Degradation and mineralization of anti-cancer drugs Capecitabine, Bicalutamide and Irinotecan by UV-irradiation and ozone

The degradation of three anti-cancer drugs (ADs), Capecitabine (CAP), Bicalutamide (BIC) and Irinotecan (IRI), in ultrapure water by ozonation and UV-irradiation was tested in a bench-scale reactor and AD concentrations were measured through ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS). A low-pressure mercury UV (LP-UV) lamp was used and degradation by UV (λ = 254 nm) followed pseudo-first order kinetics. Incident radiation in the reactor was measured via chemical actinometry using uridine. The quantum yields (φ) for the degradation of CAP, BIC and IRI were 0.012, 0.0020 and 0.0045 mol Einstein-1, respectively. Ozone experiments with CAP and IRI were conducted by adding ozone stock solution to the reactor either with or without addition of tert-butanol (t-BuOH) as radical quencher. Using this experimental arrangement, no degradation of BIC was observed, so a semi-batch setup was employed for the ozone degradation experiments of BIC. Without t-BuOH, apparent second order reaction rate constants for the reaction of the ADs with molecular ozone were determined to be 3.5 ± 0.8 ∙ 103 L mol-1 s-1 (CAP), 7.9 ± 2.1 ∙ 10-1 L mol-1 s-1 (BIC) and 1.0 ± 0.3 ∙ 103 L mol-1 s-1 (IRI). When OH-radicals (∙OH) were quenched, rate constants were virtually the same for CAP and IRI. For BIC, a significantly lower constant of 1.0 ± 0.5 ∙ 10-1 L mol-1 s-1 was determined. Of the tested substances, BIC was the most recalcitrant, with the slowest degradation during both ozonation and UV-irradiation. The extent of mineralization was also determined for both processes. UV irradiation was able to fully degrade up to 80% of DOC, ozonation up to 30%. Toxicity tests with Daphnia magna (D. magna) did not find toxicity for fully degraded solutions of the three ADs at environmentally relevant concentrations.

Towards the understanding of the uptake and depuration of microplastics in the ragworm Hediste diversicolor: Field and laboratory study

An important number of studies have evaluated the presence of microplastics, particles with a size below 5 mm, in aquatic organisms. Studies have shown that these fragments are widely present in the marine environment, but research on the estuarine ecosystem is still scarce. In this study, two different approaches were used to evaluate the presence and ingestion of plastic particles in the ragworm Hediste diversicolor: a field study for the environmental assessment and a laboratory experiment in controlled condition. For the environmental evaluation, ingestion of microplastics was evaluated in the ragworm H. diversicolor sampled from the mudflats of the Seine estuary (France) during March and June 2017 and 2018, on two locations: S1 and S2, both characterized by high anthropogenic pressures, and for S2 a more influential hydrodynamic component. Ingestion of microplastics was measured in ragworms tissues and in gut content (sediment) after depuration. The number of particles as well as their size, shape and color were reported and compared between sampling period and locations. Results showed the presence of a low number of particles in both worms and gut content. In gut content, 45.6% and 87.58% of samples from site S1 and S2 respectively contained plastic like particles. In worms, 41.7% (S1) and 75.8% (S2) of analysed samples contained plastic like items. The lowest mean number of particles was 0.21 ± 0.31 (S1 in June 2017) in worms' tissues, but 0.80 ± 0.90 (S1 in June 2017) in the gut content and the highest was 1.47 ± 1.41 (S2 in April 2017) while the highest number was 2.55 ± 2.06 (S2 in June 2017) in worms and gut content respectively. The majority of suspected microplastics observed were fibers (66%) and fragments (27%), but films (3.7%) foam (2.1%), and granules (0.2%) were also identified. In addition, the most polymer type observed by Raman spectroscopy was polypropylene. Furthermore, a preliminary study of the ingestion and egestion of fluorescent polyethylene (PE) microbeads in the digestive tract of ragworms was conducted after exposure through water, during 1h at 1.2 × 106 MP/mL. Results showed a rapid turnover of PE microbeads throughout the digestive tract of worms especially after exposure through water. This study revealed that microplastics are ingested by the ragworm H. diversicolor but do not seem to bioaccumulate. More research is needed to measure potential chronic effects of microplastics on physiological parameters of H. diversicolor and potential trophic transfer of microplastics.

