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The COVID-19 pandemic has markedly increased delays in oncologic surgeries because of the virus's impact on traditional anesthetic management. Novel protocols, developed to protect patients and medical professionals, have altered the ways and instances in which general anesthesia (GA) can be safely performed. To reduce virus exposure related to aerosol-generating procedures, it is now recommended to avoid GA when feasible and promote regional anesthesia instead. At our institution, we observed faster postoperative recovery in patients who received paravertebral blocks for breast cancer surgery instead of GA. This led us to formally evaluate whether regional anesthesia instead of GA helped improve time to hospital discharge.We conducted a historical cohort study to retrospectively analyze two cohorts of patients: prepandemic vs intrapandemic. We obtained approval from our institutional ethics committee to review files of consecutive patients who underwent breast cancer surgery between 30 March 2020 and 30 June 2020 (intrapandemic group; N = 106) and consecutive patients-moving backwards-from 28 February 2020 to 6 December 2019 (prepandemic group; N = 104). The primary outcome was the length of time between the end of surgery to readiness for hospital discharge. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), the need for postoperative analgesia, and the duration of stay in the postanesthesia care unit (PACU).The median [interquartile range (IQR)] time to readiness for hospital discharge was significantly lower in patients who received paravertebral blocks for breast cancer surgery compared with GA (intrapandemic group, 119 [99-170] min vs prepandemic group, 191 [164-234] min; P0.001) as was the incidence of PONV (3% vs 11%; P = 0.03) and median [IQR] PACU durations of stay (29 [21-39] min vs 46 [37-63] min; P0.001).Patients who received paravertebral blocks for breast cancer surgery in the intrapandemic group were ready for hospital discharge earlier, spent less time in the PACU, and experienced less PONV than those who received GA in the prepandemic group. With growing surgical wait times, concerns related to aerosol-generating procedures, and recommendations to avoid GA when feasible, paravertebral blocks as the principal anesthetic modality for breast cancer surgery offered benefits for patients and medical teams.RéSUMé: CONTEXTE: La pandémie de COVID-19 a considérablement augmenté les retards dans les chirurgies oncologiques en raison de l’impact du virus sur la prise en charge anesthésique traditionnelle. De nouveaux protocoles, mis au point pour protéger les patients et les professionnels de la santé, ont modifié les façons et les cas dans lesquels une anesthésie générale (AG) peut être réalisée en toute sécurité. Afin de réduire l’exposition au virus liée aux interventions génératrices d’aérosols, il est maintenant recommandé d’éviter l’AG lorsque possible et de privilégier l’anesthésie régionale. Dans notre établissement, nous avons observé une récupération postopératoire plus rapide chez les patientes ayant reçu des blocs paravertébraux pour une chirurgie de cancer du sein au lieu d’une AG. Cela nous a menés à évaluer de façon formelle si l’anesthésie régionale au lieu de l’AG avait contribué à réduire les délais jusqu’au congé de l’hôpital. MéTHODE: Nous avons réalisé une étude de cohorte historique afin d’analyser rétrospectivement deux cohortes de patientes : prépandémie vs intrapandémie. Nous avons obtenu l’approbation de notre comité d’éthique institutionnel pour examiner les dossiers de patientes consécutives ayant bénéficié d’une chirurgie de cancer du sein entre le 30 mars 2020 et le 30 juin 2020 (groupe intrapandémie; n = 106) et des patientes consécutives – en reculant – du 28 février 2020 au 6 décembre 2019 (groupe prépandémie; n = 104). Le critère d’évaluation principal était le délai entre la fin de la chirurgie et le moment où les patientes étaient prêtes à recevoir leur congé de l’hôpital. Les critères d’évaluation secondaires comprenaient l’incidence de nausées et vomissements postopératoires (NVPO), la nécessité d’une analgésie postopératoire et la durée de séjour en salle de réveil (SDR). RéSULTATS: Le délai médian [écart interquartile (ÉIQ)] jusqu’à la disposition au congé de l’hôpital était significativement plus court chez les patientes ayant reçu des blocs paravertébraux pour une chirurgie de cancer du sein plutôt qu’une AG (groupe intrapandémie, 119 [99-170] min vs groupe prépandémie, 191 [164–234] min; P0,001), tout comme l’incidence de NVPO (3 % vs 11 %; P = 0,03) et les durées médianes [ÉIQ] de séjour en salle de réveil (29 [21–39] min vs 46 [37–63] min; P0,001). CONCLUSION: Les patientes qui ont reçu des blocs paravertébraux pour une chirurgie de cancer du sein dans le groupe intrapandémie étaient prêtes à quitter l’hôpital plus tôt, ont passé moins de temps en salle de réveil et ont ressenti moins de NVPO que celles qui ont reçu une AG dans le groupe prépandémie. Avec des temps d’attente pour accès à la chirurgie de plus en plus longs, des préoccupations liées aux interventions génératrices d’aérosols et les recommandations d’éviter l’AG lorsque possible, les blocs paravertébraux ont offert des avantages aux patientes et aux équipes médicales en tant que principale modalité anesthésique pour la chirurgie de cancer du sein.

