Abdominal wall reconstruction (the "mutton chop" flap).

Reconstruction of full-thickness abdominal wall defects can be a difficult surgical challenge. Reconstructing the epigastrium may be especially vexing. The use of prosthetic mesh has significant drawbacks, and the use of pedicled myofascial and myocutaneous flaps should be advantageous. We present 15 consecutive cases demonstrating highly successful reconstructions of massive abdominal wall defects using myofascial and myocutaneous flaps without prosthetic mesh. The extended rectus femoris flap, or "mutton chop" flap, which is capable of resurfacing the epigastrium, is described. Complications were minimal, and use of myofascial units, particularly the rectus femoris, should be considered as the technique of choice for reconstruction of major abdominal wall deficits.     

Dichromatic color language: "reds" and "greens" don't look alike but their colors do.

When protanopes or deuteranopes arrange the Farnsworth Dichotomous Test colors in order of similarity, they reveal their lack of red/green hue discriminations by alternating chips that the normal trichromat sees as reddish and greenish test colors. The dichromatic orderings follow a systematic variation in saturation of blue hues through neutral and into yellow hues as described by theory for each of the two types. Some dichromats who show the typical test behavior nevertheless use reddish and greenish hue terms appropriately when instructed to name the same test colors. Lightness cues are probably used by these dichromats in the naming task but ignored in the perceptual similarity task. Thus, unlike normal trichromats, who use similar names for perceptually similar colors, dichromats may use dissimilar names for perceptually similar colors. In this way they can achieve concordance with the normative language system despite its discordance with their impoverished color perceptions.     

Triflimide (HNTf2)-catalyzed aldehyde cross-aldol reaction using "super silyl" enol ethers

The synthesis of the acetaldehyde-derived tris(trimethylsilyl)silyl (super silyl) enol ether is described, as well as its use in the high-yielding aldehyde cross-aldol reaction. The super silyl enol ether shows unprecedented reactivity in giving the 1:1 adduct in very high yield. This reaction is catalyzed by 0.05 mol% of the Br?nsted acid triflimide (HNTf2) and is complete within 15 min, making the protocol very attractive for large-scale synthesis.     

A history of noma,the "Face of Poverty"

Noma (necrotizing ulcerative stomatitis, stomatitis gangrenosa, or cancrum oris) is a devastating orofacial gangrene that occurs mainly among children. The disease has a global yearly incidence of 140,000 cases and a mortality rate of approximately 90 percent. Patients who survive noma generally suffer from its sequelae, including serious facial disfigurement, trismus, oral incontinence, and speech problems. The medical history of noma indicates that the disease was already known in classical and medieval civilizations in Europe. In the sixteenth and seventeenth centuries, Dutch chirurgeons clearly described noma as a clinical entity and realized that the popular name "water canker" was not sufficient, because this quickly spreading ulceration in the faces of children was different from "cancer." In the eighteenth century, awareness that noma is related to poverty, malnutrition, and preceding diseases such as measles increased in northwestern Europe. In the first half of the nineteenth century, extensive surgical procedures were described for the treatment of the sequelae of noma. At the end of that century, noma gradually disappeared in the Western world because of economic progress, which gave the poorest in society the opportunity to feed their children sufficiently. Only in the twentieth century were effective drugs (sulfonamides and penicillin) against noma developed, as well as adequate surgical treatment for the sequelae of noma. These modes of treatment remain inaccessible for the many present-day victims of noma because of their extreme poverty. The only truly effective approach to the problem of noma throughout the world is prevention, namely, combating the extreme poverty with measures that lead to economic progress. In the meantime, medical doctors in the Western world should not forget their own history and ignore this global health problem; rather, they should face "the face of poverty" with the eyes of mercy and concern suited to their profession.     

