dimanche 22 décembre 2013

Tramadol, comme le Di-antalvic: danger

Un médicament abusé régulièrement, très invalidant pendant la période d'éveil, de sevrage difficile...
Bien sur on ne sait pas combien on en consomme quelle est la croissance ni les indications...

http://www.medpagetoday.com/PainManagement/PainManagement/43554?

http://www.francesoir.fr/actualite/sante/tramadol-un-antidouleur-aux-effets-secondaires-redoutables-177625.html

Charles Dubost, Jean Mathey, Alain Carpentier

La saga de la chirurgie thoracique & cardiovasculaire française continue!
Carmat

Les respectez vous? Pourquoi?


  • Premier commandement : Je suis le Seigneur ton Dieu Qui t'ai fait sortir du pays d'Égypte.
  • Deuxième commandement : Tu n'auras pas d'autre Dieu que moi.
  • Troisième commandement : Tu ne prononceras pas le nom de Dieu en vain.
  • Quatrième commandement : Souviens-toi du jour du sabbat.
  • Cinquième commandement : Honore ton père et ta mère.
  • Sixième commandement : Tu ne tueras point.
  • Septième commandement : Tu ne commettras pas d’adultère.
  • Huitième commandement : Tu ne voleras pas.
  • Neuvième commandement : Tu ne feras pas de faux témoignage.
  • Dixième commandement : Tu ne convoiteras ni la femme, ni la maison, ni rien de ce qui appartient à ton prochain.
« Un homme s'approcha de Jésus et lui demanda : « Maître, que dois-je faire de bon pour avoir la vie éternelle ? » Jésus lui dit : « Pourquoi m'interroges-tu au sujet de ce qui est bon ? Un seul est bon. Si tu veux entrer dans la vie, obéis aux commandements. » » 
(Matthieu 19.16–17)

mercredi 18 décembre 2013

Free lunch from Moscow's largesse? Wait a minute

Another opposition leader, Arseniy Yatsenyuk, also demanded to know the conditions for Moscow's largesse, saying: "I know only one place where there's free cheese - in a mouse trap."

http://www.voanews.com/content/russia-promises-ukraine-cheaper-gas-15-billion-loan/1811836.html


Baroin au PS?

"François Baroin, lui, pense que «compte tenu du niveau de la dette de l'État et de nos engagements européens, il est irréaliste de promettre une baisse massive des impôts». Pour l'ancien ministre du Budget, le séminaire intervient au mauvais moment: à quelques semaines des municipales, de telles propositions «ne parviendront qu'à nationaliser la campagne et donc à renforcer le Front national», prédit le maire de Troyes, qui sera absent mercredi."
Le Figaro

Attention ceci concerne ceux qui travaillent!

Implacable vérité

Ainsi diminuer le temps de travail a augmenté le chômage! Bravo à Mme Aubry et à ses successeurs qui ont persisté dans l'erreur.

France/US: is there any difference in the way Big Brother is spying you?

1/ recently french law makers voted a bill which allows spying on the internet... This was done without any objection.
2/ E Snowden demonstrated that NSA spied american people and perhaps illegally.
So Big Brother is on the rise with Dems in US and Socialists in France.
One can imagine if those events occurred during the Bush era or under the presidency of Sarkozy what would have been the turmoil.
But nevertheless there is a difference.
In US judges are not all lax or bowed to the government and some of them try to undertake to submit Big Brother to the law.


"The almost-Orwellian technology that enables the government to store and analyze the phone metadata of every telephone user in the United States is unlike anything that could have been conceived in 1979," the judge wrote, adding that such bulk data collection and analysis "almost certainly does violate a reasonable expectation of privacy." 



Did NSA overpass its mission?

http://online.wsj.com/news/articles/SB10001424052702304403804579262483158344924?mod=djem10point 


http://www.nytimes.com/2013/12/17/opinion/a-powerful-rebuke-of-mass-surveillance.html?nl=todaysheadlines&emc=edit_th_20131217

http://www.nytimes.com/2013/12/17/us/politics/federal-judge-rules-against-nsa-phone-data-program.html?nl=todaysheadlines&emc=edit_th_20131217&_r=0

Après avoir planifié la pénurie l'énarchie va planifier le marché de l'intérim

Vous allez entendre parler de ce sujet mais la presse subventionnée n'a fait aucun travail d'investigation, elle répète le même message hollandais, les intérimaires médicaux sont des salauds qui gagnent plus de 4000 euro par mois. Et si on regardait qui est responsable de ces prix de marché?