In 2005, the first facial vascularized composite allotransplant was performed in France. In May 2018, our team at Maisonneuve-Rosemont Hospital, Montreal, Quebec, had the privilege to participate in the first facial transplant in Canada. Interdisciplinary collaboration, coordination, and communication formed the cornerstone of this medical undertaking and, ultimately, its success. This report details the anesthetic and organizational considerations of our experience.RéSUMé: En 2005, la première allogreffe de tissu composite vascularisée faciale était réalisée en France. En mai 2018, notre équipe à l’Hôpital Maisonneuve-Rosemont, à Montréal, au Québec, a eu le privilège de participer à la première greffe faciale au Canada. La collaboration, la coordination et la communication interdisciplinaires ont constitué les pierres angulaires de ce projet médical et, ultimement, de son succès. Ce compte-rendu détaille les considérations anesthésiques et organisationnelles de notre expérience.

Background Chronic opioid use has been documented in up to 20% of patients with traumatic injuries. Hence, we developed the Tapering Opioids Prescription Program for high-risk Trauma (TOPP-Trauma) patients. Aims To assess the feasibility and acceptability of TOPP-Trauma, examine the feasibility of the research methods, and describe its potential efficacy in reducing long-term opioid use. Design A two-arm pilot randomized controlled trial. Methods Fifty participants discharged home were assigned to TOPP-Trauma or an educational pamphlet. Feasibility was assessed based on ability to provide the program components. The acceptability was assessed with the Treatment Acceptability and Preference Questionnaire. The feasibility of the research methods was evaluated according to standard parameters. Self-reported morphine equivalent dose (MED) and MEDs supplied by pharmacies were measured at 6 and 12 weeks. Results Eighty percent or more of TOPP-Trauma components were delivered as planned, and the program was deemed highly acceptable. Approximately 10% of screened patients were eligible. Eighty-five percent of eligible patients agreed to participate with 20% attrition rates. TOPP-Trauma participants used less MED/day compared to the control group at 6 and 12 weeks (1.2. vs. 12.2 mg; 0.4. vs 4.0 mg), and pharmacies supplied less than half of cumulative MEDs to those who received the program at 12 weeks, but the differences were not statistically significant. Conclusions Some challenges need to be addressed before testing TOPP-Trauma. These include creating strategies to decrease attrition, offering the program throughout the care continuum to higher risk patients, and evaluating the impacts of reduced opioid use.

The Medical Library Association (MLA) held its 120th annual meeting and conference virtually May 19, 2020, and July 27–August 28, 2020, due to the coronavirus disease 2019 (COVID-19) pandemic. The meeting was titled the “MLA’20 vConference and Exhibits,” and the theme was “2020 Vision: The Future in Focus.”

