Novel system for distant assessment of cataract surgical quality in rural China

BACKGROUND: This study aims to assess the quality of various steps of manual small incision cataract surgery and predictors of quality, using video recordings.
DESIGN: This paper applies a retrospective study.
PARTICIPANTS: Fifty-two trainees participated in a hands-on small incision cataract surgery training programme at rural Chinese hospitals.
METHODS: Trainees provided one video each recorded by a tripod-mounted digital recorder after completing a one-week theoretical course and hands-on training monitored by expert trainers. Videos were graded by two different experts, using a 4-point scale developed by the International Council of Ophthalmology for each of 12 surgical steps and six global factors. Grades ranged from 2 (worst) to 5 (best), with a score of 0 if the step was performed by trainers.
MAIN OUTCOME MEASURES: Mean score for the performance of each cataract surgical step rated by trainers.
RESULTS: Videos and data were available for 49/52 trainees (94.2%, median age 38 years, 16.3% women and 77.5% completing > 50 training cases). The majority (53.1%, 26/49) had performed ≤ 50 cataract surgeries prior to training. Kappa was 0.57∼0.98 for the steps (mean 0.85). Poorest-rated steps were draping the surgical field (mean ± standard deviation = 3.27 ± 0.78), hydro-dissection (3.88 ± 1.22) and wound closure (3.92 ± 1.03), and top-rated steps were insertion of viscoelastic (4.96 ± 0.20) and anterior chamber entry (4.69 ± 0.74). In linear regression models, higher total score was associated with younger age (P = 0.015) and having performed >50 independent manual small incision cases (P = 0.039).
CONCLUSIONS: More training should be given to preoperative draping, which is poorly performed and crucial in preventing infection. Surgical experience improves ratings.© 2015 Royal Australian and New Zealand College of Ophthalmologists.

Phacoemulsification combined with posterior capsulorhexis and anterior vitrectomy in the management of malignant glaucoma in phakic eyes

Purpose: To describe sequential phacoemulsification-intraocular lens (IOL) implantation-posterior capsulorhexis-anterior vitrectomy in the management of phakic malignant glaucoma. Methods: Twenty consecutive patients (25 eyes) with phakic malignant glaucoma were enrolled at the Zhongshan Ophthalmic Center, Sun Yat-sen University. All patients underwent phacoemulsification, IOL implantation and posterior capsulorhexis together with anterior vitrectomy via a clear corneal paracentesis. Visual acuity, intraocular pressure (IOP), anterior chamber depth (ACD), surgical complications and medications required after the surgery were recorded. Results: After surgery, the mean LogMAR visual acuity and ACD increased significantly (visual acuity from -1.56 ± 1.17 to -0.54 ± 0.81, p < 0.001; ACD from 0.367 ± 0.397 mm to 2.390 ± 0.575 mm, p < 0.001), and mean IOP decreased significantly (from 39.6 ± 10.6 mm Hg to 14.5 ± 4.1 mmHg, p < 0.001). No serious perioperative complications occurred, and only five eyes required topical glaucoma medications after surgery. Conclusion: Combined phacoemulsification-IOL implantation-posterior capsulorhexis-anterior vitrectomy surgery is a safe and effective method for treating patients with phakic malignant glaucoma. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

A proposed simple method for measurement in the anterior chamber angle: biometric gonioscopy

OBJECTIVE:

To design a system of gonioscopy that will allow greater interobserver reliability and more clearly defined screening cutoffs for angle closure than current systems while being simple to teach and technologically appropriate for use in rural Asia, where the prevalence of angle-closure glaucoma is highest.

DESIGN:

Clinic-based validation and interobserver reliability trial.

PARTICIPANTS:

Study 1: 21 patients 18 years of age and older recruited from a university-based specialty glaucoma clinic; study 2: 32 patients 18 years of age and older recruited from the same clinic.

INTERVENTION:

In study 1, all participants underwent conventional gonioscopy by an experienced observer (GLS) using the Spaeth system and in the same eye also underwent Scheimpflug photography, ultrasonographic measurement of anterior chamber depth and axial length, automatic refraction, and biometric gonioscopy with measurement of the distance from iris insertion to Schwalbe's line using a reticule based in the slit-lamp ocular. In study 2, all participants underwent both conventional gonioscopy and biometric gonioscopy by an experienced gonioscopist (NGC) and a medical student with no previous training in gonioscopy (JK).

