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Since 2009, the law has reinforced the role of the general practitioner in coordinating care in France. Various structures, such as coordination support systems and specific regional systems, have been set up to improve the efficiency of care pathways. Primary care teams and specialized care teams organize care around patients. Multi-professional health centers and health centers facilitate local collaboration between professionals., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Flammacerium is a topical treatment composed of silver sulfadiazine and cerium nitrate initially used in burns. The objective was to assess the effectiveness of silver sulfadiazine and cerium nitrate on ischemic necrosis wounds of the lower limb as an alternative to amputation for a period of 12 weeks. Patients were prospectively randomized to receive silver sulfadiazine and cerium nitrate or standard care. Patients included adults with an ischemic wound of the lower limb, with necrosis covering over at least 50%. Critical ischemia limb was confirmed by an ankle-brachial index <0.7 or >1.3 with radiological confirmation. Patient demographic data, amputations procedures, wound area, Visual Analogue Scale pain rating, clinical infection, and adverse events were recorded. Fifty patients, 34 males and 16 females, were recruited between January 2010 and April 2014, 25 in each group. The mean age was 75.14 years (±11.64). Nine amputations (36%) occurred in each group. Amputation-free survival was superior in the active treatment group versus the standard group (169 393 days, 95% confidence interval = 134.926-203.861, vs 169 393 days, 95% confidence interval = 134.926-203.861). It was not statistically significant (log-rank, P = .958). Wound area reduction between both groups was not statistically different ( P = .651). Less adverse events of the lower limb occurred in the active treatment group ( P = .001). Our study showed that silver sulfadiazine and cerium nitrate is not inferior to standardized care on ischemic necrotic wounds of the lower extremity. Further studies are still needed to confirm its effectiveness.

Earlier cytological investigations characterize the family Diprionidae with a modal chromosome number of seven. This study shows that Diprion pini and D. similis have 14 acrocentric chromosomes (n = 14 for haploid males and 2n = 28 for diploid females). In D. pini, rRNA genes are located on the satellite and the round short arm of the chromosome carrying this segment. We studied six populations with no evidence of chromosomal polymorphism at the species level. Our results disagree with those published previously and reopen the question of karyotype evolution. Chromosome morphology, ISH and C-banding results support the hypothesis of chromosome number doubling by centric fission and not by polyploidization, followed by the growth of short arms by means of pericentromeric DNA amplification.