During the perioperative period, nociception control is certainly one of the anesthesiologist's main objectives when assuming care of a patient. There exists some literature demonstrating that the nociceptive stimuli experienced during surgery are responsible for peripheral and central sensitization phenomena, which can in turn lead to persistent postsurgical pain. An individualized approach to the evaluation and treatment of perioperative nociception is beneficial in order to avoid the sensitization phenomena that leads to prolonged postoperative pain and to minimize the consumption of opiates and their adverse effects. In terms of sensitivity, specificity, and positive/negative predictive values when compared to heart rate (HR) and mean arterial pressure (MAP), recent literature has shown that the NOL variation (ΔNOL) is the best index to distinguish noxious from non-noxious stimuli. Chronic treatment with β1-adrenergic antagonists may constitute a limitation to the use of the NOL index. β1-adrenergic antagonists induce a depressive action on the heart rate, which results in a limitation of its variability after a noxious stimulus. Since heart rate and heart rate variability are two parameters integrated into the NOL index, the validity of the NOL index in a population of patients receiving β1-adrenergic antagonists has not yet been determined. Our study sought to explore the NOL index, the BIS, and the heart rate variation in a group of patients under chronic treatment with β1-adrenergic antagonists submitted to standardized noxious stimulus under general anesthesia. We then compared those results to a control group of patients from our previous study (CJA group) that received no β1-adrenergic antagonist chronic treatment. The patients in this study were subjected to a standardized anesthetic protocol from induction up to 3 min after a standardized tetanic stimulus to the ulnar nerve at a frequency of 100 Hz and an amperage of 70 mA, for a duration of 30 s. Data were electronically recorded to obtain NOL, BIS, and heart rate values every 5 s for the duration of the protocol. The NOL maximal mean value reached after noxious stimulation was not different between our two cohorts (CJA: 30(14) versus BETANOL: 36(14) (p = 0.12)). There was no statistically significant difference between our cohorts in regards of the NOL AUC representing the variation of the NOL over a 180 s period (CJA: 595(356) versus BETANOL: 634(301) (p = 0.30)). However, a repeated measurement ANCOVA identified slight statistically significant differences between our cohorts in the peak of variation of the NOL index between 20 and 65 s after noxious stimulation, the NOL index of the cohort of beta-blocked patients being higher than the CJA patients. Moreover, the time to reach the maximum value was not different (CJA: 73(37) versus BETANOL: 63(41) (p = 0.35)). NOL sensitivity and specificity to detect a noxious stimulus under general anesthesia were similar in patients taking beta-blockers or not, and were better than those of heart rate and Bispectral index (AUC NOL 0.97, CI(0.92–1), versus AUC BIS 0.78, CI(0.64–0.89) and AUC HR 0.66, CI(0.5–0.8)). In conclusion, the NOL index is a reliable monitor to assess nociception in a population of patients under chronic beta-blocker therapy. Patients under such therapy achieve similar maximal NOL values over a 180 s period after a standardized noxious stimulus and the NOL variation over time, represented by the AUC is not significantly different from a cohort of non-beta-blocked patients. Whether the patient takes beta-blockers or not, sensitivity of the NOL index is greater than that seen for BIS index or heart rate to detect an experimental noxious stimulus under general anesthesia.

Introduction : Cet article vise à décrire l’évolution du programme de formation documentaire de la Bibliothèque X de l’Université X par rapport à ce qui a été décrit pour 2011-2012 par « auteur » et coll. [1]. Les formations seront analysées individuellement afin d’évaluer à quel point chacun des fondements du Référentiel de compétences informationnelles en enseignement supérieur de l’ACRL est abordé et d’identifier d’éventuelles lacunes dans sa couverture. Description : Cinq nouvelles formations intégrées aux cursus et deux nouvelles formations libres ont été mises en place. Plusieurs modifications ont été apportées aux formations existantes. Entre autres, l’évaluation des apprentissages se fait maintenant presque totalement en ligne et est plus souvent liée aux travaux de session des étudiants. Résultats : En 2018-2019, le programme comprenait 172 activités totalisant 304 heures et rejoignant 6 651 participants. La formation virtuelle (guides, tutoriels et capsules) est plus développée qu’auparavant. Les fondements 1 (L’autorité est contextuelle) et 5 (La production de savoirs résulte d’échanges) du Référentiel sont les moins abordés. Le fondement 6 (La recherche d’information est une exploration stratégique) est le plus couvert. Exposé : Le programme de formation documentaire est plus intégré aux cursus qu’en 2011-2012, mais une évaluation formelle des apprentissages à long terme et le renforcement des notions apprises lors de plusieurs séances étalées dans le temps sont à envisager. Davantage de formations pourraient être offertes aux étudiants des cycles supérieurs, qui sont particulièrement touchés par les fondements 4 (La recherche savante est une démarche d’investigation) et 5 (La production de savoirs résulte d’échanges).

The quest for the perfect analgesic strategy after total knee arthroplasty must consider the requirements for good analgesia to facilitate rehabilitation and discharge, while minimizing unacceptable side effects such as motor block or sedation. The key to good analgesia uses a multimodal approach using, for example, peripheral nerve blockade, analgesics of different classes, and local infiltration analgesia. In this narrative review, we describe the evidence for these different components and suggest practical ways they may be combined.