MAIN OUTCOME MEASURES:

Study 1: The association between biometric gonioscopy and conventional gonioscopy, Scheimpflug photography, and other factors known to correlate with the configuration of the angle. Study 2: Interobserver agreement using biometric gonioscopy compared to that obtained with conventional gonioscopy.

RESULTS:

In study 1, there was an independent, monotonic, statistically significant relationship between biometric gonioscopy and both Spaeth angle (P = 0.001, t test) and Spaeth insertion (P = 0.008, t test) grades. Biometric gonioscopy correctly identified six of six patients with occludable angles according to Spaeth criteria. Biometric gonioscopic grade was also significantly associated with the anterior chamber angle as measured by Scheimpflug photography (P = 0.005, t test). In study 2, the intraclass correlation coefficient between graders for biometric gonioscopy (0.97) was higher than for Spaeth angle grade (0.72) or Spaeth insertion grade (0.84).

CONCLUSION:

Biometric gonioscopy correlates well with other measures of the anterior chamber angle, shows a higher degree of interobserver reliability than conventional gonioscopy, and can readily be learned by an inexperienced observer.

Biometric gonioscopy and the effects of age, race, and sex on the anterior chamber angle.

AIM:

To utilise a novel method for making measurements in the anterior chamber in order to compare the anterior chamber angles of people of European, African, and east Asian descent aged 40 years and over.

METHODS:

A cross sectional study on 15 people of each sex from each decade from the 40s to the 70s, from each of three racial groups-black, white, and Chinese Singaporeans. Biometric gonioscopy (BG) utilises a slit lamp mounted reticule to make measurements from the apparent iris insertion to Schwalbe's line through a Goldmann one mirror goniolens. The main outcome measures were BG measurements of the anterior chamber angle as detailed above.

RESULTS:

There was no significant difference in angle measurement between black, white, and Chinese races in this study. However, at younger ages people of Chinese race appeared to have deeper angles than white or black people, whereas the angles of older Chinese were significantly narrower (p = 0.004 for the difference in slope of BG by age between Chinese and both black and white people).

CONCLUSION:

The failure to detect a difference in angle measurements between these groups was surprising, given the much higher prevalence of angle closure among Chinese. It appears that the overall apparent similarity of BG means between Chinese and Western populations may mask very different trends with age. The apparently more rapid decline in angle width measurements with age among Chinese may be due to the higher prevalence of cataract or "creeping angle closure." However, longitudinal inferences from cross sectional data are problematic, and this may represent a cohort phenomenon caused by the increasing prevalence of myopia in the younger Singaporean population.

Age, gender, biometry, refractive error, and the anterior chamber angle among Alaskan Eskimos.

BACKGROUND:

The prevalence of angle-closure glaucoma (ACG) is greater for Eskimos/Inuit than it is for any other ethnic group in the world. Although it has been suggested that this prevalence may be due to a population tendency toward shallower anterior chamber angles, available evidence for other populations such as Chinese with high rates of ACG has not consistently demonstrated such a tendency.

METHODS:

A reticule, slit-lamp, and standard Goldmann one-mirror goniolens were used to make measurements in the anterior chamber (AC) angle according to a previously reported protocol for biometric gonioscopy (BG) (Ophthalmology 1999;106:2161-7). Measurements were made in all four quadrants of one eye among 133 phakic Alaskan Eskimos aged 40 years and older. Automatic refraction, dilated examination of the anterior segment and optic nerve, and A-scan measurements of AC depth, lens thickness, and axial length were also carried out for all subjects.

RESULTS:

Both central and peripheral AC measurements for the Eskimo subjects were significantly lower than those previously reported by us for Chinese, blacks, and whites under the identical protocol. Eskimos also seemed to have somewhat more hyperopia. There were no differences in biometric measurements between men and women in this Eskimo population. Angle measurements by BG seemed to decline more rapidly over life among Eskimos and Chinese than blacks or whites. Although there was a significant apparent decrease in AC depth, increase in lens thickness, and increase in hyperopia with age among Eskimos, all of these trends seemed to reverse in the seventh decade and beyond.

