The socioeconomic impact of multiple sclerosis in France: Results from the PETALS study.

Background: Multiple sclerosis (MS) places a considerable financial burden on the society. However, data quantifying the contemporary cost burden in France are lacking. Objective: This cost-of-illness study aimed to estimate the direct and indirect costs associated with MS in France. Methods: Between October 2020-November 2020, 208 French adults with a confirmed diagnosis of MS were recruited via MSCopilot® (a new MS self-assessment digital solution) and several MS patient networks. Indirect costs were estimated using a combination of top-down and bottom-up approaches. Direct costs were retrieved from Assurance Maladie (i.e. national system of health insurance) publications. Out-of-pocket expenses (OOPEs) incurred by MS patients were also reported. All costs were expressed in €2020. Data from the survey were extrapolated to the overall French MS population. Results: MS exerted an annual cost burden of €2.7 billion on the French society (indirect costs: €1.3 billion; direct costs: €1.4 billion). Mean annual costs were €27,164.7 per-patient, with indirect and direct costs accounting for 48.1% and 51.9% of the total annual costs, respectively. OOPEs contributed over €90 million to the total annual costs. Conclusions: MS imposes a substantial cost burden on the French society, with approximately half of the total annual costs driven by indirect costs.

Cardiotoxicity among adult survivors suffered from childhood malignancies.

Late cardiotoxicity following treatment of malignancy diseases has been long established. Cancer therapeutics-related cardiac dysfunction (CTRCD), acute arrhythmias, pericardial disease, valvopathies and early atherosclerotic Cardiovascular Disease (CVD), are the clinical presentations of cardiotoxicity. Although these clinical modalities can affect adults treated for malignancies, they are more common to present in the pediatric survivors as improvement of prognosis, nowadays exists. Studies have shown that CVD can present earlier than thirty years, post treatment. If adding on this the early and late effect of cardiotoxicity on the developing in childhood cardiovascular system, we are then faced with a new Risk Factor (RF) for CVD. Anthracyclines and its derivatives have served for over fifty years as the road model of studding early, mid and late term cardiotoxicity. Today a vast number of chemical agents are used, many of them with very good results in treating the existing malignancies. Unfortunate, little or even less are known on their potential mechanism of derived cardiotoxicity when used by their own or combined with others and/or radiotherapy (RT). The 2013 existing guidelines by ACC/AHA on surveillance of the cardiovascular health of oncology survivors, are mostly addressing early cardiac adverse effects and CTRCD. Little is mentioned about the development of early CVD, its subclinical diagnosis, prevention and the need of early intervention before clinical events are present. The aim of this paper is to review the exist knowledge and practice on this condition with growing numbers of survivors facing the risk of early atherosclerotic CVD.

Myositis ossificans in children: a review.

The formation of lamellar bone in the soft tissues, where bone normally does not exist, is called myositis ossificans. However, it would be more accurate to describe as myositis ossificans the involvement of skeletal muscles and as ectopic or heterotopic ossification the involvement of soft tissues in general. The lesion is subdivided in genetic and non-genetic or acquired types. Myositis or fibrodysplasia ossificans progressiva is a debilitating rare genetic disorder. Clinical suspicion of the disease in the newborn on the basis of malformed great toes may lead to early clinical diagnosis, confirmatory diagnostic genetic testing and avoidance of iatrogenic harmful procedures. Acquired lesions involve the neurogenic myositis ossificans and the non-neurogenic disorder. The latter is defined either as circumscribed myositis ossificans that is post-traumatic or as idiopathic/pseudomalignant myositis ossificans that is non-traumatic and may be a form fruste of fibrodysplasia ossificans progressiva. Ossification in fibrodysplasia ossificans progressiva is irreversible, unlike other forms of heterotopic ossification. In this retrospective study, a total of 22 children with myositis ossificans treated in a 20-year period were identified and classified. Two patients were diagnosed with myositis/fibrodysplasia ossificans progressiva, one with neurogenic myositis ossificans, one with idiopathic/pseudomalignant myositis ossificans and 18 patients with circumscribed myositis ossificans. The clinical features, imaging and histological findings as well as treatment modalities and complications of myositis ossificans in our patients are presented and discussed.