Psychometric properties of the French and English versions of measurement instruments. (DOC 37 kb)

Background Assessing fluid responsiveness is important in the management of patients with hemodynamic instability. Passive leg raising (PLR) is a validated dynamic method to induce a transient increase in cardiac preload and predict fluid responsiveness. Variations in end-tidal carbon dioxide (ETCO2) obtained by capnography correlate closely with variations in cardiac output when alveolar ventilation and carbon dioxide production are kept constant. In this prospective observational study, we tested the hypothesis that variations in ETCO2 induced by a simplified PLR maneuver can track changes in the cardiac index (CI) and thus predict fluid responsiveness.

The Oral Health Interest Group/Groupe d’intérêt en santé buccale of CHLA/ABSC, established in 2016, aims to act as a source of networking for dental librarians in Canada, conduct research, and advocate for the specialty. In the present article, the first produced by OHIG, the authors describe the current landscape of academic dental librarianship in Canada using data resulting from an informal consultation of all OHIG members. Examples of distinctive practice are highlighted through a series of vignettes, and the overview is set in context through a literature review of dental librarianship, focussing on Canadian contributions to the speciality. The article concludes with the authors’ reflections into possible directions the specialty may take over the next few years, noting the importance of increased embedded collaboration with faculty and the need to develop new skills, for example, to support research data management and new trends in scholarly communications.

The Eastern experience has reported the safety of laparoscopic assisted gastrectomy (LAG) for gastric cancer. Its use in Western countries is still debated owing to concerns about its oncologic equivalence to open gastrectomy (OG). We sought to review and compare their operative outcomes and oncologic specimen quality (number of harvested lymph nodes and surgical margins) for gastric adenocarcinoma (GA).We reviewed the charts of all patients undergoing LAG (2007-2010) and OG (2000-2010) for GA in a single institution. Several surgeons performed the OGs, whereas 1 fellowship-trained laparoscopic surgeon performed LAGs. The primary outcome was quality of the surgical specimen, assessed by the number of harvested lymph nodes (LNs) and margin status. Secondary outcomes were perioperative events. Data were analyzed as intention to treat.We retrieved 60 cases (47 OGs, 13 LAGs). The conversion rate was 23%. Mean operative time was 115 minutes longer and blood loss was 425 mL less (both p0.001) for LAGs. A mean of 14.4 (standard deviation [SD] 9.8) and 11.2 (SD 8.2) LNs were harvested for OGs and LAGs, respectively (p = 0.29). Negative margins were achieved for all patients. Mean length of stay was similar (LAG: 19 d v. OG: 18.9 d; p = 0.91). The groups did not differ on major postoperative complications (12.7% v. 23.1%; p = 0.39) or operative mortality (2.1% v. 7.7%; p = 0.32).Laparoscopic assisted gastrectomy is a challenging but safe and feasible procedure in experienced hands. It offers the same radical resection as OG regarding negative margins and LN retrieval. Long-term follow-up is warranted.La gastrectomie assistée par laparoscopie (GAL) a été démontrée dans des études orientales comme sécuritaire dans le traitement de l'adénocarcinome gastrique (AG). En occident, l'équivalence oncologique de la GAL avec la gastrectomie ouverte (GO) demeure cependant controversée. Cette étude vise à comparer le devenir postopératoire et la qualité des spécimens oncologiques de ces interventions, dans le traitement de l'AG.Tous les dossiers de patients opérés par GAL (2007–2010) ou GO (2000–2010) pour AG dans un seul centre hospitalier ont été revus. Différents chirurgiens ont réalisé les GO. Toutes les GAL ont été réalisées par un seul chirurgien sur-spécialisé en chirurgie laparoscopique. Le critère d'évaluation principal était la qualité du spécimen chirurgical évaluée par le nombre de ganglions lymphatiques (GL) prélevés et le statut des marges de résection. Le critère d'évaluation secondaire était la morbidité postopératoire. Les données ont été analysées en fonction de l'intention de traiter.Soixante cas ont été inclus (47 GO, 13 GAL). Le taux de conversion s'est établi à 23 %. Le temps opératoire moyen était plus long de 115 minutes, et les pertes sanguines moyennes moindres de 425 mL (La gastrectomie assistée par laparoscopie est une intervention complexe, mais peut être réalisée de manière sécuritaire en des mains expertes. Elle offre un spécimen oncologique comparable à la gastrectomie ouverte, en termes de lymphadénectomie et de marges de résection. Un suivi à long terme demeure nécessaire.

