The analgesic efficacy of ultrasound-guided transversus abdominis plane block (TAP Block) in adult patients : a meta-analysis

Introduction : Le bloc transverse de l'abdomen (bloc TAP, Transversus Abdominis Plane) échoguidé consiste en l'injection d'anesthésique local dans la paroi abdominale entre les muscles oblique interne et transverse de l'abdomen sous contrôle échographique. Ceci permet de bloquer l'innervation sensitive de la paroi antérolatérale de l'abdomen afin de soulager la douleur après des interventions chirurgicales. Auparavant, cette procédure reposait sur une technique dite « à l'aveugle » qui utilisait des repères anatomiques de surface. Depuis quelques années, cette technique est effectuée sous guidage échographique ; ainsi, il est possible de visualiser les structures anatomiques, l'aiguille et l'anesthésique local permettant ainsi une injection précise de l'anesthésique local à l'endroit désiré. Les précédentes méta- analyses sur le bloc TAP n'ont inclus qu'un nombre limité d'articles et n'ont pas examiné l'effet analgésique spécifique de la technique échoguidée. L'objectif de cette méta-analyse est donc de définir l'efficacité analgésique propre du bloc TAP échoguidé après des interventions abdominales chez une population adulte. Méthode : Cette méta-analyse a été effectuée selon les recommandations PRISMA. Une recherche a été effectuée dans les bases de donnée MEDLINE, Cochrane Central Register of Controlled Clinical Trials, Excerpta Medica database (EMBASE) et Cumulative Index to Nursing and Allied Health Literature (CINAHL). Le critère de jugement principal est la consommation intraveineuse de morphine cumulée à 6 h postopératoires, analysée selon le type de chirurgie (laparotomie, laparoscopie, césarienne), la technique anesthésique (anesthésie générale, anesthésie spinale avec/ou sans morphine intrathécale), le moment de l'injection (début ou fin de l'intervention), et la présence ou non d'une analgésie multimodale. Les critères de jugement secondaires sont, entre autres, les scores de douleur au repos et à l'effort à 6 h postopératoires (échelle analogique de 0 à 100), la présence ou non de nausées et vomissements postopératoires, la présence ou non de prurit, et le taux de complications de la technique. Résultats : Trente et une études randomisées contrôlées, incluant un total de 1611 adultes ont été incluses. Indépendamment du type de chirurgie, le bloc TAP échoguidé réduit la consommation de morphine à 6 h postopératoires (différence moyenne : 6 mg ; 95%IC : -7, -4 mg ; I =94% ; p<0.00001), sauf si les patients sont au bénéfice d'une anesthésie spinale avec morphine intrathécale. Le degré de réduction de consommation de morphine n'est pas influencé par le moment de l'injection (I2=0% ; p=0.72) ou la présence d'une analgésie multimodale (I2=73% ; p=0.05). Les scores de douleurs au repos et à l'effort à 6h postopératoire sont également réduits (différence moyenne au repos : -10 ; 95%IC : -15, -5 ; I =92% ; p=0.0002; différence moyenne en mouvement : -9 ; 95%IC : -14, -5 ; I2=58% ; p<0. 00001). Aucune différence n'a été retrouvée au niveau des nausées et vomissements postopératoires et du prurit. Deux complications mineures ont été identifiées (1 hématome, 1 réaction anaphylactoïde sur 1028 patients). Conclusions : Le bloc TAP échoguidé procure une analgésie postopératoire mineure et ne présente aucun bénéfice chez les patients ayant reçu de la morphine intrathécale. L'effet analgésique mineure est indépendant du moment de l'injection ou de la présence ou non d'une analgésie multimodale.

Correlation between in vitro cytotoxicity and in vivo lethal activity in mice of epsilon toxin mutants from Clostridium perfringens

Epsilon toxin (Etx) from Clostridium perfringens is a pore-forming protein with a lethal effect on livestock, producing severe enterotoxemia characterized by general edema and neurological alterations. Site-specific mutations of the toxin are valuable tools to study the cellular and molecular mechanism of the toxin activity. In particular, mutants with paired cysteine substitutions that affect the membrane insertion domain behaved as dominant-negative inhibitors of toxin activity in MDCK cells. We produced similar mutants, together with a well-known non-toxic mutant (Etx-H106P), as green fluorescent protein (GFP) fusion proteins to perform in vivo studies in an acutely intoxicated mouse model. The mutant (GFP-Etx-I51C/A114C) had a lethal effect with generalized edema, and accumulated in the brain parenchyma due to its ability to cross the blood-brain barrier (BBB). In the renal system, this mutant had a cytotoxic effect on distal tubule epithelial cells. The other mutants studied (GFP-Etx-V56C/F118C and GFP-Etx-H106P) did not have a lethal effect or cross the BBB, and failed to induce a cytotoxic effect on renal epithelial cells. These data suggest a direct correlation between the lethal effect of the toxin, with its cytotoxic effect on the kidney distal tubule cells, and the ability to cross the BBB.

