Use of adipose derived stem cells in Treacher Collins syndrome.

OBJECTIVE: Treacher Collins syndrome (TCS) is a rare congenital disorder of craniofacial development. TCS occurs with an incidence of 1:50,000, and more than 60% of TCS cases have no previous family history and arise as the result of de novo mutations. The high rate of de novo mutations, together with the extreme variability in the degree to which individuals can be affected, makes the provision of genetic counseling extremely complicated. Consequently, every case of TCS is unique and needs to be assessed individually. Patients with TCS frequently undergo multiple reconstructive surgeries from birth through adulthood, which rarely are fully corrective in the long-term. The nascent field of regenerative medicine offers the promise to improve some of these treatments. In particular, structural fat grafting (SFG) seems to be a good strategy not only to restore the normal volume and contour of the face, but also to provide a source of adipose-derived stem cells (ADSCs) with a multilineage differentiation potential. In this work, we present genetical analyses of ADSC affected by TCS. MATERIALS AND METHODS: ADSCs from were analyzed for their stemness properties and shared many characteristics with those of a healthy subject. Screening of the genome of the TCS patient using array-Comparative Genomic Hybridization allowed us to identify some chromosomal imbalances that are probably associated with TCS. RESULTS: We found that some alterations, involving the TIMELESS gene, were usually associated with embryonic stem cells. CONCLUSIONS: With the aim to improve the final results, we need to consider combining knowledge of genetic alterations and expression profiles as a fundamental step before starting with surgical procedures.

Tissue reconstruction of abdominal wall with butyric acid-based nets: preliminary in vitro test using tissue engineering strategies.

OBJECTIVE: A hernia of the abdominal wall is an opening of the muscles in the abdominal wall, which is frequently treated via the application of a surgical mesh. The purpose of this research is to study how human adipose-derived stem cells (hADSCs) interact with Phasix™ Mesh, a commercially available mesh for hernia repair. Studying how cells derived from the abdominal region behave with Phasix™ Mesh is crucial to improve the state of the art of current surgery and achieve effective tissue restoration. MATERIALS AND METHODS: hADSCs were seeded onto Phasix™ Mesh, a fully resorbable surgical mesh of poly (4-hydroxybutyric acid) (P4HB). Cell viability was assessed through MTT assay, and cell growth and adhesion were evaluated via multiple imaging techniques and gene imaging profiling. RESULTS: Results confirm that the nets support cells proliferation, extracellular matrix production and increasing of angiogenetic factor. CONCLUSIONS: Butyric acid-based nets are promising scaffolds for abdominal wall reconstruction.

Sand flea (Tunga spp.) infections in humans and domestic animals: state of the art.

Tungiasis is a parasitic disease of humans and animals caused by fleas (Siphonaptera) belonging to the genus Tunga. Two species, Tunga penetrans (L.) and Tunga trimamillata, out of 10 described to date, are known to affect man or domestic animals; the other eight are exclusive to a few species of wild mammals. Tunga penetrans and T. trimamillata originated from Latin America, although the first species is also found in sub-Saharan Africa (between 20 degrees N and 25 degrees S). Hundreds of millions of people are at risk of infection in more than 70 nations, mostly in developing countries. The second species has been reported only in Ecuador and Peru. Males and non-fertilized females of Tunga are haematophagous ectoparasites; pregnant females penetrate the skin where, following dilatation of the abdomen, they increase enormously in size (neosomy) and cause inflammatory and ulcerative processes of varying severity. The importance of Tunga infection in humans concerns its frequent localization in the foot, which sometimes causes very serious difficulty in walking, thereby reducing the subject's ability to work and necessitating medical and surgical intervention. Tungiasis in domestic animals can be responsible for economic losses resulting from flea-induced lesions and secondary infections. Because tungiasis represents a serious problem for tropical public health and because of the recent description of a new species (Tunga trimamillata), it seems appropriate to review current knowledge of the morphology, molecular taxonomy, epidemiology, pathology, treatment and control of sand fleas of the genus Tunga.

[MRI in static and dynamic disfunction of the female floor]. / Troubles de la statique et de la dynamique pelvienne chez la femme en IRM.