The New England Collaborative Data Management Curriculum (NECDMC) is “an instructional tool for teaching data management best practices to undergraduates, graduate students, and researchers in the health sciences” (Lamar Soutter Library 2015a). This article reports on the French translation and adaptation of the first module of the NECDMC as part of the design of a short library instruction workshop.

A 4.4-kb DNA fragment was cloned from Actinobacillus pleuropneumoniae (strain 4074, serotype 1) by genetic complementation with Escherichia coli groES-groEL mutant strains. Sequence analysis of this fragment revealed a purine nucleoside phosphorylase (DeoD)-encoding gene homolog (deoD), heat-shock response-encoding genes for the small (groES) and large subunits (groEL) and a partial open reading frame encoding an alcohol dehydrogenase homolog (adhE). The predicted amino-acid sequence of groES and groEL genes showed extensive sequence identity (80-95%) with other Pasteurellaceae. The gene organization surrounding the groE locus was different from that of Haemophilus infuenzae. When expressed in E. coli, groES-groEL genes were capable of complementing the growth of a lambda lytic phage, indicating a structural as well as functional conservation.

Clostridium difficile is the major causative agent of nosocomial antibiotic-associated diarrhea, colitis, and pseudomembranous colitis. The pathogenicity of C. difficile is closely related to the production of toxins A and B. Toxigenic C. difficile detection by a tissue culture cytotoxin assay is often considered the “gold standard.” However, this assay is time consuming, as it implies an incubation period of at least 24 h. We have developed a rapid real-time fluorescence-based multiplex PCR assay targeting the C. difficile toxin genes tcdA and tcdB , with the Smart Cycler. Two molecular beacons bearing different fluorophores were used as internal probes specific for each amplicon type. The analytical sensitivity of the assay was around 10 genome copies for all nine C. difficile strains tested, representing the 6 most common toxinotypes. The specificity was demonstrated by the absence of amplification with DNA purified from bacterial species other than C. difficile ( n = 14), including Clostridium sordellii for which the lethal toxin gene sequence is closely related to the toxin genes of C. difficile . Following a rapid (15 min) and simple fecal sample preparation protocol, both tcdA and tcdB were efficiently amplified from 28 of 29 cytotoxin-positive feces samples. There was no amplification observed with all 27 cytotoxin-negative feces samples tested. This is the first real-time PCR assay for the detection of C. difficile . It is rapid, sensitive, and specific and allows detection of C. difficile directly from feces samples.

Summary A number of reports have been published describing (recurrent) respiratory depression after the use of alfentanil intraoperatively. To evaluate the severity of respiratory depression after the administration of alfentanil, 49 patients undergoing general anaesthesia for abdominal hysterectomy were randomly allocated to one of three groups and studied in a double-blind manner. During surgery patients received no opioids (group 1), low dose (group 2) or high dose of alfentanil (group 3). Postoperatively patients were monitored with pulse oximetry and respiratory inductive plethysmography. Postoperative pain was managed with PCA morphine. Thirty-nine patients completed the study. Respiratory depressant effects were found in all three groups. A higher number of apnoeas (at 60 minutes in group 1: 3.3 ± 1.6; group 2: 3.5 ± 1.8; group 3: 12.2 ± 2.8) and a higher morphine consumption was found in group 2 when compared with group 1 and 3. No differences were found among the groups in the other respiratory parameters or in terms of the number of patients with respiratory depression at any one time. No cases of clear-cut recurrent respiratory depression were identified.

Site-directed mutagenesis of Ser-289 of the class C β-lactamase from Enterobacter cloacae P99 was performed to investigate the role of this residue in β-lactam hydrolysis. This amino acid lies near the active site of the enzyme, where it can interact with the C-3 substituent of cephalosporins. Kinetic analysis of six mutant β-lactamases with five cephalosporins showed that Ser-289 can be substituted by amino acids with nonpolar or polar uncharged side chains without altering the catalytic efficiency of the enzyme. These data suggest that Ser-289 is not essential in the binding or hydrolytic mechanism of AmpC β-lactamase. However, replacement by Lys or Arg decreased by two- to threefold the k cat of four of the five β-lactams tested, particularly cefoperazone, cephaloridine, and cephalothin. Three-dimensional models of the mutant β-lactamases revealed that the length and positive charge of the side chain of Lys and Arg could create an electrostatic linkage to the C-4 carboxylic acid group of the dihydrothiazine ring of the acyl intermediate which could slow the deacylation step or hinder release of the product.