Regulation of matrix metalloproteinase-2 and -9 during healing of dermal wounds after incision using radiofrequency energy in neonatal and adult rats.

BACKGROUND: Radiofrequency energy (RFE) has many medical applications in the treatment of adults and children. The impact of RFE on healing-regulation systems in the developing tissues is not fully known. Matrix metalloproteinases (MMPs) are involved in the remodeling of the extracellular matrix and the inflammatory processes. MMPs are regulated differently among the different age groups. We evaluated possible changes in MMP activity after an incisional wound using a radiofrequency scalpel in neonatal and adult rats. METHODS: In 30 Wistar rats [15 4-day-old (neonates) and 15 4-month-old (adults) rats], a ventral wound was created using a radiofrequency scalpel. Wounded areas and non-wounded tissues were harvested one, three and seven days after the intervention. Enzymatic activities of MMP-2 and MMP-9 were evaluated using gelatin zymography. RESULTS: Adults expressed higher activity than neonates for MMP-2 on day 7 (Mann -Whitney U-test, p =0.009) and for MMP-9 on days one (p =0.005) and three (p =0.005). MMP-9 was expressed in higher amounts in the wounded tissue in comparison with non-wounded tissue during days one and three (Wilcoxon signed rank test, p =0.028 and p =0.043, respectively). MMP-2 was produced in equal amounts in the wounded and non-wounded tissue at all time-points. Only in the adult wounds at day seven, higher activity was noted compared with non-wounded skin (Wilcoxon signed rank test, p=0.043). CONCLUSIONS: RFE, despite its local burning effect, does not interfere with known patterns of MMP regulation. Neonates have lower activity of MMPs than adults. Energy conduction through adjacent non-wounded tissues does not have an impact upon MMP regulation. HIPPOKRATIA 2017, 21(1): 85-92.

Parental exposures and risk of nonsyndromic orofacial clefts in offspring: a case-control study in Greece.

OBJECTIVE: To investigate the association between cleft lip and/or palate and nongenetic factors in Greece. METHODS: We designed a case-control study including 35 patients with nonsyndromic cleft lip and/or palate, retrospectively selected, and 35 control patients matched for prefecture of residence, prospectively selected from pediatric population hospitalized for abdominal pain or injury. Parents were interviewed about drug uptake, diseases, habits, non-occupational exposure to pollutants, and occupation. Questions covered the period from one year before until three months after conception. RESULTS: High-risk paternal occupations (mostly farmers) were significantly more frequent in cleft lip and/or palate than in controls (p=0.039) and increased significantly the cleft lip and/or palate risk in offspring (OR: 3.00; 95% CI: 1.03-8.70). Maternal occupation did not correlate with cleft lip and/or palate. Parental disease, drugs uptake, hazardous habits, maternal folate supplementation and non-occupational exposure to pollutants did not correlate with cleft lip and/or palate. There was a suggestion of increased risk with maternal passive exposure to tobacco (OR: 1.81; 95% CI: 0.69-4.74) and with residential proximity to industries (OR: 1.70; 95% CI: 0.61-4.74). CONCLUSIONS: Paternal high-risk occupations probably exert a teratogenic effect on spermatogenesis or result in maternal contamination, and deserve specific preventive policies. The relation of smoking and residential proximity to industries with occurrence of cleft lip and/or palate deserves further study.

Sonographic evidence for patency of the processus vaginalis in children with acquired undescended testis.