CONCLUSIONS:

Eskimos do seem to have shallower ACs than do other racial groups. Measurements of the AC angle seem to decline more rapidly over life among Eskimos than among blacks or whites, a phenomenon also observed by us among Chinese, another group with high ACG prevalence. This apparent more rapid decline may be due to a cohort effect with higher prevalence of myopia and resulting wider angles among younger Eskimos and Chinese.

Pupil constriction can alter the accuracy of dark room provocative test.

BACKGROUND: Primary angle-closure glaucoma (PACG) is a major cause of visual morbidity in East Asia. Dark-room provocative test (DRPT) has been used to determine which narrow angles have the risk to develop angle closure. However, the accuracy of DRPT might be altered because that after emerging from the dark room, the configuration of the angle is affected by the light of the slit-lamp and the appositionally closed angle reopens. The aim of this study was to examine the pupillary diameter in different light conditions and use it as a parameter to assess the accuracy of dark-room provocative test. METHODS: Patients with suspected primary angle-closure glaucoma undergoing DRPT were recruited. The anterior chamber angle was examined by anterior segment optical coherence tomography under the following conditions: (1) in standard room illumination; (2) after short-term dark-adaptation and (3) after DRPT. Mean values of pupil size and numbers of appositionally closed angle under different conditions were compared. RESULTS: A total of 47 eyes of 47 patients were analyzed. The pupil size after DRPT was smaller than that after short-term dark-adaptation (P < 0.001) and smaller than that in standard room illumination (P = 0.026). The numbers of appositionally closed angles after short-term dark-adaptation were significantly larger than those after DRPT (P < 0.001). There was no significant difference between the numbers of appositionally closed angles in standard room illumination and after DRPT (P = 0.157). CONCLUSIONS: Constriction of pupil size immediately after prolonged dark room provocative test may lead to change in the angle configuration, which may lead to false negative results. We suggest a modified protocol of recording intraocular pressure immediately after DRPT and performing gonioscopy following short-term dark adaptation to improve the accuracy of angle closure assessment.

INVESTIGATING THE ROLE OF NOX NADPH OXIDASE SIGNALLING IN CELL MIGRATION AND ANGIOGENESIS OF ENDOTHELIAL COLONY-FORMING CELLS

Introduction. Endothelial colony-forming cells (ECFCs) hold great cytotherapeutic potential for ischaemic disease. Emerging evidence supports a key role for NADPH oxidases in underlying angiogenic processes of these and other endothelial cells. Aims. To study the influence of Nox NADPH oxidases on the pro-angiogenic function of ECFCs. Methods. Human ECFCs isolated from umbilical cord blood were treated with pro-oxidant PMA and assessed in vitro, both under basal conditions and after siRNA knockdown of Nox4, a key endothelial NADPH oxidase isoform, alongside primary mature human aortic endothelial cells (HAoECs) for comparison, using an established scratch-wound assay as the functional end-point. Results. PMA (500nM for 8h) increased cell migration (control 18.6±2.8, PMA 32.7±6.6% wound closure; n=6, P<0.05) in a superoxide-dependent manner, as indicated by attenuation of this effect in the presence of PEG-SOD. Although HAoEC migration in response to PMA also tended to increase, this did not reach statistical significance. Notably, cell migration at 16h was reduced by Nox4 knockdown in ECFCs (control siRNA 53.4±3.5, Nox4 siRNA 35.1±4.9% closure; n=3, P<0.05), but not in HAoECs, whilst the pro-migratory effect of PMA in ECFCs was potentiated after Nox4 knockdown (control siRNA 53.4±3.5, +PMA 61.5±3.2% closure; n=3, P=NS; Nox4 siRNA 35.1±4.9, +PMA 53.0±4.9% closure; n=3, P<0.05). Conclusion. ECFC migration is enhanced by low concentrations of superoxide, to a greater extent compared to mature endothelial cells, and appears to be at least partly dependent upon NADPH oxidase, including a specific role for Nox4. Although, the precise contribution of endothelial Nox NADPH oxidases isoforms remains to be determined, it is clear that these findings may have significant implications for potential ECFC-based therapies for ischaemic disease, which is associated with an oxidative microenvironment.

