Development of an in Vitro Rat Intestine Segmental Perfusion Model to Investigate Permeability and Predict Oral Fraction Absorbed

Purpose: The aims of the study are to develop and evaluate an in vitro rat intestine segmental perfusion model for the prediction of the oral fraction absorbed of compounds and to assess the ability of the model to study intestinal metabolism. Methods: The system consisted of a perfusion cell with a rat intestinal segment and three perfusion circulations (donor, receiver, and rinsing circulation). Lucifer yellow (LY) was applied as internal standard together with test compounds in the donor circulation. To validate the model, the permeability of eight noncongeneric passively absorbed drugs was determined. Intestinal N-demethylation of verapamil into norverapamil was followed in the donor and receiver circulations by high-performance liquid chromatography analysis. Results: The in vitro model allowed ranking of the tested compounds according to their in vivo absorption potential. The Spearman's correlation coefficient between the oral fraction absorbed in humans and the ratio of permeation coefficient of test compound to the permeation coefficient of LY within the same experiment was 0.98 (P < 0.01). Moreover, intestinal N-demethylation of verapamil, its permeation, and the permeation of its metabolite norverapamil could be assessed in parallel. Conclusions: Up to six permeation kinetics can be obtained per rat, and the method has shown to be a valuable tool to estimate human oral absorptio

Research priorities in regional anaesthesia: an international Delphi study

Background: Regional anaesthesia use is growing worldwide, and there is an increasing emphasis on research in regional anaesthesia to improve patient outcomes. However, priorities for future study remain unclear. We therefore conducted an international research prioritisation exercise, setting the agenda for future investigators and funding bodies. Methods: We invited members of specialist regional anaesthesia societies from six continents to propose research questions that they felt were unanswered. These were consolidated into representative indicative questions, and a literature review was undertaken to determine if any indicative questions were already answered by published work. Unanswered indicative questions entered a three-round modified Delphi process, whereby 29 experts in regional anaesthesia (representing all participating specialist societies) rated each indicative question for inclusion on a final high priority shortlist. If ≥75% of participants rated an indicative question as ‘definitely’ include in any round, it was accepted. Indicative questions rated as ‘definitely’ or ‘probably’ by &lt;50% of participants in any round were excluded. Retained indicative questions were further ranked based on the rating score in the final Delphi round. The final research priorities were ratified by the Delphi expert group. Results: There were 1318 responses from 516 people in the initial survey, from which 71 indicative questions were formed, of which 68 entered the modified Delphi process. Eleven ‘highest priority’ research questions were short listed, covering themes of pain management; training and assessment; clinical practice and efficacy; technology and equipment. Conclusions: We prioritised unanswered research questions in regional anaesthesia. These will inform a coordinated global research strategy for regional anaesthesia and direct investigators to address high-priority areas

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Background and objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. Results: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia

Bloc interscalénique échoguidé (la profondeur de l'injection modifie-t-elle l'extension du bloc?)

