Nouveautés dans l'ostéogenèse imparfaite: de la recherche à la prise en charge multidisciplinaire [News in osteogenesis imperfecta: from research to clinical management]

Osteogenesis imperfecta (OI) is a rare genetic disease. Today we are able to propose an adapted and efficient management to the patients with this rare disorder (and their families) thanks to a strong collaboration of clinicians and researchers. Recent knowledge regarding the genetics of OI permits an accurate diagnosis of the specific type of OI and its own molecular mechanism, a genetic counseling for family planning and prenatal diagnosis, and in addition more targeted therapeutic options. A specific support with re-education for patients with OI is necessary and efficient. To optimize patient care, a multidisciplinary consultation is proposed at the CHUV, moreover a web site is available for patients, families and therapists: www.infomaladiesrares.ch

Abcès pulmonaires: évolution dans la prise en charge [Lung abscess: changes in the management?].

L'abcès pulmonaire se présente de manière très pléomorphe selon les germes initialement impliqués. Des symptômes gé­ néraux et une évolution souvent subaiguë sont retrouvés en cas d'aspiration de la flore oropharyngée, chez des patients avec des troubles de l'état de conscience ou de la déglutition. L'infection est très souvent polymicrobienne, avec présence de germes anaérobes dans deux tiers des cas. La prise en charge consiste en un traitement antibiotique prolongé, jusqu'à résolution ou stabilité de l'image radiologique. En cas d'état toxique ou d'absence de drainage bronchique spontané, un drainage de l'abcès est à discuter. Les sanctions chirurgicales sont peu souvent nécessaires et envisagées indépendamment de la taille de l'abcès excepté lors de néoplasie sous-jacente. Lung abscess occurs in very pleomorphic according to germs initially involved. The mechanism commonly found is an aspiration of the oropharyngeal flora in patients with disorders of consciousness or swallowing. The infection is polymicrobial, with presence of anaerobic germs in 2/3 of the cases. The support consists of a prolonged antibiotic treatment, as well as anaerobic until resolution or stability of the radiological image. In case of prolonged toxic state, drainage of the abscess is to be discussed especially if there is no airways drainage. Surgical sanctions is rarely needed regardless of the size of the abscess, unless underlying carcinoma is present.

The effect of governance mechanism and structure on fees and performance of Mutual Funds in Canada

Taking advantage of the unique Canadian setting, this study empirically analyzes the impact of presence of the board of directors, as an internal governance mechanism, on fees and performance of mutual funds. Further, the impact of the board structure on fees and performance of corporate class funds is analyzed. We find that corporate class funds, which have a separate board of directors for the fund, charge higher fees; however, they also provide superior performance than trust funds. Furthermore, we find that for corporate class funds, smaller board, with higher percentage of independent directors, and with the fund CEO acting as the chairman of the board is likely to charge lower fees. Also, more independent boards are strongly associated with superior fee-adjusted performance.

Mirroring Enzymes: The Role of H-Bonding In HQuin-BAM Catalyzed Asymmetric Aza-Henry Reactions: A DFT Study into the Reactivity, Mechanism, and Origins of Selectivity

The exact mechanistic understanding of various organocatalytic systems in asymmetric reactions such as Henry and aza-Henry transformations is important for developing and designing new synthetic organocatalysts. The focus of this dissertation will be on the use of density functional theory (DFT) for studying the asymmetric aza-Henry reaction. The first part of the thesis is a detailed mechanistic investigation of a poorly understood chiral bis(amidine) (BAM) Brønsted acid catalyzed aza-Henry reaction between nitromethane and N-Boc phenylaldimine. The catalyst, in addition to acting as a Brønsted base, serves to simultaneously activate both the electrophile and the nucleophile through dual H-bonding during C-C bond formation and is thus essential for both reaction rate and selectivity. Analysis of the H-bonding interactions revealed that there was a strong preference for the formation of a homonuclear positive charge-assisted H-bond, which in turn governed the relative orientation of substrate binding. Attracted by this well-defined mechanistic investigation, the other important aspect of my PhD research addressed a detailed theoretical analysis accounting for the observed selectivity in diastereoselective versions of this reaction. A detailed inspection of the stereodetermining C-C bond forming transition states for monoalkylated nitronate addition to a range of electronically different aldimines, revealed that the origins of stereoselectivity were controlled by a delicate balance of different factors such as steric, orbital interactions, and the extent of distortion in the catalyst and substrates. The structural analysis of different substituted transition states established an interesting dependency on matching the shape and size of the catalyst (host molecule) and substrates (guest molecules) upon binding, both being key factors governing selectivity, in essence, offering an analogy to positive cooperative binding effect of catalytic enzymes and substrates in Nature. In addition, both intra-molecular (intra-host) and inter-molecular (host-guest, guest-guest) stabilizing interactions play a key role to the high π-facial selectivity. The application of dispersion-corrected functionals (i.e., ωB97X-D and B3LYP-D3) was essential for accurately modeling these stabilizing interactions, indicating the importance of dispersion effects in enantioselectivity. As a brief prelude to more extensive future studies, the influence of a triflate counterion on both reactivity and selectivity in this reaction was also addressed.