Effect of an environmental microplastic mixture from the Seine River and one of the main associated plasticizers, dibutylphthalate, on the sentinel species Hediste diversicolor

The aim of this study was to explore the adverse effects of a microplastic (MP) mixture obtained from litter accumulated in the Seine River (France) compared to those of their major co-plasticizer, dibutylphthalate (DBP), on the sentinel species Hediste diversicolor. A suite of biomarkers has been investigated to study the impacts of MPs (100 mg kg-1 sediment), DBP (38 μg kg-1 sediment) on worms compared to non-exposed individuals after 4 and 21 days. The antioxidant response, immunity, neurotoxicity and energy and respiratory metabolism were investigated using biomarkers. After 21 days, worms exposed to MPs showed an increasing aerobic metabolism, an enhancement of both antioxidant and neuroimmune responses. Energy-related biomarkers demonstrated that the energy reallocated to the defence system may come from proteins. A similar impact was depicted after DBP exposure, except for neurotoxicity. Our results provide a better understanding of the ecotoxicological effects of environmental MPs and their associated-contaminants on H. diversicolor.

Influence of loading conditions in finite element analysis assessed by HR-pQCT on ex vivo fracture prediction

Many fractures occur in individuals with normal areal Bone Mineral Density (aBMD) measured by Dual X-ray Absorptiometry (DXA). High Resolution peripheral Quantitative Computed Tomography (HR-pQCT) allows for non-invasive evaluation of bone stiffness and strength through micro finite element (μFE) analysis at the tibia and radius. These μFE outcomes are strongly associated with fragility fractures but do not provide clear enhancement compared with DXA measurements. The objective of this study was to establish whether a change in loading conditions in standard μFE analysis assessed by HR-pQCT enhance the discrimination of low-trauma fractured radii (n = 11) from non-fractured radii (n = 16) obtained experimentally throughout a mechanical test reproducing a forward fall. Micro finite element models were created using HR-pQCT images, and linear analyses were performed using four different types of loading conditions (axial, non-axial with two orientations and torsion). No significant differences were found between the failure load assessed with the axial and non-axial models. The different loading conditions tested presented the same area under the receiver operating characteristic (ROC) curves of 0.79 when classifying radius fractures with an accuracy of 81.5%. In comparison, the area under the curve (AUC) is 0.77 from DXA-derived ultra-distal aBMD of the forearm with an accuracy of 85.2%. These results suggest that the restricted HR-pQCT scanned region seems not sensitive to loading conditions for the prediction of radius fracture risk based on ex vivo experiments (n = 27).

Is cell culture a suitable tool for the evaluation of micro- and nanoplastics ecotoxicity?

Plastic particles have been described in aquatic ecosystems worldwide. An increasing number of studies have tried to evaluate the toxic impacts of microplastics (1-5000 µm) but also nanoplastics (<1 µm) in marine and freshwater organisms. However, the wide variety of plastic particles characteristics such as various sizes, shapes, functionalization or types of polymer, makes it difficult to evaluate their impact with regular ecotoxicity testing. In this context, cell culture, mainly used in human toxicology, could be a promising tool to evaluate micro- and nanoplastics toxicity with a wide diversity of conditions allowing to generate a large set of data. This review presents the current research on micro and nanoplastics using cell culture of marine and freshwater organisms, describes the limitations of cell culture tool and defines whether this tool can be considered as a relevant alternative strategy for ecotoxic evaluation of micro and nanoplastics especially for future regulatory needs. Articles using specifically cell culture tool from aquatic organisms such as fish or bivalves were identified. The majority evaluated the toxicity of polystyrene nanobeads on immune parameters, oxidative stress or DNA damage in fish cells. Although most of the papers characterized nanoplastic particles into the cell culture media, the relevance of testing conditions is not always clear. The development of cell culture can offer many opportunities for the evaluation of plastic particles' cellular impacts, but more research is needed to develop relevant culture models, on various aquatic organisms, and with consideration of abiotic parameters especially composition of cell culture media for nanoplastic evaluation.