Testes do ascend, but for unknown reasons. A testis may ascend through a patent processus vaginalis (PV). However, data for PV patency in acquired undescended testes (aUDT) are inconclusive. In this article, we aim to assess the sonographic PV diameter in boys with aUDT in comparison with normal group boys (obliterated PV) and boys with hydrocele or inguinal hernia (patent PVs). This retrospective study included 43 boys operated unilaterally for aUDT (n = 16), communicating hydrocele (n = 11) and inguinal hernia (n = 16). All selected patients had a preoperative measurement of the ipsilateral PV diameter. In addition, 17 boys with phimosis (normal group boys) were prospectively included, and underwent a sonographic examination of the inguinoscrotal area of a randomly selected side to measure the diameter of the respective PV. In total, 60 sides were examined. An aUDT was defined as a testis that had been identified at least twice previously in scrotal position. The results indicated that in normal group boys, PV could not be detected by sonography. In contrast, PVs ipsilateral to aUDT were visualized as hypoechoic tubules connecting the peritoneal cavity with the scrotum, similar to patent PVs in hydroceles. PV diameter in the aUDT group did not differ from the hydrocele group. However, PVs in aUDT and hydrocele were significantly narrower than in inguinal hernias. This is the first report of a patent PV in aUDT, comparable with hydrocele. Our findings suggest high ligation of the patent PV during orchidopexy.

Serum beta-endorphin response to stress before and after operation under fentanyl anesthesia in neonates, infants and preschool children.

INTRODUCTION: The endogenous opioid beta-endorphin is a known indicator of stress and pain. Opioid anesthesia during operation may prevent postoperative beta-endorphin hypersecretion. We examine the effect on serum beta-endorphin of both preoperative stress and stress of operation under opioids in neonates, infants and preschool children. In order to eliminate the effect of hospitalization anxiety we compared with inpatients of similar age with non-surgical disease. MATERIAL AND METHODS: We included 74 surgical patients (25 neonates, 24 infants, 25 preschool children), and 44 non-surgical inpatients (14 neonates, 12 infants, 18 preschool children). Anesthesia comprised propofol and fentanyl. In presence of pain after extubation, supplementary morphine was administered. Sera were taken preoperatively and 2 h postoperatively in surgical patients, and once in non-surgical patients. Beta-endorphin was tested using ELISA (ng/ml). RESULTS: In all surgical patients beta-endorphin did not increase significantly after surgery. Neonates showed significantly elevated beta-endorphin preoperatively (mean+/-SD: 2.02+/-0.76) and postoperatively (2.07+/-0.90) compared to neonates with a non-surgical disease (1.05+/-0.34; p<0.005). In contrast, infants (preoperative values: 1.75+/-1.32, postoperative values: 2.00+/-1.83) did not differ from respective non-surgical inpatients (1.49+/-0.70). Before and after surgery, beta-endorphin was significantly elevated in preschool children (7.19+/-1.85, 6.42+/-1.31), as compared with neonates and infants (p<0.0005), and with preschool children with non-surgical disease (1.01+/-0.27; p<0.0005). CONCLUSIONS: Fentanyl/propofol anesthesia, supplemented by postoperative morphine where necessary, protects from surgical stress and postoperative pain, as denoted by no postoperative increase of beta-endorphin in all age groups. Preschool children, who exhibit increased emotional perception, have explicitly high serum beta-endorphin before and after surgery. Preoperative preparation programs might be worthy in this age group. Neonates show a moderate but still significantly high response of beta-endorphin to stress, retained after operation. In contrast, infants tolerated stress better (not increased beta-endorphin pre- and post-operatively).

Smooth muscle cell differentiation in the processus vaginalis of children with hernia or hydrocele.

