging and running on land. Consequently, a variety of flotation devices have been developed to facilitate this deep-water exercise. A comprehensive evaluation of these devices revealed distinct performance limitations that interfered with this exercise. On the basis of the results of these studies, a new, improved flotation device has been conceptualized for individuals participating in deep-water exercise.

A new hydrofitness device for strengthening muscles of the upper extremity.

A new hydrofitness device has been devised for strengthening upper extremity muscles during aquatic exercise. It consists of a molded plastic fenestrated outer shell with an inner rotating disc that can be easily adjusted to alter the surface area of its frontal presentation. By changing the surface area of its frontal presentation a graded, individualized exercise program can be prescribed. A buoyant foam disc has been incorporated into the device to prevent it from sinking to the bottom of the pool. On the basis of this evaluation, performance of this device was judged to be superior to that of other devices for strengthening upper extremity muscles during aquatic exercise.