1/ Les énarques et leurs dociles à responsabilité limitée (DARL) que sont les politiques planifient depuis 40 ans la pénurie de médecins. En conséquence le nombre de postes dans les hôpitaux mais aussi ailleurs est supérieur au nombre de médecins formés. Jusque là une logique assez simple à comprendre. Les énarques persistent dans cette planification criminelle parce qu'ils ont la croyance que cela va diminuer les dépenses de soins et non de santé comme c'est souvent écrit. Là au bout de 40 ans c'est de l'acharnement thérapeutique.
2/ Les hôpitaux même les plus petits, les plus dangereux, les plus inutiles sont infermables grace aux politiques et aux énarques qui en ont besoin pour leur élection. l'énarque ou le politique du coin mais aussi les gens informés ne vont jamais se faire soigner dans des hôpitaux où il n'y a que des outils médicaux du début du siècle. Stétho radio labo mais pas de scanner IRM réanimation et opérateur  de toute spécialité 24/24h... Jusque là aussi leur comportement est rationnel.
3/ Ces hôpitaux qui devraient fermer engagent des médecins intérimaires (mais aussi des infirmières des aides soignantes des secrétaires en contrat CDD renouvelés 10, 15 fois...) pour continuer à fonctionner au moins en façade. Pour ce faire ils ne peuvent les asservir avec un statut et un contrta de PH payé au lance pierre et sont donc obligés de les rémunérer au prix du marché. Ce prix c'est le prix d'un PH dans les disciplines difficiles et on constate un écart gigantesque avec la rémunération des PH statutaires. C'est aussi tout à fait normal.
4/  Les PH statutaires sont rémunérés à la socialiste c'est à dire sans tenir compte de leur activité de la pénibilité du risque du fait de se lever la nuit... Donc les plus actifs ceux qui prennent des risques sont très sous payés pour rémunérer ceux qui en font moins. Ce type de rémunération socialiste n'est pas le fait des socialistes au pouvoir actuellement mais plutôt le résultat de l'absence de courage politique de tous ceux qui les ont précédé. Ces PH statutaires constatent avec amertume que leur employeur les méprise économiquement et dépense beaucoup d'argent pour des intérimaires avec qui ils travaillent au quotidien. Jusque là rien d'anormal et les PH statutaires ne peuvent que battre leur coulpe car leurs syndicats sont à peu près tous tenus par de bons socialistes qui veulent la "même rémunération pour tous", une litanie chez les socialistes.
5/ Et revoilà nos énarques et politiques français qui en bon constructivistes planificateurs veulent bien sur réguler l'insupportable marché de l'intérim. Quoi des médecins et des administrateurs d'hôpitaux s'enetendent par contrat sur une rémunération? Scandale intolérable. Tout doit être régulé planifié par l'avenue de Ségur pour que ça ... capote.D'où l'idée de la loi contraignante car c'est vrai la France est une société de défiance grace à eux.
6/ Faites confiance aux hommes et aux femmes de ce pays. Autonomie totale des universités et donc suppression du numerus clausus, autonomie des hôpitaux non pas à la mode Bachelot mais en les transformant en EPIC et vous verrez vous n'aurez plus besoin de réguler le marché de l'intérim médical nipour les médecins ni pour les autres professions de soins.

http://www.lefigaro.fr/conjoncture/2013/12/17/20002-20131217ARTFIG00237-un-depute-veut-plafonner-les-salaires-de-l-interim-a-l-hopital.php

http://www.leparisien.fr/societe/l-interim-a-l-hopital-une-plaie-a-500-meur-17-12-2013-3416747.php

lundi 16 décembre 2013

Cancer prevention is easy!