Phase behavior and rheological analysis of reverse liquid crystals and W/I2, W/H2 gel emulsions using an amphiphilic block copolymer.

This article reports the phase behavior determi- nation of a system forming reverse liquid crystals and the formation of novel disperse systems in the two-phase region. The studied system is formed by water, cyclohexane, and Pluronic L-121, an amphiphilic block copolymer considered of special interest due to its aggregation and structural proper- ties. This system forms reverse cubic (I2) and reverse hexagonal (H2) phases at high polymer concentrations. These reverse phases are of particular interest since in the two-phase region, stable high internal phase reverse emulsions can be formed. The characterization of the I2 and H2 phases and of the derived gel emulsions was performed with small-angle X-ray scattering (SAXS) and rheometry, and the influence of temperature and water content was studied. TheH2 phase experimented a thermal transition to an I2 phase when temperature was increased, which presented an Fd3m structure. All samples showed a strong shear thinning behavior from low shear rates. The elasticmodulus (G0) in the I2 phase was around 1 order of magnitude higher than in theH2 phase. G0 was predominantly higher than the viscousmodulus (G00). In the gel emulsions,G0 was nearly frequency-independent, indicating their gel type nature. Contrarily to water-in-oil (W/O) normal emulsions, in W/I2 and W/H2 gel emulsions, G0, the complex viscosity (|η*|), and the yield stress (τ0) decreased with increasing water content, since the highly viscous microstructure of the con- tinuous phase was responsible for the high viscosity and elastic behavior of the emulsions, instead of the volumefraction of dispersed phase and droplet size. A rheological analysis, in which the cooperative flow theory, the soft glass rheology model, and the slip plane model were analyzed and compared, was performed to obtain one single model that could describe the non-Maxwellian behavior of both reverse phases and highly concentrated emulsions and to characterize their microstructure with the rheological properties.

Micro- and nanostructuring of poly(ethylene-2,6-naphthalate) surfaces, for biomedical applications, using polymer replication techniques

Here we investigate the formation of superficial micro- and nanostructures in poly(ethylene-2,6-naphthalate) (PEN), with a view to their use in biomedical device applications, and compare its performance with a polymer commonly used for the fabrication of these devices, poly(methyl methacrylate) (PMMA). The PEN is found to replicate both micro- and nanostructures in its surface, albeit requiring more forceful replication conditions than PMMA, producing a slight increase in surface hydrophilicity. This ability to form micro/nanostructures, allied to biocompatibility and good optical transparency, suggests that PEN could be a useful material for production of, or for incorporation into, transparent devices for biomedical applications. Such devices will be able to be autoclaved, due to the polymer's high temperature stability, and will be useful for applications where forceful experimental conditions are required, due to a superior chemical resistance over PMMA.

Síntese e caracterização de dispersões aquosas de poliuretanos à base de copolímeros em bloco de poli(glicol etilênico) e poli(glicol propilênico)

Non-polluting polyurethane aqueous dispersions, with 40% of solids content, were synthesized based on block copolymers of poly(ethylene glycol) and poly(propylene glycol) (PEG-b-PPG), with PEG hydrophilic segments content of 7 and 25%, poly(propylene glycol) (PPG), dimethylolpropionic acid (DMPA), isophorone diisocyanate (IPDI), and hydrazine. Different formulations were synthesized by varying the equivalent-grams ratios between isocyanate and hydroxyl groups (NCO/OH) and PPG and (PEG-b-PPG). The presence of high amounts of PEG in the formulations provoked the formation of gels. Average particle size and viscosity of the dispersions were determined. Mechanical properties and water absorption resistance of cast films were evaluated.

