The Use of Pedicled Perforator Flaps in Chest Reconstruction: A Systematic Review of Outcomes and Reliability

BACKGROUND: In recent years, pedicled perforator flaps have revolutionized plastic surgery by reducing donor site morbidity and ensuring larger and deeper reconstructions with local pedicled cutaneous flaps. The aim of the study was to make a systematic review of perforator pedicled propeller flaps (PPPFs) in chest reconstruction. METHODS: Pubmed and Cochrane databases were searched from 1989 to October 2016 for articles describing the use of PPPFs in chest reconstruction. The preferred reporting items for systematic reviews and meta analyses statement was used in the selection process. The review was registered on international prospective register of systematic reviews. Furthermore, operative technique, indications and complications were searched. RESULTS: Twenty-four articles were selected (174 patients and 182 flaps). Oncological surgery was the first etiology (34.5%), followed by infections (11.5%), chest keloid scars (6.23%), malformations (4.6%), burns (3.4%), chronic ulcers (2.3%), Verneuil disease (1.8%), and acute wounds (1.8%). The arc of rotation was between 90° and 120° in 24.2%. The mean surface of flaps was 127.45 ± 123.11 cm. Dissection was subfascial in 78.5% of the cases. Complications were found in 9.9% of patients and included mainly wound dehiscence (4.4%) and hematoma/seroma (2.2%). One case of total necrosis (0.5%) and 2 cases of partial necrosis (1.1%) were found. CONCLUSIONS: The possibility of numerous pedicles makes it possible for PPPFs to offset most areas of wall chest defects. Furthermore, this surgical technique is reliable and reproducible, with lower donor site morbidity than that in the case of muscular flaps, which are classically used in this location

Influence of FCGRT gene polymorphisms on pharmacokinetics of therapeutic antibodies

The neonatal Fc receptor (FcRn) encoded by FCGRT is known to be involved in the pharmacokinetics (PK) of therapeutic monoclonal antibodies (mAbs). Variability in the expression of FCGRT gene and consequently in the FcRn protein level could explain differences in PK observed between patients treated with mAbs. We studied whether the previously described variable number tandem repeat (VNTR) or copy number variation (CNV) of FCGRT are associated with individual variations of PK parameters of cetuximab. VNTR and CNV were assessed on genomic DNA of 198 healthy individuals and of 94 patients treated with the therapeutic mAb. VNTR and CNV were analyzed by allele-specific PCR and duplex real-time PCR with Taqman® technology, respectively. The relationship between FCGRT polymorphisms (VNTR and CNV) and PK parameters of patients treated with cetuximab was studied. VNTR3 homozygote patients had a lower cetuximab distribution clearance than VNTR2/VNTR3 and VNTR3/VNTR4 patients (p = 0.021). We observed no affects of VNTR genotype on elimination clearance. One healthy person (0.5%) and 1 patient (1.1%) had 3 copies of FCGRT. The PK parameters of this patient did not differ from those of patients with 2 copies. The FCGRT promoter VNTR may influence mAbs’ distribution in the body. CNV of FCGRT cannot be used as a relevant pharmacogenetic marker because of its low frequency

Testing for an effect of a mindfulness induction on child executive functions

Several sessions of mindfulness practice can exert positive gains for child executive functions (EF); however, the evidence for effects of a mindfulness induction, on EF for adults, is mixed and this effect has not been tested in children. The immediate effect of an age appropriate 3-min mindfulness induction on EF of children aged 4–7 years was tested. Participants (N = 156) were randomly assigned to a mindfulness induction or dot-to-dot activity comparison group before completing four measures of EF. A composite score for EF was calculated from summed z scores of the four EF measures. A difference at baseline in behavioural difficulties between the mindfulness induction and comparison group meant that data was analysed using a hierarchical regression. The mindfulness induction resulted in higher average performance for the composite EF score (M = 0.12) compared to the comparison group (M = − 0.05). Behavioural difficulties significantly predicted 5.3% of the variance in EF performance but participation in the mindfulness or comparison induction did not significantly affect EF. The non-significant effect of a mindfulness induction to exert immediate effects on EF fits within broader evidence reporting mixed effects when similar experimental designs have been used with adults. The findings are discussed with consideration of the extent to which methodological differences may account for these mixed effects and how mindfulness inductions fit within broader theoretical and empirical understanding of the effects of mindfulness on EF

Significant Reduction of Antibiotic Use in the Community after a Nationwide Campaign in France, 2002–2007

Didier Guillemot and colleagues describe the evaluation of a nationwide programme in France aimed at decreasing unnecessary outpatient prescriptions for antibiotics. The campaign was successful, particularly in reducing prescriptions for children

Genome wide linkage study, using a 250K SNP map, of Plasmodium falciparum infection and mild malaria attack in a Senegalese population