This study tested the hypothesis that high dose systemic alfentanil administered before and during abdominal hysterectomy would pre-empt post-operative pain to a greater extent than administration of either low dose alfentanil or no alfentanil perioperatively. Patients (ASA 1 or 2) were randomly assigned to group 1 (n = 15), no opioid; group 2 (n = 15), low dose alfentanil; or group 3 (n = 15), high dose alfentanil. Anaesthesia was induced in group 1 with midazolam and thiopentone and was maintained with isoflurane and 70% N2O in O2. Anaesthesia was induced in group 2 with midazolam, thiopentone and i.v. alfentanil (30 microg kg(-1)), and was maintained with isoflurane, 70% N2O in O2, and bolus doses of i.v. alfentanil (10-20 microg kg(-1)) every hour. Anaesthesia was induced in group 3 with midazolam and i.v. alfentanil (100 microg kg(-1)), and was maintained with 70% N2O in O2, and an infusion of i.v. alfentanil (1-2 microg kg(-1) min(-1)). Blood samples were drawn at 30 and 120 min after surgery and assayed for plasma alfentanil. Morphine consumption and VAS pain scores were consistently lowest in group 3 over the 48 h study period. A composite measure of pain and morphine consumption was significantly lower in group 3 than group 2 up to 6 h after surgery, and significantly lower than group 1 up to 12 h. No adverse effects were observed. A 6-month follow-up did not reveal any significant differences among the three groups. It is concluded that intra-operative high dose alfentanil anaesthetic pre-empts post-operative pain after abdominal hysterectomy, but the effects are small and of short duration. Surgical procedures carried out under general anaesthesia using standard (and even high) doses of opioids intraoperatively provide suboptimal protection from the injury barrage brought about by incision and subsequent noxious surgical events.

In combination with goats, sheep represent the two most numerous agricultural species for which no cultural or ethical restrictions apply in their use as a source for milk, fibre and red meat. Particularly, in the developing world these species often represent the sole asset base for small-holder livestock farmers. Despite their global significance, genomic tools and approaches in disease resistance have lagged behind the efforts in the economically more influential beef and dairy cattle industries. In particular, infectious diseases have a significant economic impact on livestock production systems worldwide. The most frequently investigated diseases in sheep have focused on the economically important burdens including gastrointestinal nematodes, dermatophilosis, footrot, myiases and fasciolosis. In this study we describe the use of Indonesian Thin Tail sheep (ITT) as a resource which has been shown to have innate and acquired resistance to tropical fasciolosis (Fasciola gigantica). Using the contrast between the resistant ITT and the highly susceptible Merino in a combined functional and comparative genomics approach, we have identified putative QTL (quantitative trait loci) for an extensive panel of parasite and immune response phenotypes and putative resistance pathways and effector molecules. On refinement of candidate gene analyses and effector mechanisms we propose to map these in the economically important target species, namely cattle and buffalo. In addition we exploit the relative susceptibility of ITT sheep to temperate fasciolosis (Fasciola hepatica) to contrast parasite–host interactions and identify parasite immune evasion strategies to boost the discovery of new vaccine candidates and effector pathways, which may be amenable to exogenous control. The study highlights the power and utility of direct gene discovery in ruminant model systems. To overcome the shortage of genomic tools required for such investigations, we have drawn on the development of integrated comparative maps and alignment H.W. Raadsma Reprogen-Centre for Advanced Technologies in Animal Genetics and Reproduction, Faculty of Veterinary Science, University of Sydney, Camden NSW, Australia J.P. Gustafson et al. (eds.), Genomics of Disease, 89 C © Springer Science+Business Media, LLC, 2008 90 H.W. Raadsma et al. to the genome information–rich species such as human, murine and recently cattle. Similarly the use of bovine transcriptome tools have shown cross utility in sheep. The only species-specific requirement is the development of genome-wide high resolution SNP mapping tools which are now under development.