The "ups" and "downs" in Using Subtractive Cloning Techniques to Isolate Regulated Genes in Fish

Over the last decade, subtractive cloning approaches have beenused extensively to isolate genes that are up- or down-regulatedunder various conditions. These techniques have provided thefoundation for many subsequent studies concerning gene functionand regulation and, as such, have been valuable tools for manybiological fields. Over the past 10 years, we have used differentsubtractive cloning approaches to isolate genes in fish thatare regulated in relation to hormonal stimulation or the stageof ovarian maturation. These include conventional cDNA subtractionfollowed by library screening, differential display PCR, suppressionsubtraction hybridization, and more recently, iterative PCRsubtraction. We continue to use these techniques for the isolationof new genes involved in physiological processes in fish andbivalve molluscs. Examples that illustrate the use of thesedifferent subtractive cloning techniques are described, includingwhere possible the advantages and disadvantages of each. Inaddition, the use of ancillary methods (e.g., "Reverse Northerns")to facilitate the use of these subtractive approaches are discussed.     

Solid phase synthesis of a functionalized bis-peptide using "safety catch" methodology

In 1962, R.B. Merrifield published the first procedure using solid-phase peptide synthesis as a novel route to efficiently synthesize peptides. This technique quickly proved advantageous over its solution-phase predecessor in both time and labor. Improvements concerning the nature of solid support, the protecting groups employed and the coupling methods employed over the last five decades have only increased the usefulness of Merrifield's original system. Today, use of a Boc-based protection and base/nucleophile cleavable resin strategy or Fmoc-based protection and acidic cleavable resin strategy, pioneered by R.C. Sheppard, are most commonly used for the synthesis of peptides(1). Inspired by Merrifield's solid supported strategy, we have developed a Boc/tert-butyl solid-phase synthesis strategy for the assembly of functionalized bis-peptides(2), which is described herein. The use of solid-phase synthesis compared to solution-phase methodology is not only advantageous in both time and labor as described by Merrifield(1), but also allows greater ease in the synthesis of bis-peptide libraries. The synthesis that we demonstrate here incorporates a final cleavage stage that uses a two-step "safety catch" mechanism to release the functionalized bis-peptide from the resin by diketopiperazine formation. Bis-peptides are rigid, spiro-ladder oligomers of bis-amino acids that are able to position functionality in a predictable and designable way, controlled by the type and stereochemistry of the monomeric units and the connectivity between each monomer. Each bis-amino acid is a stereochemically pure, cyclic scaffold that contains two amino acids (a carboxylic acid with an α-amine)(3,4). Our laboratory is currently investigating the potential of functional bis-peptides across a wide variety of fields including catalysis, protein-protein interactions and nanomaterials.     

Summary--Measuring "bone quality"

The idea of bone quality is well-established in the literature and represents a real conundrum in the treatment of osteoporosis. On the one hand, there are measurements for patients that predict fracture risk for the population as a whole, but between individual patients, one will fracture but another will not, despite the fact that all of the technical measurements we use to predict fracture risk are the same. There are, of course, many aspects of bone mechanical properties that cannot yet be measured in patients. The session began with a discussion of what bone quality is, then the speakers presented work on novel aspects of bone properties that could help explain why fracture prediction in vivo is inexact.     

Use of mixture distributions to deconvolute the behavior of "hits" and controls in high-throughput screening data

The stochastic nature of high-throughput screening (HTS) data indicates that information may be gleaned by applying statistical methods to HTS data. A foundation of parametric statistics is the study and elucidation of population distributions, which can be modeled using modern spreadsheet software. The methods and results described here use fundamental concepts of statistical population distributions analyzed using a spreadsheet to provide tools in a developing armamentarium for extracting information from HTS data. Specific examples using two HTS kinase assays are analyzed. The analyses use normal and gamma distributions, which combine to form mixture distributions. HTS data were found to be described well using such mixture distributions, and deconvolution of the mixtures to the constituent gamma and normal parts provided insight into how the assays performed. In particular, the proportion of hits confirmed was predicted from the original HTS data and used to assess screening assay performance. The analyses also provide a method for determining how hit thresholds--values used to separate active from inactive compounds--affect the proportion of compounds verified as active and how the threshold can be chosen to optimize the selection process.     