Introduction: Du fait des risques de pneumothorax et de ponction vasculaire, le bloc interscalénique est un bloc superficiel qui en réserve l'indication à la chirurgie de l'épaule. L'apport de l'échographie permet de repérer ces structures adjacentes, mais aussi de repérer les racines nerveuses à bloquer. Cette étude a pour but de comparer le bloc interscalénique échoguidé avec injection au dessus de la racine C5 et au dessous de la racine C6 en faisant l'hypothèse que l'injection infraC6 augmenterait le taux de blocs nerveux distaux notamment ulnaire. Matériel et Méthodes: 60 patients consécutifs admis pour chirurgie de l'épaule ont été randomisés en deux groupes. Chacun bénéficiait d'un bloc interscalénique guidé par échographie. Le groupe C5 recevait une injection de produit anesthésique au dessus de la racine C5, le groupe C6 une injection en dessous de la racine C6, sous contrôle échographique permanent. Les patients recevaient 30 ml de ropivacaïne 0,75%. Le guidage était réalisé à l'aide d'un échographe Phillips HD11. Un neurostimulateur stimuplex HNS12 délivrait un courant de 0,4 mA pendant 0,1 ms afin de ne pas ponctionner de nerf. Nous avons étudié les paramètres suivants: temps de réalisation du bloc, efficacité des blocs sensitif et moteur des nerfs musculo-cutanés, axillaire, médian, radial et ulnaire à 10, 20 et 30 min. Résultats : Le taux de succès du bloc sensitif ulnaire était de 93% dans le groupe C6 vs 19% dans le groupe C5 à 30 min. Les taux de succès des blocs distaux (médian, ulnaire, radial) sensitifs et moteurs étaient significativement meilleurs dans le groupe C6 que le groupe C5. L'efficacité des blocs sensitifs et moteurs dans les territoires axillaire et musculo-cutané était identique entre les deux groupes. Les temps de réalisation des blocs étaient similaires dans les deux groupes. Aucune complication n'a été enregistrée. Discussion: Avec le bénéfice d'une seule injection et avec un bloc sensitivo-moteur plus efficace dans tous les territoires distaux, le bloc interscalénique échoguidé avec injection sous la racine C6 pourrait permettre de réaliser une chirurgie de tout le membre supérieur.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Tourism and Rural Heritage: A Win-Win Relation? The Conditions of Heritage Making in Touristic Rural Regions

International audienceThe relationship between heritage and rural development takes place within the heritage making process. It presents different characteristics of what exists in urban context, especially through the role that can play the built heritage in the reception of the tourists. The study of the case of a French department, the Gers, characterised by an important intangible heritage linked to gastronomy and agriculture, but away from the major flows of mass tourism, reveals three major criteria for success: the importance of organising an actor's network that gathers the world of local economy, tourism and heritage, in conjunction with local authorities; the existence of a strong legitimation structure that justifies these links. In France it was developed from a scientific approach: that of rural ethnology; the inscription in a temporality which allows successive stages and which is as much that of the local development project as that of the patrimonial action itself

Le virus de l'enroulement des feuilles du cerisier, largement répandu en France sur noyer, est-il à l'origine de l'incompatibilité de greffage du noyer Juglans regia sur Juglans nigra ?

