Recueil. Documents concernant l'histoire de France jusqu'en 1293 (chronique du ménestrel d'Alphonse, comte de Poitiers), prière, commentaire du psaume L, moralité.

Contient : 1 « Ci commence la generacion de tous les rois qui ont esté en France ». Liste enluminée des rois de France jusqu'à Louis IX ; 2 « Ci commence le prologues dou livre des croniques des roys qui ont esté en France ». Premiers mots : « A son tres chier seigneur... conte de Poitiers et de Thoulouse, cil qui est ses serjanz, ses clers et ses obeissanz, qui a ceste oevre translatée en françois... Sire, ce sachiés vous et trestuit cil qui cest escript verront... » ; 3 « Ci commence la generacion des rois de France. Il issirent du lignage Francio qui fu fiex Hector,... » ; 4 Prière ; 5 Commentaire du psaume L ; 6 Moralités ou discours sur les vertus et les vices

A novel technique using echocardiography to evaluate venous cannula performance perioperatively in CPB cardiac surgery.

OBJECTIVE: Transthoracic echocardiography (TTE) has been used clinically to disobstruct venous drainage cannula and to optimise placement of venous cannulae in the vena cava but it has never been used to evaluate performance capabilities. Also, little progress has been made in venous cannula design in order to optimise venous return to the heart lung machine. We designed a self-expandable Smartcanula (SC) and analysed its performance capability using echocardiography. METHODS: An epicardial echocardiography probe was placed over the SC or control cannula (CTRL) and a Doppler image was obtained. Mean (V(m)) and maximum (V(max)) velocities, flow and diameter were obtained. Also, pressure drop (DeltaP(CPB)) was obtained between the central venous pressure and inlet to venous reservoir. LDH and Free Hb were also compared in 30 patients. Comparison was made between the two groups using the student's t-test with statistical significance established when p<0.05. RESULTS: Age for the SC and CC groups were 61.6+/-17.6 years and 64.6+/-13.1 years, respectively. Weight was 70.3+/-11.6 kg and 72.8+/-14.4 kg, respectively. BSA was 1.80+/-0.2 m(2) and 1.82+/-0.2 m(2), respectively. CPB times were 114+/-53 min and 108+/-44 min, respectively. Cross-clamp time was 59+/-15 min and 76+/-29 min, respectively (p=NS). Free-Hb was 568+/-142 U/l versus 549+/-271 U/l post-CPB for the SC and CC, respectively (p=NS). LDH was 335+/-73 mg/l versus 354+/-116 mg/l for the SC and CC, respectively (p=NS). V(m) was 89+/-10 cm/s (SC) versus 63+/-3 cm/s (CC), V(max) was 139+/-23 cm/s (SC) versus 93+/-11 cm/s (CC) (both p<0.01). DeltaP(CPB) was 30+/-10 mmHg (SC) versus 43+/-13 mmHg (CC) (p<0.05). A Bland-Altman test showed good agreement between the two devices used concerning flow rate calculations between CPB and TTE (bias 300 ml+/-700 ml standard deviation). CONCLUSIONS: This novel Smartcanula design, due to its self-expanding principle, provides superior flow characteristics compared to classic two stage venous cannula used for adult CPB surgery. No detrimental effects were observed concerning blood damage. Echocardiography was effective in analysing venous cannula performance and velocity patterns.

Measured and predicted resting metabolic rate in obese and nonobese adolescents.

OBJECTIVES: The validity of equations for the calculation of resting metabolic rate (RMR) were studied and new predictive equations were developed. STUDY DESIGN: The RMR was measured in a sample of 371 10- to 16-year-old prepubertal and postpubertal children. The study group included 193 male (116 nonobese and 77 obese) and 178 female (119 nonobese and 59 obese) subjects; for each group the RMRs predicted from five equations recommended for this age group were compared. The RMR was assessed by indirect calorimetry with a ventilated hood system for 45 minutes after an overnight fast. Body composition was estimated from skin-fold measurements. RESULTS: The mean +/- SD RMR was found to be 5600 +/- 972 kJ/24 hr and 7223 +/- 1220 kJ/24 hr in nonobese and obese boys, and 5112 +/- 632 kJ/24 hr and 6665 +/- 1106 kJ/24 hr in nonobese and obese girls, respectively. All five equations applicable to 10- to 16-year-old children overestimated RMR by 7.5% to 18.1% (p < 0.001 for each equation). Stepwise regression analysis, with independent variables such as age, weight, height, and gender, allowed development of new predictive equations for the calculation of RMR in 10- to 16-year-old boys (RMR = 50.9 Weight (kg) + 25.3 Height (cm) -50.3 Age (yr) + 26.9; R2 = 0.884, p < 0.0001) and girls (RMR = 51.2 Weight (kg) + 24.5 Height (cm) - 207.5 Age (yr) + 1629.8; R2 = 0.824, p < 0.0001). These predictive equations were tested in a second, independent cohort of children (80 male and 61 female subject) and were found to give a reliable estimate of RMR in 10- to 16-year-old obese and nonobese adolescents. CONCLUSIONS: The currently used predictive equations overestimate RMR in 10- to 16-year-old children. The use of the newly developed equations is recommended.