Accumulation and immunotoxicity of microplastics in the estuarine worm Hediste diversicolor in environmentally relevant conditions of exposure

The presence of plastic debris < 5 mm called microplastics (MPs) which results mainly from macroplastic's fragmentation has been reported in aquatic ecosystems. Several studies have shown that MPs are persistent and their accumulation was observed in various aquatic species. However, the majority of studies focused on marine species, and much less on continental and estuarine biota. The goal of the present study was to investigate the effects of a mixture of two types of MPs (polyethylene and polypropylene), frequently found in natural environments, towards the ragworm Hediste diversicolor to determine their accumulation in organisms exposed through the water phase or sediment. Two concentrations of exposure were selected for medium and heavily contaminated areas reported for water phase (10 and 100 μg/L) and sediment (10 and 50 mg of MPs/kg). To study the potential toxic effect of MPs, immune parameters were selected since they are involved in many defense mechanisms against xenobiotics or infectious agents. An average number of MP items/worm ranging from 0 to 2.5 and from 1 to 36 were identified in animals exposed to the lowest and the highest concentration of MPs through water exposure. In worms exposed through sediment, less than 1 MP/worm was found and a greater number of particles were identified in depurated sediment. For immunotoxic impact, MP exposure induced a decrease in coelomocytes viability, but no alteration of phagocytosis activity, phenoloxydase, and acid phosphatase was measured. This study brings new results on the potential accumulation and immunotoxicity of MPs for the ragworm H. diversicolor who plays a key role in the structure and functioning of estuarine ecosystem.

Realistic environmental exposure to microplastics does not induce biological effects in the Pacific oyster Crassostrea gigas

The aim of the present study was to evaluate the presence and potential toxic effects of plastic fragments (<400 μm) of polyethylene and polypropylene on the Pacific oyster Crassostrea gigas. Oysters were exposed to environmentally relevant concentrations (0, 0.008, 10, 100 μg of particles/L) during 10 days, followed by a depuration period of 10 days in clean seawater. Effects of microplastics were evaluated on the clearance rate of organisms, tissue alteration, antioxidant defense, immune alteration and DNA damage. Detection and quantification of microplastics in oyster's tissues (digestive gland, gills and other tissues) and biodeposits using infrared microscopy were also conducted. Microplastics were detected in oyster's biodeposits following exposure to all tested concentrations: 0.003, 0.006 and 0.05 particles/mg of biodeposits in oysters exposed to 0.008, 10 and 100 μg of particles/L, respectively. No significant modulation of biological markers was measured in organisms exposed to microplastics in environmentally relevant conditions.

Immunotoxicity and genotoxicity of single-walled carbon nanotubes co-exposed with cadmium in the freshwater mussel, Elliptio complanata

Potential immunotoxicity and genotoxicity of as-produced and purified single walled carbon nanotubes (SWCNT, 500 μg L-¹) with or without cadmium (20 μg L-¹) was investigated in hemocytes of the freshwater mussel, Elliptio complanata. Our results showed a decrease in hemocyte viability after 3, and 8 days of exposure and an increase of hemocyte phagocytic efficiency for organisms exposed to Cd. No modification of the cyclo-oxygenase (COX) activity was measured. An increase in DNA damage was measured after 1 day of exposure to Cd and a potentiating effect of combined exposures was observed.

Combined influence of oxygenation and salinity on aggregation kinetics of the silver reference nanomaterial NM-300K

The combined influence of oxygenation and salinity on agglomeration and/or aggregation kinetics of the silver (Ag) nanomaterial NM-300K was investigated, and the relationship between its physicochemical fate and toxicity toward an estuarine bivalve was established. The results showed that the presence of NaCl under certain oxygen conditions (8.5 ppm) promoted the formation of AgCl aggregates that could be linked to toxicity effects on aquatic organisms. Environ Toxicol Chem 2018;37:1007-1013. © 2017 SETAC.