"Spore plate method" for transformation of steroids by fungal spores entrapped in silica gel g

A new technique for investigating steroid biotransformations involving the use of glucose-treated Silica Gel G thin-layer chromatography plates spotted with fungal spores and steroid substrates is described. The conversion is followed by the detection and identification of steroid metabolites and is carried out on single plates by using the spores of different fungi. During the entire process, the spores remain on the original spots and microscopical examination revealed no germination. The method was successfully applied to as little as 30 μg of substrates, and a single plate could be used to detect the steroid metabolizing activity of spores of as many as 15 different cultures.     

"Run-off" synthesis and application of defined single-stranded DNA hybridization probes.

A simple and efficient method for synthesizing radioactively labeled single-stranded DNA hybridization probes with Thermus aquaticus (Taq) DNA polymerase is described. This is done in a "run-off" polymerization with repeated cycles of denaturation, annealing, and extension. It leads to high yields of a single-stranded DNA of defined length (up to 5000 nt), which is labeled to a high specific activity (1.3 x 10(8) cpm/micrograms DNA). These hybridization probes are equally sensitive as nick-translated DNA probes, but strand specific. This was tested by slot blot hybridization with in vitro-transcribed target RNAs and by Northern blotting. The use of single-stranded DNA hybridization probes combines the benefits of DNA stability and single-strand RNA probes.     

Plastic isolators for treatment of acute leukaemia patients under "germ-free" conditions.

A gnotobiotic isolation system based on those developed in veterinary research has been constructed for hospital use. Fifteen patients with leukaemia and neutropenia spent a total of 110 weeks in plastic isolators, and none acquired any infection. Endogenous flora was effectively suppressed by topical antiseptics and gastrointestinal decontamination effected with nonabsorbable antibiotics. The isolator system was acceptable to patients and staff and much cheaper than the use of sterile rooms. Other advantages of the system are portability, easy storage, and use on ordinary open wards without prejudice to the microbiological protection afforded. It is as yet uncertain whether protective environments of this type will substantially improve the outcome of treatment for the acute leukaemias.     

An invitro assay system for chitin synthesis in insect tissue

The system described utilizes the abdominal integument of the grasshopper $\text{Melanoplus}$$\text{sanguinipes}$ as the tissue and radioactive glucose, glucosamine or UDP-N-acetyl glucosamine as substrate. A micromethod is described that makes it possible to use as little as 2 μl total volume of incubation. After an initial lag period, incorporation rates become linear for at least 2 hrs. Cell disruption leads to immediate and complete loss of activity.     

Postembedding immunogold labeling for electron microscopy using "LR White" resin

A method is described for performing postembedding immunogold immunocytochemistry on sections of LR White-embedded tissues. Fixation of tissue in a combination of paraformaldehyde and glutaraldehyde, or with low concentrations of glutaraldehyde followed by partial dehydration, resulted in preservation of antigenicity for a variety of proteins in different tissue samples. Good structural preservation facilitated high-resolution immunolabeling when coupled with the use of purified monoclonal antibodies. The technique is straightforward and versatile, offering the potential for many immunocytochemical applications with minimal modifications.     

"No-reflow" phenomenon during percutaneous carotid angioplasty in a scleroderma patient

Atherosclerosis remains the most common etiology of carotid artery stenosis, but other systemic diseases can also cause this disease. Percutaneous carotid angioplasty and stenting (CAS) with and without distal embolic protection devices is gaining acceptance as the treatment of choice. No-reflow phenomenon due to distal embolization has been previously described mainly during percutaneous intervention of degenerated saphenous vein graft. We describe a patient with systemic sclerosis who underwent CAS with distal embolic protection device with occurrence of no-reflow phenomenon during the procedure that resolved after retrieval of the filter device.     