EFFECTS OF ENVIRONMENTAL ANTIOXIDANTS ON PRO-ANGIOGENIC ROS SIGNALLING IN ENDOTHELIAL COLONY FORMING CELLS IN VITRO

Introduction. Endothelial colony-forming cells (ECFCs) hold great cytotherapeutic potential for ischaemic disease. Whilst increasing evidence supports a key role for reactive oxygen species (ROS), specifically those derived from Nox NADPH oxidases, in the underlying angiogenic processes of these and other endothelial cells, such studies investigating the role of redox signalling may be hampered by the standard inclusion of antioxidant agents in endothelial cell media, such as phenol red. Aims. To study the effects of antioxidants present in culture media on pro-angiogenic function of ECFCs in vitro. Methods. Human ECFCs isolated from umbilical cord blood were maintained in media with and without antioxidant components (EGM2 and phenol red-free DMEM, respectively) prior to treatment with pro-oxidant PMA and assessment of their in vitro migratory capacity using a scratch-wound assay to measure pro-angiogenic activity. Results. Our previous work in our group indicated that PMA (500nM) increased ECFC migration in a both a superoxide and NADPH oxidase-dependent manner (control 18.6±2.8, PMA 32.7±6.6% wound closure; n=6, P<0.05), as indicated by attenuation with PEG-SOD and VAS2870. However, inconsistencies in the data generated under varying experimental conditions led us to hypothesise that antioxidant agents in the standard ECFC media may be influencing these effects. Indeed, a direct comparison of cell migration between ECFCs incubated in EGM2 DMEM demonstrated a clear trend towards higher migration in the latter (EGM2 9.0±4.5, DMEM 22.7±6.4%; n=3, P=NS). Similar to our previous EGM2 studies, cell migration was potentiated by PMA (control 11.6±1.6, PMA 25.1±2.8%; n=3, P<0.05), but at a lower dose (100nM), which is consistent with a reduction in media antioxidants. Notably, this response was attenuated by VAS2870 (PMA 37.6±7.3, PMA+VAS2870 10.3±2.9%; n=6, P<0.05), underlining a likely role for Nox NADPH oxidases. Conclusion. Taken together, these data indicate that ECFC migration is sensitive to different endothelial cell growth media, which appears to be dependent upon their antioxidant content. Although further experiments, such as quantification of cellular superoxide generation by dihydroethidium fluorescence may be required to confirm a specific role for antioxidants, such blunting of ROS signalling in vitro is clearly an important consideration which may significantly impact upon data interpretation.

Retinopathy of prematurity: Causes, prevention and treatment

Advances in neonatal intensive care have improved survival rates in extremely premature an infant, which has led to an increase of Retinopathy of Prematurity (ROP) in the developed world. Left untreated, infants are at risk of developing strabismus, myopia, vitreous haemorrhage, vitreo-retinal fibrosis, retinal detachment, secondary angle closure glaucoma and ultimately complete loss of vision. The improvements in the understanding and treatment of ROP have been supported by seminal research, and its complexity is still being explored. However the importance of early screening and treatment is essential in the prevention and treatment of this disease. The following paper will examine the causes and treatments of ROP, as well as implications for future neonatal practice.

On lattices from combinatorial game theory modularity and a representation theorem: Finite case

We show that a self-generated set of combinatorial games, S, may not be hereditarily closed but, strong self-generation and hereditary closure are equivalent in the universe of short games. In [13], the question “Is there a set which will give an on-distributive but modular lattice?” appears. A useful necessary condition for the existence of a finite non-distributive modular L(S) is proved. We show the existence of S such that L(S) is modular and not distributive, exhibiting the first known example. More, we prove a Representation Theorem with Games that allows the generation of all finite lattices in game context. Finally, a computational tool for drawing lattices of games is presented.