Omics tools: New challenges in aquatic nanotoxicology?

In recent years, the implication of genomics into ecotoxicological studies has been studied closely to allow a better understanding of organism's responses to environmental contaminants including engineering nanomaterials (ENMs). ENMs are increasingly produced for various applications including cosmetics, electronics, sports equipment, biomedicine and agriculture. Because of their small size, ENMs possess chemical or physical characteristics improved compared to the corresponding macro-sized material. As their application expend, the release of manufactured ENMs into the environment is likely to increase and concern over impacts for the aquatic ecosystem is growing. Several studies reported deleterious effect of ENMs to aquatic organisms, but there is little information about the molecular mechanisms of toxicity. The development of ecotoxicogenomic approaches will improve the characterization of cellular and molecular modes of action of ENMs to aquatic organisms and allow a better prediction of contaminants toxicity. This paper presents an overview of transciptomic/proteomic studies in freshwater and marine organisms exposed to ENMs. Overall, induction of gene expression in relations to defense mechanisms, immune responses, growth and reproduction were measured after ENMs exposures of organisms, but with different patterns depending on exposure duration and concentrations used. In addition, some studies reported a positive correlation between gene expression and cellular modifications, but not at the individual level.

African humid periods triggered the reactivation of a large river system in Western Sahara

The Sahara experienced several humid episodes during the late Quaternary, associated with the development of vast fluvial networks and enhanced freshwater delivery to the surrounding ocean margins. In particular, marine sediment records off Western Sahara indicate deposition of river-borne material at those times, implying sustained fluvial discharges along the West African margin. Today, however, no major river exists in this area; therefore, the origin of these sediments remains unclear. Here, using orbital radar satellite imagery, we present geomorphological data that reveal the existence of a large buried paleodrainage network on the Mauritanian coast. On the basis of evidence from the literature, we propose that reactivation of this major paleoriver during past humid periods contributed to the delivery of sediments to the Tropical Atlantic margin. This finding provides new insights for the interpretation of terrigenous sediment records off Western Africa, with important implications for our understanding of the paleohydrological history of the Sahara.

Given the absence of a major river system in the Western Sahara, the source of late Quaternary fluvial sediments along the West African margin remains unclear. Here, the authors present geomorphological data that reveal the existence of a large buried paleodrainage network on the Mauritanian coast.

Toxic Effect of Single Walled Carbon Nanotubes Combined with Cadmium to the Crustacean Daphnia magna

The aim of this study was to assess the impact of single-walled carbon nanotubes (SWCNT) on the toxicity of cadmium (Cd) using the crustacean Daphnia magna. LC50 of Cd and SWCNT alone and combined were calculated and compared. Sorption of Cd on SWCNT was also quantified in separate batch experiments. Results showed that the maximum adsorption of Cd onto SWCNT calculated by the Langmuir equation was 24.4 mg kg-1. LC50s for Cd and SWCNT alone were 252.3 µg L-1 and 1400 µg L-1, respectively. In the presence of 500 and 1000 µg L-1 of SWCNT, Cd LC50s were 127.2 and 120.1 µg L-1 respectively. Therefore, Cd toxicity increased when organisms were exposed to both contaminants which indicated that SWCNT induces a synergistic toxic effect on the survival of D. magna. It appears that even if SWCNT had a low adsorption capacity for Cd, toxicity of the metal can be increased. Our study shows the complexity of SWCNT toxicity and how the understanding of their interactions with other contaminants is crucial to determine the consequences of their release into the environment.

Single-Walled Carbon Nanotubes Toxicity to the Freshwater Amphipod Hyalella Azteca: Influence of to the Freshwater Amphipod Sediment and Exposure Duration

Carbon nanomaterials are present in various industrial applications and therefore their release into the environment including freshwater ecosystem is expected to increase. The aim of the present study was to investigate the influence of several parameters on the toxicity of single-walled carbon nanotubes (SWCNT) to the freshwater amphipod, Hyalella azteca. The effect of period of exposure, sediment presence and possible impurities released during SWCNT preparation on survival and/or growth of such organism was evaluated. We measured a reduction of survival at concentrations ranging from 10 to 40 mg/L after 96-h exposure, while no mortality was observed with the same concentrations and in the presence of artificial sediment after 14 days of exposure. It is possible that SWCNT are adsorbed on the organic matter from the artificial sediment leading to a decrease of SWCNT bioavailability. The survival and growth toxicity tests revealed a stronger effect at 28 days compared to the 14 days of exposure, and full mortality of organisms at 1000 mg/L for both exposure times. The presence of SWCNT in the gut of survived organisms was observed. The present study demonstrates that the interaction with sediment should be considered when carbon nanotubes toxicity through water exposure is investigated.