Sur les 2 millions de noyers exploités en France, la moitié environ est cultivée en verger : 20 p. 100 des arbres du verger français de noyer sont greffés sur Juglans nigra, le reste étant greffé sur J. regia. Des symptômes de nécrose de la zone de greffe sont signalés assez couramment sur les arbres greffés sur J. nigra, surtout depuis quelques années ; ces symptômes sont tout à fait semblables à ceux décrits aux U.S.A. dans le cas d’arbres greffés sur J. hindsii ou « Paradox » (J. hindsii x J. regia). Le virus de l’enroulement chlorotique des feuilles du cerisier (cherry leaf roll : CLRV a été isolé de nombreux arbres présentant ce type de symptôme ; le virus a été également isolé de noyers greffés sur J. regia et ne présentant aucun symptôme. D’une façon générale, le virus semble bien établi sur noyer en France. Les souches de CLRV isolées de noyer en France sont très proches, sinon identiques, aux souches de CL RV américaines. Une souche française BL 1 a été purifiée et plus spécialement étudiée : elle se présente comme une souche typique de CLRV (symptomatologie, nucléoprotéines, acides nucléiques). Un sérum a été préparé ; il est utilisé pour la détection du CLRV en verger ou en pépinière par le test ELISA. La détection du virus se heurte à une difficulté résultant de la très irrégulière distribution du virus dans les tissus de J. regia lorsque celui-ci est greffé sur J. nigra ; il s’agit d’une distribution apparemment aléatoire ne résultant en aucun cas d’une diffusion lente du virus à partir d’un point d’infection. Lorsque les arbres sont greffés sur J. regia, le virus est réparti très uniformément dans les tissus de J. regia. Le porte-greffe J. nigra n’est pas totalement résistant au virus : bien que le CLRV n’ait pu être isolé des parties aériennes, il a pu, dans ce cas, être mis en évidence dans les racines. Il a été, à ce jour, impossible de détecter le CLRV chez un certain nombre d’arbres, J. regia/J. nigra présentant un net symptôme de nécrose de la ligne de greffe ; par ailleurs, différents auteurs ont isolé le CLRV d’arbres présentant, outre ce symptôme de nécrose, différents symptômes foliaires. La réussite des rétro-inoculations de différentes souches purifiées de CLRV sur de jeunes semis de noyer devrait permettre d’établir de façon claire et définitive le rôle du CLRV dans ces faciès maladifs et de poursuivre avec précision les études de sensibilité variétale et de comportement des porte-greffes hybrides J. regia x J. nigra.Twenty per cent of the walnut trees cultivated in France in orchards are grafted on Juglans nigra. This rootstock was introduced about 20 years ago and the first disorders at the union were reported in the last 5 years. The disease observed in France is very similar to the black-line disease described in the U.S.A. on trees grafted on J. hindsii or "Paradox" (J. hindsii x J. regia). Cherry leaf roll virus was detected both in J. regia/ J. nigra trees with black line and in J. regia/J. regia trees without any symptom and, generally speaking, the virus seems to be well established in walnuts in France. The CLRV strains identified in France are very similar (if not identical) to the American walnut strains. One French strain, BL 1, from J. regia/ J. nigra was purified and thoroughly investigated : it had all the characteristics of a typical CLRV strain. An antiserum was prepared and used for the routine detection of CLRV in orchards and nurseries using the ELISA technique. The main difficulty observed in the detection of CLRV arose from the uneven distribution of the virus in J. regia when this species is grafted on J. nigra : the virus seems to be randomly distributed in the tree and the restriction does not result from a slow diffusion of the virus in the plant from the infection points. In contrast, the virus is quite uniformly distributed in J. regia when this species is grafted on J. regia. This complicates indexing of CLRV when the tree is grafted on J. nigra and makes the test unreliable (sometimes, less than 5 per cent of the samples from an infected tree appear to be infected). In a few trees showing typical black-line symptoms, we have not yet been able to identify CLRV; moreover some authors have described clear leaf symptoms that we have only observed on one tree in France. These two results pose the problem of the role of CLRV in the incompatibility of J. regia/J. nigra. The recent success of back inoculations of purified CLRV strains will allow us to answer this question and to get clear information on the susceptibility and behaviour of different rootstocks including some new (J. nigra x J. regia) hybrids.

The radial nerve should be blocked before the ulnar nerve during a brachial plexus block at the humeral canal.

PURPOSE: The brachial plexus block through the humeral canal as described by Dupré is indicated in hand and forearm surgery. This block requires a multi-stimulation technique that emphasizes the necessity of a rigorous and safe technique. Nerve injury associated with regional anesthesia can entail significant morbidity for patients. Thus, we investigated the brachial block sequence in terms of unintended nerve stimulation as a surrogate of potential nerve injury. METHODS: Sixty patients were randomly allocated in two groups of 30. In Group I the radial nerve was blocked before the ulnar nerve. In Group II the ulnar nerve was blocked before the radial nerve. During the radial nerve approach we recorded, if present, an ulnar nerve response. During the ulnar nerve approach we recorded, if present, a radial nerve response. RESULTS: In Group I while looking for the radial nerve, in 50% of the cases, an ulnar motor response was recorded. In Group II while looking for the ulnar nerve, a radial motor response was recorded in 10% of the cases. CONCLUSION: Our results indicate that the radial nerve should be blocked before the ulnar nerve when performing a brachial plexus block at the humeral canal.Clinical TrialComparative StudyJournal ArticleRandomized Controlled TrialSCOPUS: ar.jinfo:eu-repo/semantics/publishe