Hydraulics of stepped chutes: experimental-numerical-theoretical study

O estudo de escoamentos turbulentos em descarregadores em degraus tem sido um desafio para os investigadores. A macro-rugosidade do leito, a ondulação da superfície livre, a intermitência da localização da secção inicial de entrada de ar e o escoamento bi-fásico a jusante da secção inicial de entrada de ar fazem com que a caracterização do escoamento deslizante sobre turbilhões em descarregadores em degraus não seja simples. Actualmente, é possível combinar técnicas de medição fiáveis com simulações numéricas e análise teórica. Nesta dissertação, o estudo experimental baseia-se em resultados experimentais obtidos em duas instalações experimentais: a instalação A, do Laboratório Nacional de Engenharia Civil (LNEC), dotada de um descarregador em degraus com declive de 1V:0.75H e a instalação B, do Instituto Superior Técnico (IST), dotada de um descarregador em degraus com declive de 1V:2H. Uma sonda de ar, um tubo de Pitot modificado e vários hidrómetros permitiram o estudo do escoamento deslizante sobre turbilhões mono- e bifásico ao longo do descarregador em degraus da instalação A. Na bacia de dissipação de energia, a observação visual do escoamento foi auxiliada pelas leituras efectuadas em tomadas de pressão localizadas na soleira da bacia e pelas leituras da altura do escoamento efectuadas em réguas graduadas localizadas nas paredes da bacia. Na instalação B foram utilizados um tubo de Pitot e vários hidrómetros para estudar a região não arejada do escoamento deslizante sobre turbilhões no descarregador em degraus. O estudo numérico é baseado em simulações numéricas da região não arejada do escoamento deslizante sobre turbilhões sobre descarregadores em degraus com o código comercial de CFD FLOW-3D® de modo a reproduzir as condições ensaiadas experimentalmente. As simulações beneficiaram da técnica de blocos múltiplos (multi-block) num sistema de coordenadas cartesianas, da determinação da superfície livre pelo método TruVOF e da utilização de dois modelos de turbulência: os modelos k- e RNG k-. Por último, o estudo teórico consistiu em desenvolver um modelo simplificado 1D para determinar as características hidráulicas principais do trecho não arejado do escoamento deslizante sobre turbilhões em descarregadores em degraus. O modelo foi desenvolvido a partir das equações de Navier-Stokes, conjuntamente com resultados experimentais e numéricos. Os resultados apresentados nesta dissertação contribuem para o conhecimento do escoamento deslizante sobre turbilhões em descarregadores em degraus, nomeadamente na região não arejada, na secção inicial de entrada de ar e na região arejada. A hidráulica dos dissipadores de energia a jusante de descarregadores em degraus, em particular das bacias tipo III do USBR, é também objecto de estudo. Em relação à região não arejada do escoamento em descarregadores com declive acentuado, e com base em resultados experimentais e numéricos, são propostas expressões para estimar o desenvolvimento da altura equivalente de água, da espessura da camada limite, da concentração média de ar, do coeficiente de energia cinética, da dissipação de energia, do factor de resistência e do coeficiente n da fórmula de Manning. São ainda propostas expressões adimensionais para a energia cinética turbulenta e sua dissipação. Para declives moderados, são propostas expressões para estimar o desenvolvimento da altura equivalente de água, do coeficiente de energia cinética e da energia específica residual. São ainda apresentados valores do expoente 1/N da expressão adimensional da distribuição de velocidades, quer para descarregadores com declive acentuado quer com declive moderado. Em conformidade com outros estudos centrados em escoamentos de parede e com derivações teóricas, para a região não arejada do escoamento em descarregadores em degraus de acentuado declive, observa-se que o factor de resistência depende da macro-rugosidade criada pelos degraus e da geometria da secção transversal e que o coeficiente n da fórmula de Manning aumenta com a rugosidade. A descrição estatística da turbulência do escoamento é igualmente explorada, contribuindo para o conhecimento da estrutura do escoamento. Observou-se que para números de Reynolds rugoso não superiores a 6.8x104 a energia cinética turbulência e a sua dissipação cumprem leis de semelhança. Estas expressões adimensionais estão de acordo com os resultados obtidos por outros autores para escoamentos completamente desenvolvidos em canais abertos e no escoamento em rios com leito de gravilha. Em acréscimo, a taxa de dissipação de energia, quer para descarregadores de declive acentuado quer de moderado declive, é baixa. Por último, observa-se que os valores da média temporal da concentração de ar entre 0 e 1 medidos na região não arejada do escoamento dizem respeito não só ao ar capturado entre ondas de água, na zona de ondulação da superfície livre, mas também ao ar emulsionado no escoamento, i.e., sob a forma de bolhas de ar, quando perto da secção média inicial de entrada de ar, devido à diferença entre localizações instantânea e média temporal. Foram revistas metodologias e fórmulas para estimar a localização da secção inicial de entrada de ar e apresentadas expressões para estimar a concentração média de ar e a altura equivalente de água nessa secção. Relativamente à região de escoamento arejado em descarregadores em degraus com declive acentuado, os resultados experimentais apresentados nesta dissertação permitiram estimar a influência da definição da superfície livre nos parâmetros hidráulicos da região do escoamento arejado e estimar a máxima elevação do escoamento nesta região do escoamento. Com base nos resultados experimentais obtidos na bacia de dissipação de energia do tipo III do USBR localizada a jusante do descarregador em degraus da instalação A, observou-se que os perfis da altura piezométrica e da altura do escoamento tendem a seguir o perfil recomendado pelo USBR para bacias tipo III. A excepção ocorre à entrada da bacia, onde as alturas piezométricas apresentadas nesta dissertação excedem largamente as apresentadas pelo USBR. É ainda observado que, tal como entre as bacias tipo I e tipo III do USBR, o ressalto hidráulico estabiliza muito mais rapidamente numa bacia tipo III a jusante de um descarregador em degraus do que uma bacia tipo I a jusante do mesmo descarregador em degraus. Finalmente, observa-se que os blocos de amortecimento a colocar no descarregador não têm influência visível nos resultados da altura piezométrica nem da altura do escoamento ao longo da bacia. Relativamente às simulações numéricas do escoamento não arejado, a proximidade entre resultados experimentais e numéricos permite validar o modelo teórico e a integração numérica usados no FLOW-3D®. As simulações desenvolvidas também mostraram que o modelo de turbulência k- permite representar as características do escoamento não arejado em descarregadores em degraus, uma vez que não foram observadas diferenças significativas entre as simulações com este modelo e com o modelo RNG k-. Finalmente, observou-se que o modelo de entrada de ar usado no FLOW-3D® é válido para estimar a localização da secção inicial de entrada de ar. Por último, a proximidade entre os resultados obtidos da aplicação do modelo teórico desenvolvido no âmbito desta dissertação e os resultados experimentais indica que as hipóteses e simplificações consideradas no desenvolvimento do modelo são adequadas.