MRI in medical practice and its future use in radiation oncology. Resume of XXV GOCO Congress (Montpellier) 2017

This publication is a resume of the GOCO Congress (Montpellier 2017). A part of this congress was about the use of MRI in clinical practice, focused on the oncology field. The role of this tool was described in diagnosis, staging of tumors, evaluation of treatment response and the future use in prognostic and investigation (radiomics). After that, in the context of the present and future uses of MRI in radiation oncology, MRI guided radiotherapy was explained, as a method that allows an increased precision in image guided treatments. This publication is a resume of the GOCO Congress (Montpellier 2017). A part of this congress was about the use of MRI in clinical practice, focused on the oncology field. The role of this tool was described in diagnosis, staging of tumors, evaluation of treatment response and the future use in prognostic and investigation (radiomics).     

Ajulemic acid: A novel cannabinoid produces analgesia without a "high"

A long-standing goal in cannabinoid research has been the discovery of potent synthetic analogs of the natural substances that might be developed as clinically useful drugs. This requires, among other things, that they be free of the psychotropic effects that characterize the recreational use of Cannabis. An important driving force for this goal is the long history of the use of Cannabis as a medicinal agent especially in the treatment of pain and inflammation. While few compounds appear to have these properties, ajulemic acid (AJA), also known as CT-3 and IP-751, is a potential candidate that could achieve this goal. Its chemical structure was derived from that of the major metabolite of Delta9-THC, the principal psychotropic constituent of Cannabis. In preclinical studies it displayed many of the properties of non-steroidal anti-inflammatory drugs (NSAIDs); however, it seems to be free of undesirable side effects. The initial short-term trials in healthy human subjects, as well as in patients with chronic neuropathic pain, demonstrated a complete absence of psychotropic actions. Moreover, it proved to be more effective than placebo in reducing this type of pain as measured by the visual analog scale. Unlike the narcotic analgesics, signs of dependency were not observed after withdrawal of the drug at the end of the one-week treatment period. Data on its mechanism of action are not yet complete; however, the activation of PPAR-gamma, and regulation of eicosanoid and cytokine production, appear to be important for its potential therapeutic effects.     

An integrated algal sulphate reducing high rate ponding process for the treatment of acid mine drainage wastewaters

Acid mine drainage pollution may be associated with large water volume flows and exceptionally long periods of time over which the drainage may require treatment. While the use and role of sulphate reducing bacteria has been demonstrated in active treatment systems for acid mine drainage remediation, reactor size requirement and the cost and availability of the carbon and electron donor source are factors which constrain process development. Little attention has focussed on the use of waste stabilisation ponding processes for acid mine drainage treatment. Wastewater ponding is a mature technology for the treatment of large water volumes and its use as a basis for appropriate reactor design for acid mine drainage treatment is described including high rates of sulphate reduction and the precipitation of metal sulphides. Together with the co-disposal of organic wastes, algal biomass is generated as an independent carbon source for SRB production. Treatment of tannery effluent in a custom-designed high rate algal ponding process, and its use as a carbon source in the generation and precipitation of metal sulphides, has been demonstrated through piloting to the implementation of a full-scale process.The treatment of both mine drainage and zinc refinery wastewaters are reported. A complementary role for microalgal production in the generation of alkalinity and bioadsorptive removal of metals has been utilised and an Integrated 'Algal Sulphate Reducing Ponding Process for the Treatment of Acidic and Metal Wastewaters' (ASPAM) has been described.     

"You Have to Be Your Own Doctor": Sociocultural Influences on Alternative Therapy Use among Gay Men with AIDS in West Hollywood

This article considers the use of alternative therapies by gay men with AIDS in West Hollywood, California. In all, 89 different alternative therapies for HIV and AIDS treatment were uncovered during the course of the study. In addition to the high number of alternative therapies, a majority of the men in the study (69.2 percent) were currently using some type of alternative treatment. Sociocultural influences on the use of alternative therapies are explored, including AIDS activism. Because most of the men (92 percent) also use Western medicine as well, the interface of these two types of treatments is also explored, [alternative therapies, AIDS, gay men]