Intraoperative hemodynamic instability during and after separation from cardiopulmonary bypass : importance, mechanism and prevention

Chaque année, environ 1 à 1,25 million d’individus subiront une chirurgie cardiaque. [1] Environ 36 000 chirurgies cardiaques sont effectuées au Canada et 8000 procédures au Québec (http://www.ccs.ca). Le vieillissement de la population aura pour conséquence que la chirurgie cardiaque sera offerte à des patients de plus en plus à risque de complications, principalement en raison d’une co-morbidité plus importante, d’un risque de maladie coronarienne plus élevée, [2] d’une réserve physiologique réduite et par conséquent un risque plus élevé de mortalité à la suite d’une chirurgie cardiaque. L’une des complications significatives à la suite d’une chirurgie cardiaque est le sevrage difficile de la circulation extracorporelle. Ce dernier inclut la période au début du sevrage de la circulation extracorporelle et s’étend jusqu’au départ du patient de la salle d’opération. Lorsque le sevrage de la circulation extracorporelle est associé à une défaillance ventriculaire droite, la mortalité sera de 44 % à 86 %. [3-7] Par conséquent le diagnostic, l’identification des facteurs de risque, la compréhension du mécanisme, la prévention et le traitement du sevrage difficile de la circulation extracorporelle seront d’une importance majeure dans la sélection et la prise en charge des patients devant subir une chirurgie cardiaque. Les hypothèses de cette thèse sont les suivantes : 1) le sevrage difficile de la circulation extracorporelle est un facteur indépendant de mortalité et de morbidité, 2) le mécanisme du sevrage difficile de la circulation extracorporelle peut être approché d’une façon systématique, 3) la milrinone administrée par inhalation représente une alternative préventive et thérapeutique chez le patient à risque d’un sevrage difficile de la circulation extracorporelle après la chirurgie cardiaque.

Apport d’une évaluation biomécanique 3D du genou dans la prise en charge orthopédique de patients ayant une rupture du ligament croisé antérieur

Parmi les blessures sportives reliées au genou, 20 % impliquent le ligament croisé antérieur (LCA). Le LCA étant le principal stabilisateur du genou, une lésion à cette structure engendre une importante instabilité articulaire influençant considérablement la fonction du genou. L’évaluation clinique actuelle des patients ayant une atteinte au LCA présente malheureusement des limitations importantes à la fois dans l’investigation de l’impact de la blessure et dans le processus diagnostic. Une évaluation biomécanique tridimensionnelle (3D) du genou pourrait s’avérer une avenue innovante afin de pallier à ces limitations. L’objectif général de la thèse est de démontrer la valeur ajoutée du domaine biomécanique dans (1) l’investigation de l’impact de la blessure sur la fonction articulaire du genou et dans (2) l’aide au diagnostic. Pour répondre aux objectifs de recherche un groupe de 29 patients ayant une rupture du LCA (ACLD) et un groupe contrôle de 15 participants sains ont pris part à une évaluation biomécanique 3D du genou lors de tâches de marche sur tapis roulant. L’évaluation des patrons biomécaniques 3D du genou a permis de démontrer que les patients ACLD adoptent un mécanisme compensatoire que nous avons intitulé pivot-shift avoidance gait. Cette adaptation biomécanique a pour objectif d’éviter de positionner le genou dans une condition susceptible de provoquer une instabilité antérolatérale du genou lors de la marche. Par la suite, une méthode de classification a été développée afin d’associer de manière automatique et objective des patrons biomécaniques 3D du genou soit au groupe ACLD ou au groupe contrôle. Pour cela, des paramètres ont été extraits des patrons biomécaniques en utilisant une décomposition en ondelettes et ont ensuite été classifiés par la méthode du plus proche voisin. Notre méthode de classification a obtenu un excellent niveau précision, de sensibilité et de spécificité atteignant respectivement 88%, 90% et 87%. Cette méthode a donc le potentiel de servir d’outil d’aide à la décision clinique. La présente thèse a démontré l’apport considérable d’une évaluation biomécanique 3D du genou dans la prise en charge orthopédique de patients présentant une rupture du LCA; plus spécifiquement dans l’investigation de l’impact de la blessure et dans l’aide au diagnostic.