Thirty patients presenting with post-dural puncture headache (PDPH) were prospectively studied to determine the influence of the duration of the decubitus position after epidural blood patch on the efficacy of treatment. All patients received 12 ml of autologous blood. They were randomly distributed into three groups of ten patients. Patients in Group 1 were maintained in a decubitus position for 30 min after the epidural injection of autologous blood in the epidural space. Patients in Group 2 were maintained for 60 min in decubitus and patients in Group 3 for 120 min. Post-dural puncture headache was evaluated using a visual analogue scale before the epidural blood patch, at the time of initially adopting a standing position after the blood patch, and 24 hr later. The severity of PDPH in the three groups was reduced at the time of initially adopting a standing position and after 24 hr, in comparison with pre-blood patch VAS (P < 0.001). Patients in Group 3 presented less severe PDPH than patients in Group 1 at the time of initially standing up and 24 hr later (P < 0.05). We conclude that epidural blood patch was effective in treating PDPH but that the maintenance of a decubitus position for at least one hour and preferably for two hours after the blood patch was more effective than maintenance for 30 min.

The present study tested the hypothesis that patients receiving epidural bupivacaine before surgery would require less morphine postoperatively and/or report less intense pain than patients receiving epidural bupivacaine after incision but before the end of surgery. Forty-two patients (ASA class I-III) scheduled for lower abdominal surgery were randomly assigned to 1 of 2 groups of equal size and prospectively studied using a double-blind, placebo-controlled crossover design. Epidural catheters were placed in the T12-L1 or L1-L2 interspaces pre-operatively, the position of the catheter was confirmed with 3% chloroprocaine with epinephrine 1:200,000, and sensory testing was carried out until levels had receded to below T12. Group 1 received 15 ml of 0.5% epidural bupivacaine injected 35 min before incision followed by 15 ml of epidural normal saline 30 min after incision. Group 2 received 15 ml of epidural normal saline injected 37 min before incision followed by 15 ml of 0.5% epidural bupivacaine 30 min after incision. General anaesthesia was induced with thiopental (4–6 mg/kg) and maintained with N 2 O/O 2 and isoflurane. Paralysis was achieved with pancuronium (0.1 mg/kg). Opioids were not used as pre-medication or during surgery. Postoperative analgesia consisted of patient-controlled (PCA) intravenous morphine. Visual analogue pain scores (VAS) (at rest and after standardized mobilization) did not differ significantly between the 2 groups but McGill Pain Questionnaire (MPQ) pain ratings were significantly lower in group 1 at the 24 and 72 h assessments. Group 1 used significantly less morphine than did group 2 between 12 and 24 h after surgery. Cumulative PCA morphine consumption in group 1 (55.2 ± 4.7 mg) was significantly lower than in group 2 (71.7 ± 6.1 mg) 24 h and 48 h (group 1: 86.8 ± 6.3 mg vs. group 2: 108.9 ± 9.8 mg) after surgery, but not at the 72 h assessment. Reduction in morphine dose at 24, 48 and 72 h amounted to 30%, 25% and 22%, respectively. The results suggest that single-shot pre-emptive epidural local anaesthesia is associated with a short-term morphine-sparing effect which is most pronounced between 12 and 24 h after surgery. Extending the pre-operative blockade into the postoperative period may prolong the initial advantage conferred by pre-emptive epidural local anaesthesia.

Transmission of pain signals evoked by tissue damage leads to sensitization of the peripheral and central pain pathways. Pre-emptive analgesia is a treatment that is initiated before the surgical procedure in order to reduce this sensitization. Owing to this ‘protective’ effect on the nociceptive system, pre-emptive analgesia has the potential to be more effective than a similar analgesic treatment initiated after surgery. Theoretically, immediate postoperative pain may be reduced and the development of chronic pain may be prevented. Although some clinical studies have demonstrated significant effects on acute postoperative pain, no major clinical benefits of pre-emptive analgesia have been documented. The only way to prevent sensitization of the nociceptive system might be to block completely any pain signal originating from the surgical wound from the time of incision until final wound healing. Other pharmacological interventions, including ‘antihyperalgesic’ drugs such as NMDA-receptor antagonists and gabapentin, may interfere with the induction and maintenance of sensitization. Future studies will investigate the analgesic effect of prolonged multimodal combinations of different classes of ‘traditional’ analgesics and ‘antihyperalgesics’ on postoperative pain. The concept Pain signals from damaged tissue are not transmitted to the central nervous system (CNS) through ‘hard-wired’ pathways. In contrast, nociceptive signals, once initiated, will launch a cascade of alterations in the somatosensory system, including an increase in the responsiveness of both peripheral and central neurons. These alterations will increase the response to subsequent stimuli and thus amplify pain. 1 Pre-emptive analgesia is a treatment that is initiated before and is operational during the surgical procedure in order to reduce the physiological consequences of nociceptive transmission provoked by the procedure. Owing to this ‘protective’ effect on the nociceptive pathways, pre-emptive analgesia has the potential to be more effective than a similar analgesic treatment initiated after surgery. Consequently, immediate postoperative pain may be reduced and the development of chronic pain may be prevented. 2