  • Smoking is the single biggest cause of cancer in the world

    Experts agree that smoking is the single biggest cause of cancer in the world. 1-3 Smoking causes over a quarter of cancer deaths in developed countries and nearly one in five cancer cases. 4, 5
    Around half of current smokers will be killed by their habit if they continue to smoke. And 25-40% of smokers will die in middle age 6, 7
    Smoking causes even more deaths from other respiratory diseases and heart conditions than from cancer. 2 If current trends continue, scientists estimate that tobacco will kill about one billion people in the twenty-first century. 2
  • Lung cancer is the most preventable form of cancer death in our society. (Source: Cancer Facts & Figures 2013)
  • Besides lung cancer, tobacco use also increases the risk for cancers of the mouth, lips, nasal cavity (nose) and sinuses, larynx (voice box), pharynx (throat), esophagus (swallowing tube), stomach, pancreas, kidney, bladder, uterus, cervix, colon/rectum, ovary (mucinous), and acute myeloid leukemia. (Source: Cancer Facts & Figures 2013)
  • Breast cancer: in the new study, published online February 28, 2013 in the Journal of the National Cancer Institute, researchers analyzed data from 73,388 women in the American Cancer Society’s Cancer Prevention Study II (CPS-II) Nutrition Cohort. A cohort is a study that follows a large group of people over time. During more than 13 years of follow-up, researchers counted 3,721 cases of invasive breast cancer. The rate of new cases was 24% higher in smokers than in nonsmokers and 13% higher in former smokers than in nonsmokers.

Le 8 mai 1794 place de la Concorde

La guillotine abattait l'intelligence. La révolution totalitaire amputait la France d'un de ses plus grands savants.
Antoine Lavoisier était guillotiné sans motif sous les ordres d'un procureur fanatique.

"Ayant demandé un sursis pour pouvoir achever une expérience, il s’entend répondre par Jean-Baptiste Coffinhal, le président du tribunal révolutionnaire : « La République n'a pas besoin de savants ni de chimistes ; le cours de la justice ne peut être suspendu7. » (cette célérité s'explique par le fait que les biens des condamnés sont confisqués au profit de l'État or les fermiers généraux possèdent les plus grosses fortunes de France). Il est inhumé au cimetière des Errancis.
Le lendemain de l'exécution de Lavoisier, le grand savant Louis Lagrange regretta le geste du tribunal révolutionnaire en prononçant ces paroles : « Il ne leur a fallu qu'un moment pour faire tomber cette tête et cent années, peut-être, ne suffiront pas pour en reproduire une semblable8,9 »." 


http://fr.wikipedia.org/wiki/Antoine_Lavoisier

Nietzsche and human believes

«Les convictions sont des ennemis de la vérité plus dangereux que les mensonges.»
Nietzsche, Humain, trop humain

US: Fed state is amazing!

"Investigators remain in the dark partly because the facility where the former National Security Agency contractor Edward J. Snowden worked was not equipped with software to monitor employees."

Actually? And would you give us the amount of tax payer money which costs the NSA?


http://www.nytimes.com/2013/12/15/us/officials-say-us-may-never-know-extent-of-snowdens-leaks.html?

Système de soins: construire l'open data depuis la base!

Il y a un gisement de création de valeur et donc d'entreprises en rassemblant les statistiques les plus détaillées du sytème depuis la base...
En réalité un échantillon bien fait est un reflet très fiable de la population générale.
Et par ailleurs l'open data par en haut ne sera effectif que quand la sécu n'aura plus le monopole, c'est plus loin qu'on ne le pense et trop loin pour les patients qui subissent les avatars de ce système aveugle...
Ces données sont plus importantes pour piloter le système que pour soigner un patient d'où le scepticisme vis à vis du dossier médical électronique.
Infections nosocomiales, effets secondaires des traitements, médiocre performance des soins ne sont pas des indicateurs de rémunérations des services et de ce fait les tarifs immuables et indiscriminats favorisent les performaces médiocres ou même les comportements de tricheurs.





http://www.medpagetoday.com/PatientCenteredMedicalHome/PatientCenteredMedicalHome/43403?

http://www.medpagetoday.com/PatientCenteredMedicalHome/PatientCenteredMedicalHome/41591

La puissance la plus décisive de notre vie moderne : le capitalisme.