PURPOSE: Incomplete obliteration of the processus vaginalis (PV) in children with inguinal hernia or hydrocele has recently been proposed to relate to smooth muscle cell (SMC) persistence. The aim of this study was to evaluate the diversity and differentiation of smooth muscle phenotypes in sacs associated with inguinal hernia and hydrocele through the expression of alpha-smooth muscle actin (SMA), h-caldesmon, desmin, and vimentin. METHODS: Sacs associated with male hernia (n = 22), female hernia (n = 8), and hydrocele (n = 10) were immunohistochemically evaluated using monoclonal antibodies against SMA, h-caldesmon, desmin, and vimentin. Peritoneal samples (male, 4; female, 3) and obliterated PV (male, 3) obtained from age-matched patients served as controls. Expressions according to the groups were compared through chi-squared test, and P values less than 0.05 were considered to be statistically significant. RESULTS: Immunohistochemistry did not shown the presence of SMCs in control samples. The expression of SMA, desmin, and h-caldesmon did not differ among sacs obtained from patients with inguinal hernia and hydrocele. However, strong expression of vimentin in SMCs within sacs obtained from patients with hydrocele in comparison with sacs from male patients with inguinal hernia were observed. CONCLUSIONS: Our results indicate that sacs from patients with inguinal hernias and especially from male inguinal hernias have fully differentiated SMCs. On the other hand SMCs in sacs obtained from boys with hydrocele are in an intermediate state of differentiation-dedifferentiation. This phenotypic modulation may represent attempted apoptosis of SMCs, since sacs more sensitive to apoptosis appeared to have more dedifferentiated SMCs. It also probably depicts the differing influence of sympathetic and parasympathetic tonuses during the descent of the testis and the obliteration of PV.

Lymphatic regeneration following hind limb replantation: an experimental study in the dog.

Different types of trauma to the lymphatic system can often occur, but surgical intervention can be performed only in specific cases. We report on lymphatic regeneration following limb replantation in traumatic amputations and replantation of extremities. The aim of this study was to observe the progression and reaction after surgical trauma that is similar to other kinds of trauma, both in children or adults, and to monitor the possible lymphatic regeneration. Particular attention was paid to two parameters: firstly, the physical examination of the replanted limbs by checking the post-traumatic lymphoedema, and secondly, the study of the images taken from indirect lymphangiography of the replanted limbs. Histological specimens of the surgical trauma area were also examined to reconfirm or exclude lymphatic regeneration. The study population consisted of sixteen mongrel dogs, divided into two groups of eight animals each, who underwent hind limb elective amputation and replantation combined with (group A) or without (group B) sciatic nerve division. Lymphoedema formation was followed quantitatively by measurement of the circumference of the hind limb for 21 days after replantation. Indirect lymphography, never performed before in such cases, and histopathology, were performed to evaluate and confirm lymphatic regeneration. Lymphatic regeneration after replantation of the operated hind limbs was first confirmed between 7th and 11th postoperative day by indirect lymphangiography and clinical observation of the post-traumatic lymphoedema of these limbs. The mean time of visualisation of lymphatic regeneration through lymphography was 10.12 days for group A and 9.37 days for group B. However, nerve transection had no effect on lymphatic regeneration (p = 0.46). Histopathological examination showed first evidence of lymphatic regeneration on the ninth postoperative day and a network of newly formed capillary lymphatics on the 21st postoperative day. It is concluded that lymphatic regeneration following replantation of the extremities without anastomosing of the interrupted lymph vessels, is an unquestionable fact. To achieve the best lymphatic drainage and use of the replanted extremities it is important to resect all non-vital tissues of the replantation area. Local or general infections decelerate lymphatic regeneration. Indirect lymphography with iotrolan is a reliable, easy to perform technique without complications that may be used repeatedly for confirmation and evaluation of post-traumatic lymphoedema.

Imperforate anus associated with atresia of the transverse colon: a case report.

We describe here a rare case of association of imperforate anus with transverse colon atresia in a male neonate. Preoperative X-ray studies demonstrated: a) a distended loop in the epigastrium with fluid levels on plain A/P upright radiography, b) absence of pelvic intestinal gas on the invertogram 16 hours later. A three-stage operative approach was undertaken comprising resection of the atretic loop and colostomy, posterior sagittal anorectoplasty a few months later, and finally closure of the colostomy. The postoperative outcome was good. The association of these anomalies should be kept in mind in neonates with anal atresia and abdominal distention.