Hydrodynamic and sediment fluxes through the inlets of the Ria Formosa

Tese de dout., Ciências do Mar, da Terra e do Ambiente (Ciências do Mar-Oceanografia Física), Faculdade de Ciências e Tecnologia, Univ. do Algarve, 2011

The rise and demise of a book-review magazine interpreting the cultural work of Books in Canada (1971-2008)

This interdisciplinary study examines the contribution that a book-review magazine makes to the cultural identity of its readers. It is the result of reflections on the cultural work of Books in Canada , on whether or not this periodical was a cultural worksite and if that is the case how it performed that cultural work. In addition, it interrogates factors that may have contributed to the magazine's demise. The study affirms that Books in Canada, a cultural enterprise from 1971 to 2008, mirrored and helped to shape book and literary culture in Canada through its circulation, through the personalities of its editors, through its front covers and through its reviewers and their reviews. Furthermore, it proposes that the demise of the enterprise was due to a combination of factors. The study begins with an introduction to book reviewing and special-interest magazines. Chapter I examines the interplay between selected visual and textual contents published in Books in Canada in its founding years. These components reflected and helped to fuel the cultural nationalism that was sweeping Canada subsequent to the 1967 World's Fair in Montreal. There were also persistent rumours and comments about the magazine that caused certain"cracks in the foundation" to appear. Chapter II compares the aims and editorial challenges of Val Clery, founder of Books in Canada , with those of Adrien Thério, founder of Lettres québécoises, and of the editors of the magazines' twentieth-anniversary issues, Paul Stuewe in the case of the former and André Vanasse in the case of the latter. Evidence in the content of the magazine, editorial and otherwise, indicated that the"contracts" that the editors made with their readers over the years were similar, to reflect and shape a cultural identity, but the result of their"projects," that is, the nature of those identities, was distinctly different. Evidently then, personal aims, preferences and political leanings of editors can have a major impact on the content of a book-review magazine and thus on the cultural work that it does. Therefore, in Chapter III, I focus on selected contents published during the tenures of two of Books in Canada 's key editors, Paul Stuewe and Olga Stein, in order to understand ways that their choices constituted a form of cultural work. The second part of this chapter moves from an analysis of the cultural work of editors to an examination of the cultural work of reviewers. Here, through a close-reading of a selection of reviews published in Books in Canada, and in other periodicals, I argue that reviewers do cultural work in the way that they negotiate their presence in a review, and in how they signal that presence through lexical choices and through the degree of intellectual interaction that they invite. Intellectual interaction is at the core of Chapter IV.This chapter consists of close readings of some of the"billboards" of the enterprise, that is, the front covers of Books in Canada , in order to show how these important components do cultural work by requiring readers to make an intellectual leap from image to text. Chapter V suggests that book reviews, the company's"bills of goods," do cultural work in much the same way as the paratexts of a book. One of my own reviews is offered as a case-study along with a number of other reviews of how central components of a book-review magazine do cultural work through the illocutionary force of their sentences. The first part of Chapter VI, the final chapter, measures the legacy of the magazine, in particular, the annual Books in Canada First Novel Award. Created in 1976, this prize is awarded to the author of the novel judged by a Books in Canada prize committee to be the best first novel in English of the year. The second part of Chapter VI sheds light on factors that may have contributed to the closure of the enterprise, including the copyright uproar that accompanied the agreement that Adrian Stein, publisher of Books in Canada and Olga Stein's husband, made in 2001 with the online book merchant, Amazon.com. Furthermore, this penultimate section of the study suggests that one of the most important factors in the magazine's demise was the decision by the Steins to exploit their position as owners, publisher, and editor of a book-review periodical, a government-subsidized one at that, to publish their own lengthy pre-trial defense of Conrad Black. The chapter then zooms back from the particular to the general with a broader consideration of the impact of technology and globalization on the book industry and on the ability of Books in Canada to survive in any form, print or digital.