Vers une prise en charge améliorée des patients avec glycogénose : nouvelles approches diagnostique et thérapeutique

Les glycogénoses sont des maladies touchant la synthèse ou la dégradation du glycogène. Un diagnostic précoce et une diète optimale, incluant la prévention des hypoglycémies, sont d’une importante cruciale pour le devenir des patients. Les présents travaux visaient la confirmation génétique de glycogénose chez des patients inuits du Nunavik ainsi que l’évaluation de l’impact sur le sommeil et la qualité de vie d’une nouvelle thérapie nutritionnelle, GlycosadeTM, dans une cohorte de patients montréalaise. Par séquençage d’exome, nous avons identifié la mutation causale de glycogénose au Nunavik, permettant un diagnostic précoce et un dépistage des membres de la famille. Nous avons aussi introduit une fécule de maïs à action prolongée et évalué prospectivement le sommeil et la qualité de vie des patients avec glycogénose avant et après ce traitement. Nous avons mis en évidence des troubles de sommeil chez les patients et avons discuté du GlycosadeTM comme d’une option thérapeutique prometteuse.

Investigations on Photoconductivity and Electrical Switiching in Selected Chalcogenide Glasses

In this thesis, we present the results of our investigations on the photoconducting and electrical switching properties of selected chalcogenide glass systems. We have used XRD and X-ray photoelectron spectroscopy (XPS) analysis for confinuing the amorphous nature of these materials and for confirming their constituents respectively.Photoconductivity is the enhancement in electrical conductivity of materials brought about by the motion of charge carriers excited by absorbed radiation. The phenomenon involves absorption, photogeneration, recombination and transport processes and it gives good insight into the density of states in the energy gap of solids due to the presence of impurities and lattice defects. Photoconductivity measurements lead to the determination of such important parameters as quantum efficiency, photosensiti\'ity, spectral sensitivity and carrier lifetime. Extensive research work on photoconducting properties of amorphous semiconductors has resulted in the development of a variety of very sensitive photodetectors. Photoconductors are finding newer and newer uses eyery day. CdS, CdSe. Sb2S3, Se, ZnO etc, are typical photoconducting materials which are used in devices like vidicons, light amplifiers, xerography equipment etc.Electrical switching is another interesting and important property possessed by several Te based chalcogenides. Switching is the rapid and reversible transition between a highly resistive OFF state, driven by an external electric field and characterized by a threshold voltage, and a low resistivity ON state, Switching can be either threshold type or memory type. The phenomenon of switching could find applications in areas like infonnation storage, electrical power control etc. Investigations on electrical switching in chalcogenide glasses help in understanding the mechanism of switching which is necessary to select and modify materials for specific switching applications.Analysis of XRD pattern gives no further infonuation about amorphous materials than revealing their disordered structure whereas x-ray photoelectron spectroscopy,XPS) provides information about the different constituents present in the material. Also it gives binding energies (b.e.) of an element in different compounds and hence b.e. shift from the elemental form.Our investigations have been concentrated on the bulk glasses, Ge-In-Se, Ge-Bi-Se and As-Sb-Se for photoconductivity measurements and In-Te for electrical switching. The photoconducting properties of Ge-Sb-Se thin films prepared by sputtering technique have also been studied. The bulk glasses for the present investigations are prepared by the melt quenching technique and are annealed for half an hour at temperatures just below their respective glass transition temperatures. The dependence of photoconducting propenies on composition and temperature are investigated in each system. The electrical switching characteristics of In-Te system are also studied with different compositions and by varying the temperature.