Multiple factors are involved in the variability of host's response to P. falciparum infection, like the intensity and seasonality of malaria transmission, the virulence of parasite and host characteristics like age or genetic make-up. Although admitted nowadays, the involvement of host genetic factors remains unclear. Discordant results exist, even concerning the best-known malaria resistance genes that determine the structure or function of red blood cells. Here we report on a genomewide linkage and association study for P. falciparum infection intensity and mild malaria attack among a Senegalese population of children and young adults from 2 to 18 years old. A high density single nucleotide polymorphisms (SNP) genome scan (Affimetrix GeneChip Human Mapping 250K-nsp) was performed for 626 individuals: i.e. 249 parents and 377 children out of the 504 ones included in the follow-up. The population belongs to a unique ethnic group and was closely followed-up during 3 years. Genome-wide linkage analyses were performed on four clinical and parasitological phenotypes and association analyses using the family based association tests (FBAT) method were carried out in regions previously linked to malaria phenotypes in literature and in the regions for which we identified a linkage peak. Analyses revealed three strongly suggestive evidences for linkage: between mild malaria attack and both the 6p25.1 and the 12q22 regions (empirical p-value = 5 x 10(-5) and 96 x 10(-5) respectively), and between the 20p11q11 region and the prevalence of parasite density in asymptomatic children (empirical p-value = 1.5 x 10(-4)). Family based association analysis pointed out one significant association between the intensity of plasmodial infection and a polymorphism located in ARHGAP26 gene in the 5q31-q33 region (p-value = 3.7 x 10(-5)). This study identified three candidate regions, two of them containing genes that could point out new pathways implicated in the response to malaria infection. Furthermore, we detected one gene associated with malaria infection in the 5q31-q33 region

Etudes de diffraction de poudres de protéines

La technique de diffraction de monocristaux est la plus utilisée pourdéterminer une structure tridimensionnelle de protéine, permettantainsi la compréhension de sa fonction biologique.Cependant, cette technique nécessite l'obtention d'un monocristal.La détermination d'une structure par diffraction de poudre ne requiertque l'obtention d'un précipité cristallin, souvent obtenu lors de larecherche d'une condition de cristallisation.Nous présentons dans cette thèse plusieurs protéines étudiées pardiffraction de poudre. Le développement de nouvelles méthodes pour lapréparation des échantillons et l'acquisition des données sontprésentées, étant donnée leur importance cruciale dans ces études.Nous avons étudié le polymorphisme de l'urate oxidase par ladétermination des différentes phases cristallines résultant desmodi cations des conditions de cristallisation. Cette étude a débouchésur l'identi cation d'une forme cristalline nouvelle d'intérêtpharmaceutique. Une des phases d'urate oxidase à permis l'obtentiond'un cliché de diffraction de qualité suffisante à la redéterminationet l'affinement de sa structure.Un protocole pour le refroidissement cryogénique de poudre de protéineest présenté, offrant une durée de vie accrue de l'échantillon lors del'acquisition de données.Ce protocole a permis l'affinement de deux structures d'insulinehumaine. Nous présentons également la détermination d'une structurepréliminaire du domaine macro du virus Mayaro, basé uniquement sur desdonnées acquises sur un unique échantillon polycristallin en formed'oursin. Une étude de la matrice de protection de deux baculovirusillustre les limites auxquelles se heurte actuellement la technique dediffraction de poudre de protéines.En annexes, les étapes nécessaires pour la préparation et l'analysedes données sont présentées.Knowledge of the structure of proteins helps in understanding theirbiological function.The main technique used, single crystal diffraction, requires thelimiting step of growing a single crystal.On the other hand, powder diffraction requires only a crystallineprecipitate made of many microcrystals such as those often discardedduring the search for suitable single crystal growth conditions.We present in this thesis different studies of proteins by powder diffraction.Development of new methods for sample preparation and data acquisitionare also presented, as they have been crucial steps to obtain highquality diffraction data.We studied the polymorphism of Urate oxidase by observing thedifferent crystallographic phases resulting from the changes in thecrystallisationconditions.A crystallographic phase of pharmaceutical interest has been identified.Also one phase of urate oxidase complexed with its inhibitor gave apowder pattern sufficient to re-determine and refine its structure.A protocol for cryocooling protein powder samples has been found,extending the lifespan of the sample in the intense X-ray beam.This allowed the refinement from powder data of two forms ofcryocooled human insulin.We present also the determination of a preliminary structure of themayaro virus macro domain, based on a powder diffraction patternobtained on a single urchin-like bundle of needles.A study of the protective protein matrix of two baculoviruses ispresented, showing some current limits of the method.In annexes, the steps for preparing and analysing protein powders are described.SAVOIE-SCD - Bib.électronique (730659901) / SudocGRENOBLE1/INP-Bib.électronique (384210012) / SudocGRENOBLE2/3-Bib.électronique (384219901) / SudocSudocFranceF