The Drosophila cdc25 homolog twine is required for meiosis.

We have identified a second cdc25 homolog in Drosophila. In contrast to string (the first homolog identified in Drosophila) this second homolog, twine, does not function in the mitotic cell cycle, but is specialized for meiosis. Expression of twine was observed exclusively in male and female gonads. twine transcripts are present in germ cells during meiosis, and appear only late during gametogenesis, well after the end of the mitotic germ cell divisions. The sterile Drosophila mutant, mat(2)synHB5, which had previously been isolated and mapped to the same genomic region as twine (35F), was found to carry a missense mutation in the twine gene. This missense mutation in twine abolished its ability to complement a mutation in Schizosaccharomyces pombe cdc25. Phenotypic analysis of mat(2)synHB5 mutant flies revealed a complete block of meiosis in males and severe meiotic defects in females.

Effects of epigenetic regulatory elements on telomeric gene expression

Transgene expression in eukaryotic cells strongly depends on the locus of integration in the host genome and often results in limited transcription level because of unfavorable chromatin structure at the integration site. Epigenetic regulators are DNA sequences which are believed to act on the chromatin structure and may protect transgenes from this so-called position effect. Despite being extensively used to increase transgene expression, the mechanism of action of many of these elements remains largely unknown. Here we evaluated different epigenetic regulatory DNA elements for their ability to protect transgene transcription at telomeres, a defined chromatin environment associated to low or inconsistent expression caused by the Telomere Position Effect (TPE). For the assessment of the effects of epigenetic regulators at telomeres, a novel dual reporter system had to be designed. Telomeric integration of the newly-developed dual reporter system carrying different epigenetic regulators showed that MARs (Matrix Attachment Regions), a UCOE (Ubiquitous Chromatin-Opening Element) or the chicken cHS4 insulator have strong barrier activity which prevented TPE from spreading toward the centromere, resulting in stable and in some cases increased expression of a telomeric-distal reporter gene. In addition, MARs and STAR element 40 resulted in an increase of cells expressing the telomeric-proximal reporter gene, suggesting also an anti-silencing effect. Chromatin immunoprecipitation assays revealed that at telomeres MARs actively promote the deposition of euchromatic histone marks, especially acetylation of both histone H3 and H4, which might be involved in MARs' barrier and transcriptional activator activities. Differently, the chromatin in proximity of the UCOE element was depleted of several repressive chromatin marks, such as trimethylated lysine 9 and lysine 27 on histone H3 and trimethylated lysine 20 of histone H4, possibly favoring the preservation of an open chromatin structure at the integration site. We conclude that epigenetic regulatory elements that may be used to enhance and sustain transgene expression have all a specific epigenetic signature which might be at the basis of their mechanism of action, and that a combination of different classes of epigenetic regulators might be advantageous when high levels of protein expression are required. - L'expression des transgènes dans les cellules eucaryotes est fortement influencée par leur site d'intégration dans le génome. En effet, une structure chromatinienne défavorable au niveau du site d'intégration peut fortement limiter le degré d'expression d'un transgène. Il existe toutefois des séquences d'ADN qui, en agissant sur la structure de la chromatine, permettent de limiter cet effet de position et, par conséquent, de promouvoir l'expression soutenue d'un transgène. Ces éléments génomiques, connus comme régulateurs épigénétiques, sont largement utilisés dans plusieurs domaines où une expression élevée et soutenue est requise, malgré un mode de fonctionnement parfois méconnu. Dans cette étude, j'ai évalué la capacité de différents régulateurs épigénétiques à protéger la transcription de transgènes au niveau des télomères, régions chromatiniennes bien définies qui ont été associées à un fort effet de silençage, connu comme «effet de position télomérique». Pour cela, un nouveau système à deux gènes rapporteurs a été développé. Lorsque des MARs (Matrix Attachment Regions, séquences d'ADN pouvant s'associer à la matrice nucléaire), un UCOE (Ubiquitous Chromatin-Opening Element, élément pouvant ouvrir la chromatine) ou l'isolateur génétique cHS4 (dérivé du locus de la β-globine de poulet) sont placés entre les deux gènes rapporteurs, une forte activité barrière bloquant la propagation de la chromatine répressive télomérique est observée, résultant en un plus grand nombre de cellules exprimant le gène télomérique-distal. D'autre part, une augmentation du nombre de cellules exprimant le gène télomérique-proximal, observée en présence des éléments MAR et STAR 40 (Stabilizing Anti-Repressor element 40, un élément pouvant prévenir la répression génique), suggère aussi un faible effet anti-silençage pour ces éléments. Des expériences d'immunoprécipitation de la chromatine démontrent qu'au télomère, les MARs favorisent l'assemblage de marqueurs de la chromatine active, surtout l'acétylation des histones H3 et H4, qui pourraient être à la base de l'activité barrière et de celle d'activateur transcriptionel. Différemment, la chromatine à proximité de l'élément UCOE est particulièrement pauvre en marqueurs de la chromatine silencieuse, comme la trimethylation des lysines 9 et 27 de l'histone H3, ainsi que la trimethylation de la lysine 20 de l'histone H4. Cela suggère que UCOE pourrait préserver une structure chromatinienne ouverte au site d'intégration, favorisant l'expression des gènes à sa proximité. En conclusion, les régulateurs épigénétiques analysés lors de cette étude ont tous montré une signature épigénétique spécifique qui pourrait être à la base de leurs mécanismes de fonctionnement, suggérant aussi qu'une utilisation d'éléments épigénétiques de classe différente dans un même vecteur d'expression pourrait être avantageuse lorsque de hauts et soutenus niveaux d'expression sont nécessaires.