Ligation of the splenic artery in operations of the spleen in children.

BACKGROUND: Every effort is made during surgery of the spleen to preserve splenic function. This serves the purpose of maintaining the integrity of the defence mechanisms of the patient against infection in the short - and long-term. With ligation of the splenic artery prior to excision of splenic lesions and splenic repair we aimed to secure control of peri- operative bleeding, thus, making feasible the preservation of the spleen. METHODS: Six patients with splenic pathology aged 5-14 years old (four boys and two girls) were operated on for splenic pathology between 1994-1999. Three had splenic cysts (dermoid), one had a hamartoma and 2 had hydatid cysts. Investigations included radiography, ultrasound scan, computerised tomography and scintigraphy. All patients were administered antibiotics and pneumovax pre-operatively. Ligation of the splenic artery was carried out with ligaclips. Congenital anomalies or hydatid cysts were excised and repair of the spleen with splenorrhaphy was performed. Peri-operative blood loss was minimal and this aided greatly in performing the excision of the splenic lesions and the repair of the spleen. RESULTS: All patients had an uncomplicated post-operative course. Scintigraphy in the follow-up from 6 months after the operation showed good splenic function. Laboratory investigations did not show decreased levels of immunological factors in the early or later post- operative period. CONCLUSION: Splenic artery ligation reduced the amount of bleeding and allowed for the preservation of the spleen in all patients in this study.

Genetic analysis in the diagnosis of familial paragangliomas.

OBJECTIVES: In the management of two related patients with multicentric glomus jugulare tumors, given the incidence of 1:30,000 with approximately 20% familial cases, our objective was to review the genetic characteristics and inheritance patterns of these tumors and to determine what molecular genetic screening possibilities exist for the phenotypically normal family members. In addition, our aim was to review the incidence of various multicentric paraganglioma (PGL) tumor location combinations. METHODS: Molecular genetic linkage analysis testing was performed on the 2 patients and 14 other unaffected family members. We report the results of this screening and review the literature on the incidence and genetics of paragangliomas. RESULTS: The inheritance pattern in the literature demonstrates autosomal dominant transmission with maternal imprinting (inactivation). The proclivity for multicentric origin increases to 26% in familial cases, as reflected in our patients. In addition to the two patients, four unaffected family members demonstrated the presence of the disease haplotype at chromosome band 11q23, which indicates a very high likelihood of developing a paraganglioma, given the highly penetrant nature of the disease. CONCLUSIONS: It is clear that the familial PGL gene locus is situated at chromosome 11q23. The gene itself and its exact degree of penetrance, however, still await identification. Since early detection of paragangliomas reduces the incidence of morbidity and mortality, genotypic analysis as a screening tool in families of affected patients should play a front-line diagnostic role, leading to more timely and cost-effective patient management.

Induction of facial muscle neurotization by temporalis muscle transposition: literature review and animal model evaluation using horseradish peroxidase uptake.

OBJECTIVE: To study the concept of facial muscle reinnervation from the trigeminal pathway following facial nerve paralysis. DESIGN AND METHODS: We studied this phenomenon in an animal model using the neuronal marker, horseradish peroxidase (HRP). The temporalis transposition procedure was performed at varying intervals post facial nerve transection. To evaluate the trigeminal-facial reinnervation process and its timing, the zygomaticus major muscle was injected with HRP at varied periods after temporalis transposition, and histologic sections of the brainstem nuclei were examined for the final location of the HRP. RESULTS: The presence of HRP in the trigeminal nucleus provided evidence of trigeminal-facial neurotization in those animals that underwent temporalis transposition up to 2 months following facial denervation and in which the HRP injection was performed 4 months after temporalis transposition. CONCLUSIONS: The findings of our pilot study are strongly supportive of the trigeminal-facial neurotization hypothesis in those animals that underwent temporalis transposition up to 2 months post facial denervation and in which 4 months were allowed thereafter for adequate neurite ingrowth and neurotization to occur. This suggests that the neurotrophic signals are greatest up to 2 months post denervation and denotes the optimal time for performance of reconstructive procedures. Future studies with a larger number of animals in each group will be necessary to ensure more potent statistical significance and to augment our experimental evidence that trigeminal-facial crossover does occur and can be used as an adjunctive concept to maximize early rehabilitation of the paralyzed face.