Altruism during predation in an assassin bug

Zelus annulosus is an assassin bug species mostly noted on Hirtella physophora, a myrmecophyte specifically associated with the ant Allomerus decemarticulatus known to build traps on host tree twigs to ambush insect preys. The Z. annulosus females lay egg clutches protected by a sticky substance. To avoid being trapped, the first three instars of nymphs remain grouped in a clutch beneath the leaves on which they hatched, yet from time to time, they climb onto the upper side to group ambush preys. Long-distance prey detection permits these bugs to capture flying or jumping insects that alight on their leaves. Like some other Zelus species, the sticky substance of the sundew setae on their forelegs aids in prey capture. Group ambushing permits early instars to capture insects that they then share or not depending on prey size and the hunger of the successful nymphs. Fourth and fifth instars, with greater needs, rather ambush solitarily on different host tree leaves, but attract siblings to share large preys. Communal feeding permits faster prey consumption, enabling small nymphs to return sooner to the shelter of their leaves. By improving the regularity of feeding for each nymph, it likely regulates nymphal development, synchronizing molting and subsequently limiting cannibalism.

DNA strand breaks detected in embryos of the adult snails, Potamopyrgus antipodarum, and in neonates exposed to genotoxic chemicals

We tested the freshwater mudsnail Potamopyrgus antipodarum, which is a species that has already been used for endocrine-disrupting compounds (EDCs) to determine whether early life stages of aquatic organisms are sensitive to genotoxic chemicals. For this purpose, we first developed the alkaline comet assay on adults, embryos, and neonates. The comet assay protocol was validated on both embryonic cells exposed in vitro to hydrogen peroxide and adult snails in the reproducing stage exposed to methyl methane sulfonate. During the latter experiment, DNA strand breaks were investigated on both embryonic cells and on adult gill cells. The second part of this study investigated the stability of DNA strand breaks in adult reproducing snails and neonates exposed to cadmium (Cd) and bisphenol A for 8 days. Hydrogen peroxide-induced DNA strand breaks in vitro in isolated embryonic cells. Exposure of adult reproducing snails to methyl methane sulfonate for 24h induced DNA strand breaks in embryos. Bisphenol A induced a significant increase in the DNA strand-break level in whole embryonic cells and whole neonate cells. Cd was genotoxic for both embryos and neonates during the exposure time and also after 7 days of depuration, suggesting that Cd could inhibit DNA repair enzymes. These preliminary results on this original model have encouraged us to consider the impact of genotoxic environmental contaminants on the F1 generation.

Computerized tomographical study of dorsal neck muscles for insertion of EMG wire electrodes

A computerized tomographical (CT) study of the main dorsal neck muscles was performed on 60 subjects (30 males and 30 females) in order to quantify individual anatomical variations and to describe valid means of accurately inserting intramuscular wire electrodes in these deep and superimposed muscle layers. Depth and thickness of transverso-spinalis (TS), semispinalis capitis (SSC) and splenius capitis (SPL) muscles were measured on a cross-sectional image of the neck at the level of the fith cervical vertebrae. Thickness and depth were significantly greater in males than in females. SSC and SPL thicknesses were less than 10 mm in most subjects and their depths were highly variable depending on the subject's morphology. TS was thicker but its depth was also variable. This CT study clearly demonstrated that the interindividual variations of dorsal neck muscles are important and CT may provide a valid way to position wire electrodes accurately in most cervical muscles.