MRI is taking a growing place for pelvic prolapse diagnosis. A strict technical protocol with static and dynamic sequences is required with rectal and vaginal ultrasound gel. A good knowledge of physiology and anatomy of pelvic and perineal muscles is mandatory as well as a clinical approach of various pathologic prolapses. MRI fundings are presented and correlated with several clinical situations of prolapse and post operative features.

[Imaging of female infertility]. / Imagerie de l'infertilité féminine.

Medical treatment of a couple's infertility depends upon the cause(s) of infertility. The goals of imaging are to determine these causes (male, female, mixed, unexplained), to evaluate their severity and type on the female side central, ovarian, uterine, tubal, peritoneal, endometriosis, in order to propose an adapted treatment. Imaging modalities are essentially non ionising (US and MRI). Hysterosalpingogram retains its indication to study tubal patency, it can be completed by tubal catheterisation in cases of proximal tubal obstruction.

Anatomy of Tunga trimamillata Pampiglione et al., 2002 (Insecta, Siphonaptera, Tungidae) and developmental phases of the gravid female.

This paper deals with some internal anatomical features observed in histological sections and freshly dissected mounts of Tunga trimamillata, a Siphonaptera recently discovered in Andean regions of Ecuador from several mammals, including man. It was possible to study in males and also non-gravid and gravid females, the location and anatomy of several organs not previously described for this species: the testes, epididymis, ganglia, Malpighian tubules, eyes, rectal ampulla with one of its pads and structures which could be interpreted as midgut diverticula, whose presence has not been recorded in the Siphonaptera. The process of neosomy in the female during pregnancy is illustrated by photographs of the consecutive developmental phases, taken at the stereomicroscope. Furthermore, some details of the exoskeleton, spermatheca during different phases of pregnancy of the gravid female and the presence of a foreign body (parasite?) within the haemocoel have been displayed in specimens cleared with Hoyer's medium.

Molecular characterization of Tunga trimamillata and T. penetrans (Insecta, Siphonaptera, Tungidae): taxonomy and genetic variability.

A new species of the genus Tungo, T. trimamillata has recently been described on the basis of several morphological traits. To explore the taxonomic status of this flea with respect to T. penetrans, we undertook a molecular analysis of cytochrome oxydase II and 16S rDNA mitochondrial genes and of the internal transcribed spacer 2 nuclear marker on samples of both species. Maximum Parsimony evaluations of the three data set indicate a differentiation compatible with a specific rank between the two fleas with very high levels of divergence. Both mitochondrial and nuclear data are in line with a recent bottleneck in the Malagasy population of T. penetrans, possibly due to the recent colonisation of Africa via human transportation. Further, significantly lower mitochondrial variability in the Ecuadorian populations of T. penetrans with respect to the T. trimamillata ones is also evidenced.

Differential diagnosis between Tunga penetrans (L., 1758) and T. trimamillata Pampiglione et al., 2002 (Insecta, Siphonaptera), the two species of the genus Tunga parasitic in man.

Of the ten currently known species of sand fleas, only two, Tunga penetrans and Tunga trimamillata, are known to be parasites of man, besides other warm blooded animals, most of which are peridomestic. The hosts of the other eight are limited to a few genera of wild mammals. T. trimamillata was only recently identified and differentiated from T. penetrans by features of the gravid female phase. In the present paper the different morphological characters of both for non-gravid females and males of the two species are described. In the non-gravid-females the distinguishing characters are: a) differences in the length of the first two segments of the maxillary palps (the first is the longest in T. trimamillata, whereas the second is the longest in T. penetrans), this feature is associated with another character i.e. the presence of short, thick spines in addition to the bristles on the surface of the segments only in T. trimamillata; b) the presence, only in T. trimamillata, of a row of spines on the antero-medial surface of the libia of the 3rd pair of legs; c) the last abdominal spiracle protrudes in T. trimamillata but not in T. penetrans; d) the hood of the hilla in spermatheca is surrounded by a papilla only in T. penetrans. The following morphological characters differentiate males of T. trimamillata and T. penetrans: a) T. trimamillata has a row of spines on the antero-medial surface of the tibia of the 3rd pair of legs; b) the diameter of the abdominal spiracles of T. trimamillata is smaller than that of T. penetrans and the edges of the spiracles are more regular; c) the claspers and aedeagus of T. trimamillata are shorter than those of T. penetrans; d) the profile of the oedeagal apodeme differs between the two species.