Investigations on the mechanism of carrier transport in plasma polymerized pyrrole thin films

Plasma polymerization is found to be an excellent technique for the preparation of good quality, pinhole-free, polymer thin films from different monomer precursors. The present work describes the preparation and characterization of polypyrrole (PPy) thin films by ac plasma polymerization technique in their pristine and in situ iodine doped forms. The electrical conductivity studies of the aluminiumpolymeraluminium (AlpolymerAl) structures have been carried out and a space charge limited conduction (SCLC) mechanism is identified as the most probable mechanism of carrier transport in these polymer films. The electrical conductivity shows an enhanced value in the iodine doped sample. The reduction of optical band gap by iodine doping is correlated with the observed conductivity results.

Mechanism of ac conduction in nanostructured manganese zinc mixed ferrites

Mn1−xZnxFe2O4 nanoparticles (x = 0 to 1) were synthesized by the wet chemical co-precipitation technique. X-ray diffraction and transmission electron microscopy and high resolution transmission electron microscopy were effectively utilized to investigate the different structural parameters. The ac conductivity of nanosized Mn1−xZnxFe2O4 were investigated as a function of frequency, temperature and composition. The frequency dependence of ac conductivity is analysed by the power law σ(ω)ac = Bωn which is typical for charge transport by hopping or tunnelling processes. The temperature dependence of frequency exponent n was investigated to understand the conduction mechanism in different compositions. The conduction mechanisms are mainly based on polaron hopping conduction

Determination of charge carrier transport in radio frequency plasma polymerized aniline thin films

The carrier transport mechanism of polyaniline (PA) thin films prepared by radio frequency plasma polymerization is described in this paper. The mechanism of electrical conduction and carrier mobility of PA thin films for different temperatures were examined using the aluminium–PA–aluminium (Al–PA–Al) structure. It is found that the mechanism of carrier transport in these thin films is space charge limited conduction. J –V studies on an asymmetric electrode configuration using indium tin oxide (ITO) as the base electrode and Al as the upper electrode (ITO–PA–Al structure) show a diode-like behaviour with a considerable rectification ratio

Global iron-dependent gene regulation in Escherichia coli - A new mechanism for iron homeostasis

Organisms generally respond to iron deficiency by increasing their capacity to take up iron and by consuming intracellular iron stores. Escherichia coli, in which iron metabolism is particularly well understood, contains at least 7 iron-acquisition systems encoded by 35 iron-repressed genes. This Fe-dependent repression is mediated by a transcriptional repressor, Fur ( ferric uptake regulation), which also controls genes involved in other processes such as iron storage, the Tricarboxylic Acid Cycle, pathogenicity, and redox-stress resistance. Our macroarray-based global analysis of iron- and Fur-dependent gene expression in E. coli has revealed several novel Fur-repressed genes likely to specify at least three additional iron- transport pathways. Interestingly, a large group of energy metabolism genes was found to be iron and Fur induced. Many of these genes encode iron- rich respiratory complexes. This iron- and Fur-dependent regulation appears to represent a novel iron-homeostatic mechanism whereby the synthesis of many iron- containing proteins is repressed under iron- restricted conditions. This mechanism thus accounts for the low iron contents of fur mutants and explains how E. coli can modulate its iron requirements. Analysis of Fe-55-labeled E. coli proteins revealed a marked decrease in iron- protein composition for the fur mutant, and visible and EPR spectroscopy showed major reductions in cytochrome b and d levels, and in iron- sulfur cluster contents for the chelator-treated wild-type and/or fur mutant, correlating well with the array and quantitative RT-PCR data. In combination, the results provide compelling evidence for the regulation of intracellular iron consumption by the Fe2+-Fur complex.

Doped sodium aluminium hydrides as hydrogen storage materials: characterizations and mechanistic insights

The dehydriding and rehydriding of sodium aluminium hydride, NaAlR4, is kinetically enhanced and rendered reversible in the solid state upon doping with a small amount of catalyst species, such as titanium, zirconium or tin. The catalyst doped hydrides appear to be good candidates for development as hydrogen carriers for onboard proton exchange membrane (PEM) fuel cells because of their relatively low operation temperatures (120-150 degrees C) and high hydrogen carrying capacities (4-5 wt.%). However, the nature of the active catalyst species and the mechanism of catalytic action are not yet known. In particular, using combinations of Ti and Sri compounds as dopants, a cooperative catalyst effect of the metals Ti and Sn in enhancing the hydrogen uptake and release kinetics is hereby reported. In this paper, characterization techniques including XRD, XPS, TEM, EDS and SEM have been applied on this material. The results suggest that the solid state phase changes during the hydriding and dehydriding processes are assisted through the interaction of a surface catalyst. A mechanism is proposed to explain the catalytic effect of the Sn/Ti double dopants on this hydride.