Interleukin-6 and interleukin-6 receptor secretion by chronic lymphatic leukaemia and normal B lymphocytes: effect of PMA and PWM

Interleukin-6 (IL-6) and soluble interleukin-6 receptor (sIL-6R) were detected in supernatants of cultures of B chronic lymphatic leukaemia (CLL) lymphocytes. Phorbol-12-myristate 13 acetate (PMA) caused a decrease in the levels of IL-6 in 14 out of 16 cultures and an increase in levels of sIL6R in all 15 cases. The effect of pokeweed mitogen (PWM) was variable and not significant. The levels of IL-6 were below the detection limit (60 pg/ml) in sera of 13 CLL patients whereas sIL-6R was detected (13 ng/ml to 97 ng/ml) in the 13 sera. IL6 was not detected in cultures of unstimulated or stimulated with PMA or PWM normal human B cells. Levels of sIL-6R were minimal in cultures of normal B lymphocytes and were increased in PMA stimulated cultures. The results are consistent with the view that B-CLL cells produce spontaneously IL-6 which could act in an autocrine fashion to cause shedding of surface IL-6R and account for the correlation found between serum levels of sIL-6R and B-CLL lymphocyte numbers. The fall in levels of IL-6 in PMA stimulated CLL cultures might express masking or degradation of IL-6 after combination with the receptor.

An assassin among predators: the relationship between plant-ants, their host Myrmecophytes and the Reduviidae Zelus annulosus

Tropical plants frequently live in association with ants that protect their foliage from defoliators. Among them, myrmecophytes have evolved mutualisms with a limited number of plant-ants that they shelter and feed, and, in return, benefit from some protection. Hirtella physophora (Chrysobalanaceae), for example, houses Allomerus decemarticulatus (Myrmicinae) that build gallery-shaped traps to catch large prey. In French Guiana, we frequently observed the assassin bug Zelus annulosus (Reduviidae, Harpactorinae) on the leaves of H. physophora. Here, we studied the distribution of Zelus annulosus among understory plants in the Guianese rainforest and found it only on pubescent plants, including H. Physophora, whether or not it was sheltering an A. decemarticulatus colony, but only rarely on other myrmecophytes. The relationship between Z. annulosus and its host plants is, then, also mutualistic, as the plant trichomes act as an enemy-free space protecting the nymphs from large predatory ants, while the nymphs protect their host-plants from herbivorous insects. Through their relationship with A. decemarticulatus colonies, Z. annulosus individuals are protected from army ants, while furnishing nothing in return. In those cases where H. physophora sheltered both an A. decemarticulatus colony and Z. annulosus nymphs, certain plant individuals repeatedly sheltered nymphs, indicating that female bugs may select not only pubescent plants but also particular H. physophora treelets having characteristics more favourable to the development of their progeny.

Evidences of memory dysfunction and maladaptive coping in chronic low back pain and rheumatoid arthritis patients: challenges for rehabilitation

AIM

This study investigates whether chronic low back pain (LBP) and rheumatoid arthritis (RA) patients have deficits in memory functioning and whether there is correlation between memory scores and coping skills, as a disability evaluation measure.

METHODS

We studied 2 samples of patients of both genders between 20 and 70 years-old, in a cross-sectional design: 21 low back pain and 23 rheumatoid arthritis. Patients were compared to historical controls. Assessment of primary outcome included memory evaluation (Wechsler Memory Scale III) and measures of coping strategies (FABQ, CPCI, CSQ). Other data included depression (HAD), pain (VAS), work status, use of medications, and perceived memory complaints. Analysis were made of between-group differences.

RESULTS

Both groups were comparable regarding demographic status, had high scores of memory complaint, and low performance in memory assessment when compared to normative data. Only LBP patient's measures of catastrophizing and coping were significantly correlated to late memory indices. No correlations were found between memory and Visual Analogue Scale (VAS) or pain chronicity in both groups. One may suggest that both chronic localized and widespread pain can imply in cognitive changes and be correlated to coping dysfunction. However, bias of existence of depression/ anxiety and psychotropic medication cannot be excluded.