Effect of the structure of commercial poly(ethylene oxide-b-propylene oxide) demulsifier bases on the demulsification of water-in-crude oil emulsions: elucidation of the demulsification mechanism

Water-in-crude oil emulsions are formed during petroleum production and asphaltenes play an important role in their stabilization. Demulsifiers are added to destabilize such emulsions,however the demulsification mechanism is not completely known. In this paper, the performances of commercial poly(ethylene oxide-b-propylene oxide) demulsifiers were studied using synthetic water-in-oil emulsions and model-systems (asphaltenes in organic solvent). No change in the asphaltene aggregate size induced by the demulsifier was observed. The demulsification performance decreased as the asphaltene aggregate size increased, so it can be suggested that the demulsification mechanism is correlated to the voids between the aggregates adsorbed on the water droplets surface.

NOVEL SUPERABSORBENT HYDROGEL COMPOSITE BASED ON POLY(ACRYLAMIDE-CO-ACRYLATE)/NONTRONITE: CHARACTERIZATION AND SWELLING PERFORMANCE

A novel superabsorbent hydrogel (SH) composite based on a poly(acrylamide-co-acrylate) matrix filled with nontronite (NONT), a Fe(III)-rich member of the smectite group of clay minerals, is described in this manuscript. A variety of techniques, including FTIR, XRD, TGA, and SEM/EDX, were utilized to characterize this original composite. Experimental data confirmed the SH composite formation and suggested NONT was completely dispersed in the polymeric matrix. Additionally, NONT improved the water uptake capacity of the final material, which exhibited fast absorption, low sensitivity to the presence of salt, high water retention and a pH sensitive properties. These preliminary data showed that the original SH composite prepared here possesses highly attractive properties for applications in areas such as the agriculture field, particularly as a soil conditioner.

Kinetics of epsilon antitoxin antibodies in different strategies for active immunization of lambs against enterotoxaemia

Enterotoxaemia, a common disease that affects domestic small ruminants, is mainly caused by the epsilon toxin of Clostridium perfringens type D. The present study tested four distinct immunization protocols to evaluate humoral response in lambs, a progeny of non-vaccinated sheep during gestation. Twenty-four lambs were randomly allocated into four groups according to age (7, 15, 30 and 45 days), receiving the first dose of epsilon toxoid commercial vaccine against clostridiosis with booster after 30 days post vaccination. Indirect ELISA was performed after the first vaccine dose and booster to evaluate the immune response of the lambs. Results showed that for the four protocols tested all lambs presented serum title considered protective (≥0.2UI/ml epsilon antitoxin antibodies) and also showed that the anticipation of primovaccination of lambs against enterotoxaemia conferred serum title considered protective allowing the optimization of mass vaccination of lambs.

Thalidomide and pentoxifylline block the renal effects of supernatants of macrophages activated with Crotalus durissus cascavella venom

Because thalidomide and pentoxifylline inhibit the synthesis and release of tumor necrosis factor-alpha (TNF-alpha), we determined the effect of these drugs on the renal damage induced by supernatants of macrophages activated with Crotalus durissus cascavella venom in order to identify the role of TNF-alpha in the process. Rat peritoneal macrophages were collected with RPMI medium and stimulated in vitro with C.d. cascavella venom (10 µg/ml) in the absence and presence of thalidomide (15 µM) or pentoxifylline (500 µM) for 1 h and washed and kept in culture for 2 h. Supernatant (1 ml) was tested on an isolated perfused rat kidney (N = 6 for each group). The first 30 min of each experiment were used as control. The supernatant was added to the perfusion system. All experiments lasted 120 min. The toxic effect of the preparation of venom-stimulated macrophages on renal parameters was determined. At 120 min, thalidomide (Thalid) and pentoxifylline (Ptx) inhibited (P < 0.05) the increase in perfusion pressure caused by the venom (control = 114.0 ± 1.3; venom = 137.1 ± 1.5; Thalid = 121.0 ± 2.5; Ptx = 121.4 ± 4.0 mmHg), renal vascular resistance (control = 4.5 ± 0.2; venom = 7.3 ± 0.6; Thalid = 4.5 ± 0.9; Ptx = 4.8 ± 0.6 mmHg/ml g-1 min-1), urinary flow (control = 0.23 ± 0.001; venom = 0.44 ± 0.01; Thalid = 0.22 ± 0.007; Ptx = 0.21 ± 0.009 ml g-1 min-1), glomerular filtration rate (control = 0.72 ± 0.06; venom = 1.91 ± 0.11; Thalid = 0.75 ± 0.04; Ptx = 0.77 ± 0.05 ml g-1 min-1) and the decrease in percent tubular sodium transport (control = 77.0 ± 0.9; venom = 73.9 ± 0.66; Thalid = 76.6 ± 1.1; Ptx = 81.8 ± 2.0%), percent tubular chloride transport (control = 77.1 ± 1.2; venom = 71.4 ± 1.1; Thalid = 77.6 ± 1.7; Ptx = 76.8 ± 1.2%), and percent tubular potassium transport (control = 72.7 ± 1.1; venom = 63.0 ± 1.1; Thalid = 72.6 ± 1.0; Ptx = 74.8 ± 1.0%), 30 min before and during the stimulation of macrophages with C.d. cascavella venom. These data suggest the participation of TNF-alpha in the renal effects induced by supernatant of macrophages activated with C.d. cascavella venom.