"L'avidité d'un gain sans limite n'implique en rien le capitalisme, bien moins encore son « esprit ». Le capitalisme s'identifierait plutôt avec la domination [Bändigung], à tout le moins avec la modération rationnelle de cette impulsion irrationnelle."
Max Weber


Je ne sais pas pourquoi on attache autant d'importance en France à un philosophe comme Comte Sponville, tout est dit dans le livre magistral de Weber!


http://classiques.uqac.ca/classiques/Weber/ethique_protestante/Ethique_protestante.pdf

Oden data et système de soins: pourquoi l'establishment n'en veux pas

Un autre exemple de l'opacité française, le taux de réadmission dans les hôpitaux (privés et publics). Inconnu et bien sur cette opacité favorise les tricheurs et les médiocres.

http://www.medscape.com/viewarticle/817531?nlid=42203_1382&src=wnl_edit_medn_surg&uac=7267HX&spon=14

La liberté de savoir: trisomie 21

Il est parfaitement légitime de connaître les anomalies génétiques de son enfant. Ce qui est parfaitement insupportable c'est la prétention de certains médecins d'en avoir l'exclusivité ou d'empêcher les parents de connaître ces informations.
Bien évidemment toute barrière à la connaissance est un rideau de fumée, les parents iront ailleurs faire la prise de sang ou la feront faire à leurs frais...

http://sante.lefigaro.fr/actualite/2013/12/13/21687-depistage-sanguin-trisomie-21-reticences

vendredi 13 décembre 2013

The failure of computerized prescriptions or the failure of interfaces in medical software?


5-193
Category: Quality Assurance / Medication Safety
Title: Effect of electronic prescribing on medication reconciliation
Primary Author: Jill Covyeou, Ferris State University College of Pharmacy, 1458 W. Center
Rd.- Suite 1, Essexville, MI, 48732; Email: jill.covyeou@mclaren.org
Purpose: Lack of medication documentation is linked to 46% of all medication errors, up to
20% of adverse drug events, and up to 27% of all prescribing errors in hospitalized patients
(demonstrating that inaccuracies in the outpatient medication list can be responsible for
complications in the hospitalized patient). In this study we look to see if implementation of an
electronic prescribing system increases medication reconciliation accuracy in a family practice
residency clinic.
Methods: This chart review was conducted in two phases. In the first phase medication
reconciliation accuracy was measured using handwritten paper forms. In the phase 2 study,
medication reconciliation accuracy was assessed after implementation of an electronic
prescribing system. Audits consisted of a chart review to determine the accuracy of the
medication lists. Any new medications prescribed had to appear on the list and any medications
discontinued had to have been removed from the medication list. The provider must have also
documented that the medication list was reviewed with the patient on the day of the visit and that
they provided the patient with an updated medication list before they left. A medication list was
considered to be accurate if it contained all the required information, and inaccurate if it was
missing any information. Of the lists that were considered inaccurate, it was also determined
where they were deficient (one list could be found deficient in more than one area).
Results: Over the course of phase 1, 17 audits were completed and a total of 650 charts were
reviewed. The percentage of medication lists with inaccuracies over phase 1 was 51% (49% were
considered accurate). In phase 1, the most common reason for a medication list being inaccurate
was that the provider did not document that the medication list was reviewed on the day of the
visit (42%). Over the course of phase 2, 15 chart audits were completed and a total of 923 charts
were reviewed. The percentage of medication lists with inaccuracies during phase 2 was 37%
(63% were considered accurate). Once again, the most common reason for a medication list
being inaccurate was an undocumented date (63%), which may indicate that provider motivation
to perform the medication reconciliation is a major factor in medication list accuracy. When
comparing phase 1 to phase 2, the percentage of medication lists that were accurate significantly
increased from 49% to 63% (p<0 .001="" p="">Conclusion: While electronic prescribing did significantly increase the accuracy of medication
lists, the 14% increase is far from a complete solution. A multifaceted approach (technology,
provider education, and patient education) will most likely be required to further increase the
accuracy of medication lists and prevent medication errors in both the inpatient and outpatient
setting.