CONCLUSIONS

Both groups of chronic pain patients are likely to have impaired memory. Maladaptive coping correlates to LBP, but not to RA. A further controlled protocol must include greater sample of patients. By analyzing memory deficits of chronic pain patients, clinicians could establish targeted rehabilitation programs and outcomes. Some techniques are discussed.

Impact of digital ulcers on disability and health-related quality of life in systemic sclerosis

Objective:

To assess the impact of digital ulcers (DUs) on disability and health-related quality of life (HRQoL) in systemic sclerosis (SSc).

Methods:

Two hundred and thirteen patients with SSc were evaluated at four annual meetings of a patient society between 2004 and 2007 (n = 177) or during hospital stay (n = 36). HRQoL was assessed by the SF-36, global disability by the health assessment questionnaire (HAQ), hand disability by the Cochin Hand Function Scale (CHFS) and global hand and wrist mobility by the Kapandji index.

Results:

Sixty-seven patients (31.4%) had at least one DU at the time of evaluation. Patients with DUs showed significantly more pitting scars (p<0.001) and calcinosis (p<0.0001) than others. Patients with DU had significantly greater HAQ (mean (SD) 1.218 (0.723) vs 0.930 (0.717), p = 0.008), CHFS (mean (SD) 27.38 (20.68) vs 16.73 (18.19), p<0.0001) and aesthetic prejudice (mean (SD) 6.1 (2.2) vs 3.9 (2.5), p<0.0001) scores than others. Hand and wrist mobility were significantly diminished in patients with DU (mean (SD) Kapandji score 75.3 (22.8) vs 81.7 (19.2), p<0.0001). The presence of a DU did not significantly alter the physical component but influenced the mental component (mean (SD) 43.38 (12.53) vs 39.58 (9.54), p = 0.026) of the SF36.

Conclusion:

Patients with SSc with DUs have reduced wrist and hand mobility, increased global and hand disabilities and decreased mental component of HRQoL.

Test of a novel transparent floating carrier by recombinant cho cells expressing sIL6 receptor protein

We describe a carrier with some unusual properties."Cellrafts" increase yields from adherent cells in conventional static T150 flasks, by floating multilayer strips of transparent film at the oxygen-rich surface of unstirred medium. This new technique allowed microscopic inspection of cell growth inside the carriers during bulk culture. Individual carriers could be picked out for subculture of selected colonies. A novel surface treatment by hypochlorite/uv allowed recycling of used carriers. Cellrafts' open-deck structure facilitated trypsinization with90% release as viable single cells from bulk carriers. Macro size (10mm by 1 mm) enables retention in flask by a coarse sieve insert in its neck, facilitating separation of product cells or media. Residual cells in carriers regenerated repeated harvests without need for reseeding. Carriers were tested with shear-sensitive CHO clones expressing soluble human IL6 receptor (sIL6R). Control was monolayer bulk culture on trays. Floating multilayer cultures remained viable longer than monolayers, had higher cellular activity of protein expression, and were less serum dependent (resembling cells on porous carriers). Purity and anti-sIL6R binding were identical to control product. Cellrafts were also tested in a small spinner vessel, but for litre batches this proved less convenient than in T-flasks. Though yields are low compared to well established porous carrier technology (spinner or packed bed) static transparent carriers might provide transitional scaleup from normal cytogenetics laboratory culture.

Disability and quality of life of patients with knee or hip osteoarthritis in the primary care setting and factors associated with general practitioners' indication for prosthetic replacement within 1 year

OBJECTIVE

To assess disability and health-related quality of life (HRQoL) of patients with knee or hip OA in primary care and to determine factors associated with GPs' opinion that their patients will need prosthetic replacement within 1 year after the consultation.

DESIGN

A cross-sectional national survey.

SETTING

Primary care in France.

PARTICIPANTS

1471 GPs and 4183 patients with hip or knee OA.

MEASURES

Pain on an 11-point numeric scale (0-10), disability on the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) (1-100) and Lequesne index (0-24), and quality of life on the Medical Outcomes Study 36-item Short Form (MOS SF-36; 0-100).