Isolation, cloning, and characterization of a new mammalian coronin family member, coroninse, which is regulated within the protein kinase C signaling pathway.

In order to understand the regulatory role of protein kinase C (PKC) in secretory epithelia, it is necessary to identify and characterize specific downstream targets. We previously identified one such protein in studies of gastric parietal cells. This protein was referred to as pp66 because it migrated with an apparent molecular mass of 66 kDa on SDS-polyacrylamide gels. The phosphorylation of pp66 is increased by the cholinergic agonist, carbachol, and by the PKC activator, phorbol-12-myristate-13-acetate, in a calcium-independent manner. In this study, we have purified pp66 to homogeneity and cloned the complete open reading frame. GenBankTM searches revealed a 45% homology with the Dictyostelium actin-binding protein, coronin, and approximately 67% homology with the previously cloned human and bovine coronin-like homologue, p57. pp66 appears to be most highly expressed in the gastrointestinal mucosa and in kidney and lung. Confocal microscopic studies of an enhanced green fluorescent protein fusion construct of pp66 in cultured parietal cells and in Madin-Darby canine kidney cells indicate that pp66 preferentially localizes in F-actin-rich regions. On the basis of our findings, we propose that pp66 may play an important, PKC-dependent role in regulating membrane/cytoskeletal rearrangements in epithelial cells. We have tentatively named this protein coroninse, because it appears to be highly expressed in secretory epithelia.

Reactivity of human trophoblast monoclonal antibodies with marmoset monkey trophoblast cultures.

The aim of this study was to determine whether cultured trophoblast tissues, derived from the trophectoderm of marmoset monkey blastocysts, contain homologues of human trophoblast antigens. This is an essential prerequisite to determine whether the marmoset may be a suitable model for preclinical testing of a human antitrophoblast antigen for fertility regulation. Previously evaluated monoclonal antibodies from the Flinders University laboratory, which reacted with human trophoblast with a high degree of specificity, were tested for immunohistochemical reactivity using an immunoperoxidase detection method on both frozen and paraformaldehyde-fixed sections of the cultured marmoset monkey trophoblast. All monoclonal antibodies raised against human placenta reacted positively, when compared to controls, suggesting that human and marmoset trophoblast cells share common epitopes. The specificity of the monoclonal antibodies was investigated by determining whether there was cross-reactivity with other marmoset monkey tissues, including adrenal, spleen, kidney, liver, muscle, ovary and testis. The specificities of the monoclonal antibodies on these marmoset tissues were similar to those previously found on the corresponding human tissues. We have concluded that marmoset monkey trophoblast exhibits homologues of human trophoblast antigens. The findings also suggest that marmoset monkeys should be evaluated further as a primate model to test suitable target antigens for antitrophoblast vaccines that may be useful contragestation agents in humans.

Yaw sensory rearrangement alters pitch vestibulo-ocular reflex responses.