Additional description of a new species of Tunga (Siphonaptera) from Ecuador.

A new species of chigoe flea belonging to the genus Tunga Jarocki, 1838 (Siphonaptera, Pulicidae, Tunginae), Tunga trimamillata, was recently described by Pampiglione et al. (2002). A better description and more details of the epidemiology of the flea are now presented. It is a species found in goats, pigs and cattle in Santa Isabel in Andean Ecuador. This new species differs from its most similar congener, Tunga penetrans (L., 1758), by several features, the most important of which are a) the presence on the anterior extremity of the gravid female of three rounded humps surrounding the head and thorax (which, however, are not visible if viewed in profile), b) slightly larger dimensions and c) the length of the first segment of the maxillary palpi which is longer than each of the other three.

[On a new species of sand flea from Ecuador and tungiasis, a problem of Public Health in many developing countries]. / Su di una nuova specie di pulce penetrante dell'Ecuador esulla tungiasi, problema di Sanità Pubblica in molti paesi in via di sviluppo.

The authors recently described a new species of sand flea (genus Tunga) occurred in goat, sheep, cow, pig and man, in the Andean village of S.ta Isabel (Ecuador) and named Tunga trimamillata. Its most important morphological characteristics are: slightly larger dimensions than T. penetrans, both in male and female; presence on the anterior extremity of gravid female of three rounded humps surrounding head and thorax; length of the first segment of maxillary palpi which is longer than each of the other three. The importance of this parasite is due to the fact that it can cause the same damages as T. penetrans both in humans and domestic animals, with conseguent walking difficulties and local or generalized infections. For breeders, economic losses can be remarkable. Tungiasis is a serious problem of Public Health in many countries of Latin America and Subsaharian Africa, and it can be considered in these localities as an indicator of underdevelopment and poor hygiene conditions.

Diptera Brachycera horse parasites in a stable/manège in northern Italy.

The presence of tabanids and muscoid fly (Diptera Brachycera) parasites of horses in a stable/manège near Verona (Northern Italy) is reported. Tabanus quatuornotatus, T. glaucopis, T. exclusus, Hybomitra muehlfeldi, Haematopota pandazisi, Stomoxys calcitrans and Haematobia irritans were the blood-sucking species directly found on horses. Musca domestica, Ophyra sp. and Fannia canicularis were the flies most frequently collected by sticky traps in the stable.

Effectiveness of geriatric evaluation and care. One-year results of a multicenter randomized clinical trial.

The aim of this study was to demonstrate the effectiveness of outpatient elderly care based on Comprehensive Geriatric Assessment (CGA). Eleven hospital Geriatric Evaluation and Management units (GEMs) systematically screened 1386 inpatients over a 10-month period, using the same uniform selection plan which included 15 programmed exclusion-inclusion criteria and a standard CGA. At the end of this screening, 152 eligible frail elderly patients were randomized to either a comprehensive outpatient GEMs program (intervention group: N=79) or to usual care by their family doctors (control group: N=73). We did not find any statistically significant difference between the two groups at entry. During the one-year follow-up period, 6 GEMs patients (7.6%) and 12 controls (17.1%) died, without significant differences between the two survival curves. Only three patients (all controls) ultimately dropped out, and eight (3 unit patients and 5 controls) entered a nursing home. GEMs patients were significantly more likely to have individual improvement in mental status (p=0.006), morale (p=0.024) and functional level (p=0.023), compared to controls. Even though intervention participants spent fewer days in hospital and nursing home (p<0.05), they received much more home care and day-hospital assistance (p<0.001), which explains why total expenditure on health care was the same in the two groups. We conclude that: 1) a standardized selection plan may contribute to identify the older inpatients in need of CGA; and 2) CGA-based outpatient care may be clinical- and cost-effective if directly managed by GEMs, and may provide targeted older patients with more substantial benefits than standard care, without inflating health care expenses.

[A case of 'contagious delusional parasitosis' in an adult pair of twin sisters]. / Un caso di 'Parassitosi Illusoria Contagiosa' in una coppia di mature gemelle.