DNA methylation regulates expression of VEGF-C, and S-adenosylmethionine is effective for VEGF-C methylation and for inhibiting cancer growth

DNA hypomethylation may activate oncogene transcription, thus promoting carcinogenesis and tumor development. S-adenosylmethionine (SAM) is a methyl donor in numerous methylation reactions and acts as an inhibitor of intracellular demethylase activity, which results in hypermethylation of DNA. The main objectives of this study were to determine whether DNA hypomethylation correlated with vascular endothelial growth factor-C (VEGF-C) expression, and the effect of SAM on VEGF-C methylation and gastric cancer growth inhibition. VEGF-C expression was assayed by Western blotting and RT-qPCR in gastric cancer cells, and by immunohistochemistry in tumor xenografts. VEGF-C methylation was assayed by bisulfite DNA sequencing. The effect of SAM on cell apoptosis was assayed by flow cytometry analyses and its effect on cancer growth was assessed in nude mice. The VEGF-C promoters of MGC-803, BGC-823, and SGC-7901 gastric cancer cells, which normally express VEGF-C, were nearly unmethylated. After SAM treatment, the VEGF-C promoters in these cells were highly methylated and VEGF-C expression was downregulated. SAM also significantly inhibited tumor growthin vitro and in vivo. DNA methylation regulates expression of VEGF-C. SAM can effectively induce VEGF-C methylation, reduce the expression of VEGF-C, and inhibit tumor growth. SAM has potential as a drug therapy to silence oncogenes and block the progression of gastric cancer.

Phase transitions in biodegradable films based on blends of gelatin and poly (vinyl alcohol)

The aim of this work was to study the effect of the hydrolysis degree (HD) and the concentration (C PVA) of two types of poly (vinyl alcohol) (PVA) and the effect of the type and the concentration of plasticizers on the phase properties of biodegradable films based on blends of gelatin and PVA, using a response-surface methodology. The films were made by casting and the studied properties were their glass (Tg) and melting (Tm) transition temperatures, which were determined by diferential scanning calorimetry (DSC). For the data obtained on the first scan, the fitting of the linear model was statistically significant and predictive only for the second melting temperature. In this case, the most important effect on the second Tm of the first scan was due to the HD of the PVA. In relation to the second scan, the linear model could be fit to Tg data with only two statistically significant parameters. Both the PVA and plasticizer concentrations had an important effect on Tg. Concerning the second Tm of the second scan, the linear model was fit to data with two statistically significant parameters, namely the HD and the plasticizer concentration. But, the most important effect was provoked by the HD of the PVA.

Photograph - Col. Frank C. McCordick

A photograph of Col. Frank C. McCordick in military uniform standing in a field. The reverse of the photograph reads "Copies of this photograph can be obtained from The Rembrandt Studio, 207 Cuthbertson Block Fort William, Ont, When ordering please quote 402."

Synthèse de 4-désoxy hexopyrannoses, C-disaccharides et C-glycosides biologiquement actifs