We have isolated a partial 2.0 kb cDNA (pRATC) encoding the entire 489 amino acids of the NAD binding domain located at the C terminus of the rat poly(ADP-ribose) polymerase. pRATC sequences were analysed and compared with the human mRNA. Our analysis reveals a remarkable homology between the rat and human nucleotide and amino acid sequences. Although a few minor amino acid changes were detected, we have found that the total number of possible phosphorylation sites remained constant in the NAD binding domain of both enzymes. We have also found that a 102 amino acid sequence, containing the putative nucleotide binding site Gly-Lys-Gly (position 378), is perfectly conserved between the rat and human sequences. Strong homology was also detected between pRATC and genomic DNA isolated from various vertebrates. In addition, we have analysed the levels of poly(ADP-ribose) polymerase mRNA throughout the cell cycle. Our results show that the levels of mRNA culminate in the G1 phase. We have also found that the increase in enzymatic activity observed in rats following treatment with phenobarbital did not correspond to an increase in the mRNA levels.Key words: poly(ADP-ribose) polymerase.

Phytohemagglutinin (PHA) isolated from Phaseolus vulgaris has been modified by treatment with various chemical reagents and the modified proteins have been tested for their ability to stimulate peripheral lymphocytes from two healthy human donors, in vitro. Reaction of PHA with citraconic anhydride, S-methyl isothiourea, or 2-hydroxy-5-nitrobenzyl bromide produced derivatives which retained the ability to stimulate lymphocytes, at low concentrations. Acylation of the lectin with acetic anhydride or masking of the carboxyl side chains by reaction with glycinamide–carbodiimide impaired stimulation. When PHA was treated with N-bromosuccinimide or with tetranitromethane, the derivatives were ineffective as lymphocyte stimulants. Chemical modifications affected, in some cases, the quaternary structure of the lectin. Glycinamide-, homoarginine-, and nitro-PHA were tetramers whereas acetyl-, citraconyl-, and N-bromosuccinimide-treated lectin were dimers. Antinative lectin antiserum cross-reacted with all the modified proteins, except in the case of the N-bromosuccinimide derivative. The results show that, in the human lymphocyte transformation assay, the mitogenic property of PHA may depend on intact aspartic, glutamic, and tyrosine residues whereas lysine residues do not appear to be essential.

The mitogenic activity of Phaseolus vulgaris phytohemagglutinin (PHA) and its acetyl, citraconyl, glycinyl, homoarginyl, N-bromosuccinimide, and nitro derivatives has been assayed using pig spleen lymphocytes. Nitrated and N-bromosuccinimide-treated PHA were not mitogenic. Whereas the mitogenicity of acetyl PHA was impaired, the other derivatives were as active as untreated lectin. Binding studies of [125I]PHA and derivatives to purified pig spleen lymphocytes were performed at 37 °C. Results show that the lymphocytes bound various amounts of lectin derivatives. Maximum amounts were observed in the case of mitogenic lectins. Data were analyzed by Scatchard plots and two kinds of binding sites were found for PHA and the mitogenic derivatives. High affinity and low affinity binding sites have been characterized in terms of (apparent) association constant and (apparent) number of sites. Binding of PHA or its chemical derivatives to a small fraction (4.6–9.0%) of all available lectin binding sites was sufficient for maximal lymphocyte stimulation. Nonmitogenic PHA derivatives (nitro or N-bromosuccinimide) bound, with low affinity, to one kind of binding site. The relevancy of these findings to lymphocyte activation is discussed.