Identification and study of novel genes expressed in the heart precursor cells

Understanding heart development on a molecular level is a requirement for uncovering the causes of congenital heart diseases. Several genes have been implicated as critical for heart development. However, the inducers of these genes as well as their targets and pathways, remain largely unknown. We have identified a promoter element of chick cCer able to drive EGFP expression in a population of cells that consistently exit from the anterior primitive streak region, from as early as stage HH3+, and that later will populate the heart. Using this promoter element as a tool allowed us to identify novel genes previously not known to potentially play a role in heart development. In order to identify and study genes expressed and involved in the correct development and differentiation of the vertebrate heart precursor cell (HPC) lineages, a differential screening using Affymetrix GeneChip® system technologies was performed. Remarkably, this screening led to the identification of more than 700 transcripts differentially expressed in the heart forming regions (HFR). Bioinformatic tools allowed us to filter the large amount of data generated from this approach and to select a few transcripts for in vivo validation. Five genes were selected for further characterization by whole mount in situ hybridization leading to the validation of their expression in the HPC. From those, Adtk1 and Ccbe1 were selected for functional analysis. Regarding to ccbe1, a more detailed WISH analysis was performed and showed that Ccbe1 is expressed specifically on the cardiac progenitors regions at HH4, more specifically in primary heart field and at later stages is present in the second heart field. Further functional analyses by knockdown and overexpression revealed an important role for Ccbe1 in early heart tube formation. Moreover, the results presented in this thesis suggested that Ccbe1 is a key gene during heart development and might be limited to multipotent and highly proliferative progenitors and downregulated upon cellular commitment into more specific cardiac phenotypes. Other of the genes identified, Adtk1 was also subjected to further functional studies. Knockdown of Adtk1 using morpholino oligonucleotides suggested that it might be necessary for the migration and fusion of the heart tube as well as for neural tube closure.

Évaluation de l’impact de pansements biologiques humains produits par génie tissulaire sur la guérison de plaies cutanées murines

L’étude de la guérison des plaies à l’aide de substituts produits par génie tissulaire est un domaine en plein essor. Dans ces travaux, les effets de pansements biologiques produits en laboratoire à partir de cellules souches/stromales du tissu adipeux (CSTA) différenciées ou non en adipocytes ont été évalués sur des plaies cutanées in vivo. Un modèle de souris possédant un épiderme fluorescent a permis de démontrer que les plaies traitées avec les pansements biologiques guérissent plus rapidement que les plaies non traitées, et ce, de manière indépendante de la réépithélialisation. Une augmentation de la formation du tissu de granulation et une angiogenèse accrue ont également été observées dans les groupes traités. Ces résultats établissent que les substituts contenant des CSTA ou des adipocytes fonctionnels favorisent la réparation tissulaire. À terme, ces travaux pourraient mener au développement de nouvelles indications cliniques pour le traitement des ulcères cutanés.