Ten male subjects underwent two types of adaptation paradigm designed either to enhance or to attenuate the gain of the canal-ocular reflex (COR), before undergoing otolith-ocular reflex (OOR) testing with constant velocity, earth horizontal axis and pitch rotation. The adaptation paradigm paired a 0.2 Hz sinusoidal rotation about an earth vertical axis with a 0.2 Hz optokinetic stimulus that was deliberately mismatched in peak velocity or phase and was designed to produce short-term changes in the COR. Preadaptation and postadaptation OOR tests occurred at a constant velocity of 60 degrees/sec in the dark and produced a modulation component of the slow phase velocity with a frequency of 0.16 Hz due to otolithic stimulation by the sinusoidally changing gravity vector. Of the seven subjects who showed enhancement of the COR gain, six also showed enhancement of the OOR modulation component. Of the seven subjects who showed attenuation of the COR gain, five also showed attenuation of the OOR modulation component. The probability that these two cross-axis adaptation effects would occur by chance is less than 0.02. This suggests that visual-vestibular conditioning of the yaw axis COR also induced changes in the pitch axis OOR. We thus postulate that the central nervous system pathways that process horizontal canal yaw stimuli have elements in common with those processing otolithic stimuli about the pitch axis.

[Post traumatic myositis ossificans of the iliopsoas muscle. Apropos of a case with review of the literature]. / Myosite ossifiante post-traumatique du muscle psoas iliaque. A propos d'un cas avec revue de la littérature.

A case of traumatic myositis ossificans of the iliopsoas muscle in a 13 year old ballet dancer is presented. A history of multiple minor injuries to the region of the left hip in addition to the radiographic appearance of calcification were indicative of ectopic bone formation. The lesion was explored surgically because of the clinical symptoms of the coexistant femoral hernia as well as to obtain biopsy material to exclude a soft tissue tumor. Histological examination demonstrated the zoning effect of myositis ossificans with patterns varying from a cellular central zone to a peripheral one of fairly well oriented bone. The patient remains symptom-free and no radiographic evidence of recurrence was observed four years postoperatively.

Effect of gemfibrozil on early carotid atherosclerosis in diabetic patients with hyperlipidaemia.

BACKGROUND: An increased thickness of the carotid artery wall is thought to be a sign of early atherosclerosis. We have investigated the effects of gemfibrozil in asymptomatic diabetic hyperlipidaemic subjects on the 12-month progression of arterial wall thickness. METHODS: Forty non-insulin-dependent diabetics with hyperlipidaemia and without hypertension were studied. After a 4-week run-in-diet phase, oral gemfibrozil was administered (900 mg once daily) in 20 patients randomly selected, while 20 subjects were treated only with diet. The two groups were matched for age, sex, body mass index (BMI), duration of diabetes and glycaemic control. Arterial wall thickness was measured as the mean of the maximum intima of media thickness (IMT) in 16 carotid segments by B-mode ultrasound. RESULTS: Baseline size of IMT and lipid values were similar in both groups. The IMT increase over 12 months was 5% in the gemfibrozil group vs 15.2% in subjects treated by diet alone. CONCLUSIONS: We conclude that gemfibrozil treatment may be useful in decreasing the progression rate of arterial wall thickness.

A monoclonal antibody to human placental lactogen hormone facilitates isolation of fetal cells from maternal blood in a model system.

A cocktail of trophoblast-reactive monoclonal antibodies (MAbs) is required for efficient isolation of trophoblasts from maternal blood. A modified antibody screening procedure was used to identify a clone, in a COS cell placental cDNA expression library, that expressed the gene product recognized by MAb FDO202N. The antigen recognised by MAb FDO202N was identified as human placental lactogen (hPL) hormone. hPL hormone is secreted into the maternal blood by trophoblasts at high levels during pregnancy. Immunohistochemical localization of hPL hormone was consistent with expression in the syncytiotrophoblast and extravillous cytotrophoblast. A model system was used where known numbers of syncytiotrophoblast sprouts were seeded into saline or maternal blood, bound by trophoblast-specific MAbs, recovered magnetically, and then counted. MAb FDO202N was shown to facilitate the efficient recovery of trophoblast sprouts from saline and maternal blood.