In July 1992, a 50-year-old married woman, who was a hospital administrative clerk with an adult daughter, stated that, for over 5 years, she had been parasitised by 'small animals coming out from her skin'. While physical and microscopical examinations did not show either lesions or parasites on the skin, both the patient's medical history and the conviction with which she reported the phenomenon, led to a diagnosis of Delusory Parasitosis, a condition which has been well-defined for over 50 years and considered of prevailingly psychiatric competence. The patient was examined several times during the course of 6 years. She exhibited varying levels of anxiety, and brought with her different species of insects which she had captured 'when she saw them coming out of her skin'. In July 1998 the patient returned with her twin sister, who 'had been infected by her'. Indeed, she too 'had discharged various insects from her skin' for more than a year. The authors provide information on the response of this hallucinatory syndrome to therapy which, as in this case, appears to be resistant to treatment, unless appropriate psychoactive drugs are used.

A multicenter randomized trial of comprehensive geriatric assessment and management: experimental design, baseline data, and six-month preliminary results.

Between October 1992 and July 1993, 11 Northern Italian geriatric departments systematically screened 1386 inpatients hospitalized for at least 10 days. Of those screened, 74% (N = 1019) were excluded by one or more of 7 exclusion criteria; 32% (N = 118) of the 367 remaining subjects failed to meet more than 1 of 8 inclusion criteria. The 11 Geriatric Evaluation Units (GEUs) examined the remaining eligible 249 inpatients with a uniform comprehensive geriatric assessment (CGA) plan, which included a number of validated assessment scales. Of those evaluated, 39% (N = 97) were ineligible for the study because of being unwilling, noncompliant, too sick or "not truly frail", and the remaining 152 (11% of all patients screened) were randomly enrolled in two groups; 79 were assigned to the GEU (experimental group), and 73 to standard care in the National Health Care System (control group). At entry there was no statistically significant difference between the two groups. At 6 months, preliminary results are encouraging; GEU patients had a lower mortality than controls (2 vs 8, 2.5% vs 10.9%; p < 0.05). Slight differences were seen in both clinical-cognitive-affective-functional status and the use of health and social care resources. Only 3 subjects dropped out, 8 refused further follow-up, and 3 went to a nursing-home. We conclude that a standardized selection plan can recognize frail elderly inpatients and that GEU care seems to achieve good results.

[Living with an ostomy: a preliminary study]. / Vivendo com um ostoma: um estudo preliminar.

This study reveals some aspects of ostomy patients life experience. The data were obtained by using the participant observation technique during the monthly meeting session of the Ostomy Patients Association from July 1989 to August 1991. The findings showed that the ostomized patients were concerned with: 1) the ostomy pouch (how to get it); 2) other persons opinion about ostomized patients; 3) their sexuality, and stoma care. The patients perceived themselves as physically disable and inferior persons. Some of them perceived themselves as having a normal life. Other patients also had to cope with the stigma of cancer.

[Is nursing a science or a profession?]. / Enfermagem ciência ou profissão?

Traditionally, human knowledge has been considered in the context of disciplines which can be divided in two groups: Academics and professionals. The aim of academic disciplines is the knowledge and their theories are descriptive in nature. For this reason they are named science. In contrast, professional disciplines are move comprehensive, directed toward practical aims and there is a need to and to work. Nursing as a professional discipline has been influenced by four school of thought named; service, administration, academic and practice. Currently the nursing practice is developed based on three different theoretic and philosophic branches.

[The quality of life of individuals with chronic cardiovascular diseases and diabetes mellitus]. / Qualidade de vida dos indivíduos com doenças cardiovasculares crônicas e diabetes mellitus.

The purpose of this study was to verify the chronically ill patient's quality of life. The study conceptual framework was deryged from the quality of life conceptualization according to Wenger et al. (1984). In this framework the main components of quality of life were viewed as a functional capacity, perception and symptoms. The study sample consisted of 94 chronically ill patients. Of these, 35 were in and outpatients with cardiovascular diseases (GROUP I), 29 patients were on a special rehabilitation program for cardiovascular patients (GROUP II), and 30 were diabetic patients (GROUP III). The McMaster Health Index questionnaire developed by Chambers (1984) was used for data collection. The findings revealed that patients of the GROUP II showed better quality of life than the patients of GROUP I and GROUP III in relation to the physical function, health perception, and life satisfaction.