An insight into the mechanism of protein separation by colloidal gas aphrons (CGA) generated from ionic surfactants

Colloidal gas aphrons (CGA), which are surfactant stabilised microbubbles, have been previously applied for the recovery of proteins from model mixtures and a few studies have demonstrated the potential of these dispersions for the selective recovery of proteins from complex mixtures. However there is a lack of understanding of the mechanism of separation and forces governing the selectivity of the separation. In this paper a mechanistic study is carried out to determine the main factors and forces influencing the selectivity of separation of whey proteins with CGA generated from ionic surfactants. Two different separation strategies were followed: (i) separation of lactoferrin and lactoperoxidase by anionic CGA generated from a solution of sodium bis-(2-ethyl hexyl) sulfosuccinate (AOT); (ii) separation of beta-lactoglobulin by cationic CGA generated from a solution of cetyltrimethylammonium bromide (CTAB). Separation results indicate that electrostatic interactions are the main forces determining the selectivity however these could not completely explain the selectivities obtained following both strategies. Protein-surfactant interactions were studied by measuring the zeta potential changes on individual proteins upon addition of surfactant and at varying pH. Interestingly strongest electrostatic interactions were measured at those pH and surfactant to protein mass ratios which were optimum for protein separation. Effect of surfactant on protein conformation was determined by measuring the change in fluorescence intensity upon addition of surfactant at varying pH. Differences in the fluorescence patterns were detected among proteins which were correlated to differences in their conformational features which could in turn explain their different separation behaviour. The effect of conformation on selectivity was further proven by experiments in which conformational changes were induced by pre-treatment of whey (heating) and by storage at 4 degrees C. Overall it can be concluded that separation of proteins by ionic CGA is driven mainly by electrostatic interactions however conformational features will finally determine the selectivity of the separation with competitive adsorption having also an effect. (c) 2006 Elsevier B.V. All rights reserved.

Ultrafast charge separation in a photoreactive rhenium-appended porphyrin assembly monitored by picosecond transient infrared spectroscopy

Rhenium(bipyridine)(tricarbonyl)(picoline) units have been linked covalently to tetraphenylmetalloporphyrins of magnesium and zinc via an amide bond between the bipyridine and one phenyl substituent of the porphyrin. The resulting complexes, abbreviated as [Re(CO)(3)(Pic)Bpy-MgTPP][OTf] and [Re(CO)(3)(Pic)Bpy-ZnTPP][OTf], exhibit no signs of electronic interaction between the Re(CO)(3)(bpy) units and the metalloporphyrin units in their ground states. However, emission spectroscopy reveals solvent-dependent quenching of porphyrin emission on irradiation into the long-wavelength absorption bands localized on the porphyrin. The characteristics of the excited states have been probed by picosecond time-resolved absorption (TRVIS) spectroscopy and time-resolved infrared (TRIR) spectroscopy in nitrile solvents. The presence of the charge-separated state involving electron transfer from MgTPP or ZnTPP to Re(bpy) is signaled in the TRIR spectra by a low-frequency shift in the nu(CO) bands of the Re(CO)(3) moiety similar to that observed by spectroelectrochemical reduction. Long-wavelength excitation of [Re(CO)(3)(Pic)Bpy-MTPP][OTf] results in characteristic TRVIS spectra of the S-1 state of the porphyrin that decay with a time constant of 17 ps (M = Mg) or 24 ps (M = Zn). The IR bands of the CS state appear on a time scale of less than 1 ps (Mg) or ca. 5 ps (Zn) and decay giving way to a vibrationally excited (i.e., hot) ground state via back electron transfer. The IR bands of the precursors recover with a time constant of 35 ps (Mg) or 55 ps (Zn). The short lifetimes of the charge-transfer states carry implications for the mechanism of reaction in the presence of triethylamine.