Perfil dos egressos de gerenciamento de enfermagem dos programas da área de enfermagem da região Sul

Estudo exploratório-descritivo, em base documental, de natureza quantitativa com o objetivo de descrever o perfil dos egressos dos Programas de Pós-Graduação da Área de Enfermagem da Região Sul titulados nas linhas de pesquisa de gerenciamento de enfermagem, de 2006 a 2009. A coleta dos dados ocorreu mediante consulta aos Cadernos de Indicadores da CAPES e busca dos Currículos Lattes/CNPq dos egressos. Os Programas de Pós-Graduação em Enfermagem da Região Sul titularam 409 alunos, sendo 129 (31,5%) nas linhas de pesquisa de gestão/gerenciamento em enfermagem: 116 (89,9%) Mestres e 13 (10,1%) Doutores, que atuam majoritariamente na docência. Dos Mestres titulados, dois (1,7%) já são Doutores e 39 (33,6%) estão cursando o Doutorado. A produção intelectual após titulação soma um total 501 artigos científicos publicados, com uma média de 1,1 e 1,8 artigo/ano entre mestres e doutores, respectivamente. Apontam-se indicativos para a formação de mestres e doutores diferenciados para atuar na gestão/gerência em saúde e enfermagem.

Risco cardiovascular em profissionais de saúde de serviços de atendimento pré-hospitalar

Avaliar os fatores de risco cardiovascular, com ênfase na hipertensão, e estratificá-los de acordo com o Escore de Risco de Framingham (ERF). Estudo com 154 profissionais que atuavam em aten-dimento pré-hospitalar na cidade de São Paulo e rodovia Br-116. Foi considerado significante o valor de p<0,05. A prevalência de hipertensão foi de 33%, sendo que 20,1% eram tabagistas, 47% ingeriam bebidas alcoólicas, 64% eram sedentários, 66% apresentaram obesidade/sobrepeso e 70% cintura abdominal alterada, glicemia>110mg/dL- 11%, colesterol total>200mg/dL- 36%, LDL-c>130mg/dL- 33%, HDL-c<60mg/dL- 89%, triglicérides>150mg/dL- 30% e proteína C reativa>0,5mg/dL- 16%. O ERF foi médio em 10,3% e alto em 1,3%. Na análise de regressão logística verificou-se que a hipertensão associou-se com as variáveis: HDL-c (odds ratio: 0,257) e ERF (odds ratio: 23,159). Houve forte associação entre ERF e hipertensão. Os dados chamam a atenção, por se tratar principalmente de profissionais da área da saúde relativamente jovens.