RESULTS

We analyzed records of 4121 patients (2540 knee, 1581 hip OA). Patients with knee or hip OA exhibited high and similar levels of pain (5.2+/-2.1 and 5.3+/-2.3) and disability (Lequesne score: 12.0+/-4.2 and 11.8+/-4.3; WOMAC score: 45.7+/-19.3 and 45.2+/-17.3) The decrease in HRQoL was similar for patients with either location of the disease. GPs more often considered that their patients with hip OA would need prosthetic replacement within 1 year (28.1%) than those with knee OA (15.8%). Most factors associated with GPs' opinion were identified for both locations of disease and were related to disability and pain levels.

CONCLUSIONS

In the primary care setting, patients with knee or hip OA have similar, high disability levels and substantially low HRQoL. Patients' disability seems to play a central role in GPs' opinion of the need for their patients with either type of OA to undergo prosthetic replacement within 1 year.

[What is the interest of early mobilization after total hip arthroplasty? Development of French guidelines for clinical practice]

AIMS

To develop clinical practice guidelines for early mobilisation after total hip replacement (THR).

METHOD

We used the French Society of Physical and Rehabilitation Medicine (Sofmer) methodology, which associates a systematic review of the literature, the collection of information regarding current clinical practice and external review by a multidisciplinary expert panel.

RESULTS

Recommending early mobilisation after THR is not established by a review of the literature. A survey of French clinical practice allows for recommending early mobilisation in the context of complex hip issues. Trials with good methodology must be developed to evaluate the interest of early functional mobilisation corresponding to when patients first stand and take their first steps after surgery. These trials should focus mainly on the final pain, functional status, and reduction of handicap.

[What is the interest of early knee mobilization after total knee arthoplasty?]

AIMS

To develop clinical practice guidelines for early mobilisation after total knee replacement (TKR).

METHOD

We used the French Society of Physical and Rehabilitation Medicine (SOFMER) methodology, which associates a systematic review of the literature, collection of information regarding current clinical practice and external review by a multidisciplinary expert panel.

RESULTS

A review of the literature and French clinical practice allow for recommending early mobilisation, at day 0, after TKR. This practice, with continuous passive motion, does not seem to increase the frequency of complications and seems to help with rapid recovery of the joint range of motion. Trials with good methodology must be developed to define the criteria for prescribing early mobilisation after TKR. These trials should focus mainly on joint range of motion but also on economical criteria (duration of hospitalisation, rehabilitation, physiotherapy, use of painkillers) and the satisfaction of the patient.

Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture. A randomized controlled trial

BACKGROUND

There have been few randomized controlled trials evaluating nonoperative treatment of proximal humeral fractures. To investigate shortening the period of dependence, we assessed the feasibility and efficacy of early mobilization of the shoulder (within three days after the fracture) in comparison with those of conventional three-week immobilization followed by physiotherapy.

METHODS

We randomly assigned seventy-four patients with an impacted proximal humeral fracture to receive early passive mobilization or conventional treatment. The primary outcome was the overall shoulder functional status (as measured with the Constant score) at three months. The secondary outcomes were the Constant score at six weeks and at six months, the change in pain (on a visual analog scale), and the active and passive range of motion.

RESULTS

At three months and at six weeks, the early mobilization group had a significantly better Constant score than did the conventional-treatment group (between-group difference, 9.9 [95% confidence interval, 1.9 to 17.8] [p = 0.02] and 10.1 [95% confidence interval, 2.0 to 18.1] [p = 0.02], respectively) and better active mobility in forward elevation (between-group difference, 12.0 [95% confidence interval, 1.7 to 22.4] [p = 0.02] and 28.1 [95% confidence interval, 7.1 to 49.1] [p = 0.01], respectively). At three months, the early mobilization group had significantly reduced pain compared with the conventional-treatment group (between-group difference, 15.7 [95% confidence interval, 0.52 to 30.8] [p = 0.04]). No complications in displacement or nonhealing were noted.

CONCLUSIONS

Early mobilization for impacted nonoperatively treated proximal humeral fractures is safe and is more effective for quickly restoring the physical capability and performance of the injured arm than is conventional immobilization followed by physiotherapy.