5-189
Category: Quality Assurance / Medication Safety
Title: Assessment of the impact of computerized prescriber order entry (CPOE) system on the
reported occurrence of medication errors in a community hospital
Primary Author: Ramadas Balasubramanian, Carolinas Medical Center-Pineville, Department
of Pharmacy, 10628 Park Road, Charlotte, NC, 28210; Email:
ramadas.balasubramanian@carolinashealthcare.org
Additional Author(s):
David Bilotta
Joseph Bero
Ashlee Andreason
Carolyn Kerr
Purpose: To assess the impact of the CPOE system on the reported occurrence of medication
errors in a community hospital.
Methods: The implementation of CPOE and other electronic services is thought to reduce
medication errors and increase patient safety in hospitals. In late 2011, CPOE CANOPY system
was implemented hospital-wide in our community hospital. Several standard shared baselines
were developed. In early 2012, the number of beds in our hospital increased from 110 to 240,
and the hospital pharmacy operation became 24-hours. The purpose of this study was to assess
the impact of CPOE system on the occurrence of reported medication errors. A medication error
was defined as an error which occurred in the process of ordering or delivering a medication.
The medication errors were categorized as omission, wrong time, unauthorized drug, improper
dose, wrong dosage form, wrong drug preparation, wrong administration technique, deteriorated
drug, monitoring. This retrospective study consisted of comparing the reports of different
medication error types during January-October 2008 (Pre-CPOE) and January- October 2012
(Post-CPOE). The medication errors were reported per 1000 doses of medications dispensed.
The percentages were calculated using Microsoft Excel. Chi-square tests were used to evaluate
the association of CPOE with increase or decrease in medication errors with a P-value of less
than 0.05 considered significant. This study was exempt from Institutional Review Board
approval.
Results: The total number of doses of medications dispensed from the pharmacy increased from
665,172 in 2008 (Pre-CPOE) to 1,044,014 in 2012 (57 percent) (Post-CPOE). The total number
of reported medication errors also increased from 161 in 2008 to 319 in 2012 (98.1 percent).
These increases in medication errors could certainly be attributed to the total volume and
increased hospital beds and 24-7 pharmacy operation. However, the medication errors per 1000
doses dispensed as a volume-adjusted quality measure also increased from 0.24 in 2008 to 0.31
in 2012. The top four types of medication errors reported for 2008 versus 2012 as a percentage
were as follows, respectively--omission error--13.7, 20.7, wrong time error--11.2, 16.9,
unauthorized drug--38.5, 31.3, and improper dose--20.5, 14.4. Medication administration factors,
Page 623
followed by order processing and dispensing factors accounted for the top three reasons
contributing to these reported medication errors in both 2008 and 2012. Overall, the total number
of medication errors reported increased statistically significantly in 2012 versus 2008 compared
with the number of doses dispensed (P less than 0.05). However, the four top medication errors
shown above did not have statistical significancePre- versus Post-CPOE implementation.
Conclusion: Overall, the reported occurrence of medication errors increased Post-CPOE
implementation. This is attributable to the overall growth of the hospital. However, fewer
medication errors such as unauthorized drug, and improper dose were reported since the CPOE
implementation which could be due to the elimination of hand-written and illegible orders. But,
the omission and wrong time errors had increased. The inflexibility of the commercially
available CPOE software could also have played a role in the results of the study. In summary,
CPOE system has not helped with the reduction of medication errors in our hospital, despite the
expectation to the contrary.

http://www.ashp.org/DocLibrary/Midyear13/Professional-Poster-Abstracts.pdf

http://www.medpagetoday.com/MeetingCoverage/ASHP/43400?

State legal violence

In France the government regulates very tightly the number of places in med schools all over the territory. This is the Numerus Clausus which became law 40 years ago.
This tightening was supposed to slow healthcare expenses.
It was a flaw but despite this successive governments backed the process and in the same time to alleviate shortage they authorize medical practice in public and private institutions to a growing number of immigrant doctors who has not succeeded the french examination.

http://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000027222429&dateTexte&categorieLien=id

mercredi 11 décembre 2013

Comment l'état freine la croissance en voulant interdire le travail détaché...