Age over 40 years increases the failure rate of non-operative management of blunt splenic injuries

Objective: Non-operative management (NOM) of blunt splenic injuries (BSI) is nowadays considered the standard treatment. The study aimed to determine the criteria applied for NOM and to identify risk factors for its failure. Methods: Review of all adult patients with BSI treated at the University Hospital Bern, Switzerland, between 2000 and 2008. Results: There were 206 patients (146 men, 70·9%) with a mean age of 38·2 ± 19·1 years and an Injury Severity Score of 30·9 ± 11·6. The American Association for the Surgery of Trauma classification of the splenic injury was: grade I, n=43 (20·9%); grade II, n=52 (25·2%); grade III, n=60 (29·1%); grade IV, n=42 (20·4%) and grade V, n=9 (4·4%). 47 patients (22·8%) required immediate surgery. Five or more units of red cell transfusions (P<0·001), Glasgow Coma Scale<11 (P=0·009) and age ≥55 years (P=0·038) were associated with primary operative management (OM). 159 patients (77·2%) qualified for NOM, which was successful in 89·9% (143/159). The overall splenic salvage rate was 69·4% (143/206). Multivariate analysis found age ≥40 years to be the only factor independently related to the failure of NOM (P=0·001). Conclusion: Advanced age is associated with an increased failure rate ofNOM in patients with BSI.

New genetic loci implicated in fasting glucose homeostasis and their impact on type 2 diabetes risk.

Levels of circulating glucose are tightly regulated. To identify new loci influencing glycemic traits, we performed meta-analyses of 21 genome-wide association studies informative for fasting glucose, fasting insulin and indices of beta-cell function (HOMA-B) and insulin resistance (HOMA-IR) in up to 46,186 nondiabetic participants. Follow-up of 25 loci in up to 76,558 additional subjects identified 16 loci associated with fasting glucose and HOMA-B and two loci associated with fasting insulin and HOMA-IR. These include nine loci newly associated with fasting glucose (in or near ADCY5, MADD, ADRA2A, CRY2, FADS1, GLIS3, SLC2A2, PROX1 and C2CD4B) and one influencing fasting insulin and HOMA-IR (near IGF1). We also demonstrated association of ADCY5, PROX1, GCK, GCKR and DGKB-TMEM195 with type 2 diabetes. Within these loci, likely biological candidate genes influence signal transduction, cell proliferation, development, glucose-sensing and circadian regulation. Our results demonstrate that genetic studies of glycemic traits can identify type 2 diabetes risk loci, as well as loci containing gene variants that are associated with a modest elevation in glucose levels but are not associated with overt diabetes.

Chylothorax in children: guidelines for diagnosis and management.

STUDY OBJECTIVE: To establish guidelines for the diagnosis and management of chylothorax in children. DESIGN: Retrospective study. PATIENTS: Fifty-one patients with a diagnosis of chylothorax. Twelve patients were excluded because of incomplete data or incorrect diagnosis. The following parameters were analyzed: triglyceride level, total cell number, and lymphocyte percentage; amount of pleural effusion on day of diagnosis, day 5, and day 14; and total time of pleural effusion. Prospectively, the same parameters were analyzed in a control group of 10 patients with pleural drainage. INTERVENTION: Patients with chylothorax were treated primarily with fat-free oral nutrition; if chyle did not stop, total parenteral nutrition with total enteric rest was started. If conservative therapy was not successful, pleurodesis was performed. RESULTS: In children with chylothorax triglyceride, triglyceride content ranged from 0.56 to 26.6 mmol/L; all values except one were > 1.1 mmol/L. In 36 of 39 patients (92%), the cell count was > 1,000 cells/microL. In 33 of 39 patients (85%), lymphocytes were > 90%. In patients without chylothorax triglyceride, triglyceride levels ranged from 0.1 to 0.71 mmol/L (median, 0.38 mmol/L) and cell count was from 20 to 1400 cells/microL (median, 322 cells/microL), with a maximum of 60% lymphocytes. With fat-free nutrition, chyle disappeared in 29 of 39 patients. Five patients died, and five required pleurodesis. CONCLUSIONS: Pleural effusion in children is chyle when it contains > 1.1 mmol/L triglycerides (with oral fat intake) and has a total cell count > or 1,000 cells/microL, with a lymphocyte fraction > 80%. Chylous effusions usually last long; however, after 6 weeks, the majority of the effusions (29 of 39 patients) had ceased. Late surgical interventions reduce the number of thoracotomies substantially, but can lead to very long hospitalization times. Early surgical interventions (after < 3 weeks) lead to a high number of thoracotomies, but certainly reduce hospitalization time.