Les glucides constituent la classe de molécules organiques la plus abondante et ceux-ci jouent des rôles cruciaux dans divers processus biologiques. De part leur importance médicinale, la préparation des désoxy-sucres, des C-glycosides et des C-disaccharides est devenue un sujet de pointe en synthèse organique. De façon générale, cette thèse décrit une nouvelle synthèse de novo des 4-désoxy hexopyrannoses en plus de la préparation de C-glycosides biologiquement actifs. De plus, une attention particulière a été portée à la préparation de novo de 4-désoxy-C-disaccharides. Dans un premier temps, le catalyseur de Cr(III) de Jacobsen et un complexe binaphtol/titane ont été utilisés pour réaliser des hétéro-Diels-Alder énantiosélectives. Les dihydropyrannes ainsi générés ont été transformés en 4-désoxy hexopyrannoses présents dans la nature. De cette façon, un dérivé de l’acide ézoaminuroïque, un précurseur de la désosamine et de la néosidomycine, a été préparé suivant cette approche de novo. De plus, à titre comparatif, la néosidomycine a également été fabriquée selon une approche chiron, à partir du méthyl alpha-D-mannopyrannoside. Finalement, une évaluation biologique préliminaire de la néosidomycine a été effectuée sur une la concanavaline-A (Chapitre 2). Dans un deuxième temps, une allylation stéréosélective sur un aldéhyde lié via des liens C-C à une unité mannoside a permis de générer un alcool homoallylique. Cette dernière fonctionnalité a été transformée en 4-désoxy hexopyrannose de configuration D ou L. De cette façon, la préparation de pseudo 4-désoxy-C-disaccharides, de 4-désoxy-C-disaccharides et de pseudo 4-désoxy aza-C-disaccharides a facilement été réalisée. Les rapports diastéréoisomériques de la réaction d’allylation ont été déterminés en plus de la configuration absolue des nouveaux centres stéréogéniques formés. La transformation des alcools homoallyliques en pyrannes poly hydroxylés ou en lactames poly hydroxylés a été réalisée, en plus de la déprotection de certains membres de cette famille pour une évaluation biologique préliminaire sur la concanavaline-A (Chapitre 3). Finalement, la synthèse de C-glycosides biologiquement actifs a été réalisée selon deux volets: i) préparation de 3-C-mannopyrannosyl coumarines et ii) synthèse de C-galactosides, inhibiteurs de la lectine PA-IL. Pour ce faire, le couplage de Heck a été utilisé à partir d’un ester alpha,bêta-insaturé, attaché à une unité glycosidique via des liens C-C, pour générer un dérivé glycosyl cinnamate de méthyle. Cependant, lorsque le 2-iodophénol est utilisé comme partenaire de Heck, la coumarine correspondante a été isolée. Les dérivés C-galactopyrannosyl cinnamates de méthyle représentent de bons inhibiteurs monovalents de la PA-IL avec un Kd aussi bas que 37 micro M (Chapitre 4).

La cristallisation de quatre poly(1,3-dioxolannes) de masses molaires différentes

Le poly(1,3-dioxolanne) (PDOL) est un polymère semi-cristallin présentant à l’état solide quatre morphologies différentes (Phases I, IIa, IIb et III). Les transformations d'une phase à l'autre ont été suivies par microscopie optique polarisée (MOP) et microscopie à force atomique (AFM) en fonction de la température de cristallisation et de la masse molaire. La Phase I présente une morphologie sphérolitique tandis que la Phase IIa peut croître à partir de la Phase I ou spontanément. De façon inattendue, la Phase IIa, devient très biréfringente et cette nouvelle morphologie est appelée Phase IIb. Quand la transformation IIa-IIb est terminée, une nouvelle phase, la Phase III, croît à partir de la Phase IIb. La Phase III n'a jamais été observée sans la présence de Phase IIb; en outre, la Phase IIb remplace toujours la Phase IIa. Ce phénomène est appelé germination croisée. La mesure de la température de fusion des phases par MOP a permis d’établir leur stabilité relative: IIb > III >IIa. La vitesse de croissance (G) des sphérolites a été mesurée sur une plage de températures de 10,0 à 24,0 °C et montre une grande dépendance avec la masse molaire. Ces mesures ont révélé l’existence d’une masse molaire critique, autour de 5000 g.mol-1, en-dessous de laquelle nous avons observé GIIa > GIII et au-dessus de laquelle la relation est inversée avec GIII > GIIa. Finalement, nous avons exploré l’influence de l’ajout d’un deuxième polymère amorphe sur l’évolution des phases optiques dans des mélanges PDOL-PMMA, PDOL-PVC et PDOL-PVAc. Nous avons observé les mêmes transitions de phases que pour le PDOL pur et un certain degré de compatibilité dans le cas du PDOL-PMMA et du PDOL-PVC.

Linear block copolymers of L–lactide and 2–dimethylaminoethyl methacrylate : synthesis and properties

Part of the research described in this thesis is conducted in collaboration with Centre d' étude et de Recherche sur les Macromolécules (CERM), Université de Liège, Sart-Tilman, Belgium