Cette loi n'aura qu'une seule conséquence mesurable: fermer des chantiers et diminuer la création de valeur. Les socialistes croient que leurs lois vont contraindre les entreprises à embaucher en France. Ils se trompent les entreprises n'embaucheront pas en France car le nouveau devis de stravaux ne sera pas accepté car trop cher. Les investisseurs annuleront leur projet et iront le faire ailleurs.
Nous sommes en récession et cela durera aussi longtemps que l'état empêchera la déflation des salaires  et des prix. Dans les pays à faible dépense publique la reprise économique pourra intervenir car le cout du travail est moins impacté par les charges sociales, mais dans les pays à très haute taxation du travail comme la France cette reprise est impossible. Ou bien il faut créer beaucoup, beaucoup de monnaie. N'est ce pas Mr Draghi?

http://www.lefigaro.fr/conjoncture/2013/12/11/20002-20131211ARTFIG00296-travail-detache-la-france-prepare-deja-une-loi.php?

mardi 10 décembre 2013

Overtraining, above physiological level exercise and lifespan

http://well.blogs.nytimes.com/2013/12/05/ask-well-endurance-exercise-and-life-span/?

I don't endorse the famous "No sport" of WC although I am in keeping with a lot of his assertions but on the other hand we must be careful with extreme endurance.

Recession flirt of France's economy


FRANCEIndustrial production was down 0.3% on the month in October against an expected rise of 0.2% and following a decline of 0.5% on the month in September.
The numbers aren’t quite as bad as they seem at first. A 3.4% drop in energy production amid an unusually warm autumn knocked French industrial output in October. Other components were mostly up. But overall, the French economy continues to flirt with recession, with few indications that it’s developing upward momentum. (AM)

According to the new Keynesians the solution is an european QE. 



What is the answer about this real time experiment?


http://macromarketmusings.blogspot.fr/2013/06/what-great-natural-experiment-reveals.html

lundi 9 décembre 2013

Top much healthcare means less Health

http://m.theatlantic.com/health/archive/2013/12/you-re-getting-too-much-healthcare/281896/

We know that there is no free lunch but we have to learn that an unnecessary lunch is deleterious!

dimanche 8 décembre 2013

A could be useful quizz

http://projects.wsj.com/quiz/?uid=bonds1202&type=flat&mod=djem10point

Perhaps it's not too late to:

Rate Your Marriage

By giving each of the following 40 statements a rating from A (least agree) to E (most agree), a couple can get a sense of the strengths and weaknesses in their marriage in eight categories. The quiz, while unscientific, can be a useful tool for gaining insight or sparking discussion.

vendredi 6 décembre 2013

Thank you Dr Nissen

i don't agree with all your assertions but some of them are so obvious...
I love the contra Flynn effect of watching TV!

http://www.medpagetoday.com/PracticeManagement/PracticeManagement/43257?

Paying bone marrow donors?

http://www.medpagetoday.com/HematologyOncology/Hematology/43270?

My answer is yes. This is a renewable organ and payment could improve the status of patients who die because of organ shortage.

Les paroles qui guérissent les haines sont plus importantes que les accents belliqueux de ceux qui croient à la guerre sainte


Nelson Mandela (1918-2013)

"As I walked out the door toward the gate that would lead to my freedom, I knew if I didn't leave my bitterness and hatred behind, I'd still be in prison."

Sex differences in the brain: what we observed in the daily life and brain wiring


Sex differences in the structural connectome of the human brain

  1. Ragini Vermaa,2
  1. Edited by Charles Gross, Princeton University, Princeton, NJ, and approved November 1, 2013 (received for review September 9, 2013)

Significance

Sex differences are of high scientific and societal interest because of their prominence in behavior of humans and nonhuman species. This work is highly significant because it studies a very large population of 949 youths (8–22 y, 428 males and 521 females) using the diffusion-based structural connectome of the brain, identifying novel sex differences. The results establish that male brains are optimized for intrahemispheric and female brains for interhemispheric communication. The developmental trajectories of males and females separate at a young age, demonstrating wide differences during adolescence and adulthood. The observations suggest that male brains are structured to facilitate connectivity between perception and coordinated action, whereas female brains are designed to facilitate communication between analytical and intuitive processing modes.

Abstract

Sex differences in human behavior show adaptive complementarity: Males have better motor and spatial abilities, whereas females have superior memory and social cognition skills. Studies also show sex differences in human brains but do not explain this complementarity. In this work, we modeled the structural connectome using diffusion tensor imaging in a sample of 949 youths (aged 8–22 y, 428 males and 521 females) and discovered unique sex differences in brain connectivity during the course of development. Connection-wise statistical analysis, as well as analysis of regional and global network measures, presented a comprehensive description of network characteristics. In all supratentorial regions, males had greater within-hemispheric connectivity, as well as enhanced modularity and transitivity, whereas between-hemispheric connectivity and cross-module participation predominated in females. However, this effect was reversed in the cerebellar connections. Analysis of these changes developmentally demonstrated differences in trajectory between males and females mainly in adolescence and in adulthood. Overall, the results suggest that male brains are structured to facilitate connectivity between perception and coordinated action, whereas female brains are designed to facilitate communication between analytical and intuitive processing modes.

Footnotes

  • Author contributions: M.I., T.D.S., H.H., R.E.G., R.C.G., and R.V. designed research; A.S., M.A.E., K.R., and H.H. performed research; A.S. and D.P. analyzed data; and M.I., R.E.G., R.C.G., and R.V. wrote the paper.
  • The authors declare no conflict of interest.
  • This article is a PNAS Direct Submission.
  • Data deposition: The data reported in this paper have been deposited in the dbGaP database,www.ncbi.nlm.nih.gov/gap (accession no. phs000607.v1.p1).

Hair regeneration


Microenvironmental reprogramming by three-dimensional culture enables dermal papilla cells to induce de novo human hair-follicle growth

  1. Angela M. Christianoa,b,1
  1. Edited by Zena Werb, University of California, San Francisco, CA, and approved September 5, 2013 (received for review May 28, 2013)

Significance

Growth of de novo hair follicles in adult skin occurs by a process known as hair neogenesis. One way of initiating neogenesis is to place dermal papillae isolated from the hair follicle in contact with an overlying epidermis where they reprogram the epidermis to adopt a follicular fate. This approach, however, has not been successful using cultured human dermal papilla cells in human skin because the cells lose their ability to induce hair growth after expansion in vitro. In this paper, we demonstrate that by manipulating cell culture conditions to establish three-dimensional papilla spheroids, we restore dermal papilla inductivity. We also use several systems biology approaches to gain a comprehensive understanding of the molecular mechanisms that underlie this regenerative process.

Abstract

De novo organ regeneration has been observed in several lower organisms, as well as rodents; however, demonstrating these regenerative properties in human cells and tissues has been challenging. In the hair follicle, rodent hair follicle-derived dermal cells can interact with local epithelia and induce de novo hair follicles in a variety of hairless recipient skin sites. However, multiple attempts to recapitulate this process in humans using human dermal papilla cells in human skin have failed, suggesting that human dermal papilla cells lose key inductive properties upon culture. Here, we performed global gene expression analysis of human dermal papilla cells in culture and discovered very rapid and profound molecular signature changes linking their transition from a 3D to a 2D environment with early loss of their hair-inducing capacity. We demonstrate that the intact dermal papilla transcriptional signature can be partially restored by growth of papilla cells in 3D spheroid cultures. This signature change translates to a partial restoration of inductive capability, and we show that human dermal papilla cells, when grown as spheroids, are capable of inducing de novo hair follicles in human skin.

Footnotes

  • This Feature Article is part of a series identified by the Editorial Board as reporting findings of exceptional significance.
  • Author contributions: C.A.H., C.A.B.J., and A.M.C. designed research; C.A.H., J.C.C., and J.E.C. performed research; C.A.H., C.A.B.J., and A.M.C. analyzed data; and C.A.H., C.A.B.J., and A.M.C. wrote the paper.
  • The authors declare no conflict of interest.
  • This article is a PNAS Direct Submission.
  • Data deposition: The data reported in this paper have been deposited in the Gene Expression Omnibus (GEO) database, www.ncbi.nlm.nih.gov/geo (accession no. GSE44765).
  • See Commentary on page 19658.
  • This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1309970110/-/DCSupplemental.