Etude sur l'intérêt des valeurs de la troponine Ic dans l'évaluation de la qualité d'un greffon cardiaque et sur la survie du patient transplanté

La transplantation cardiaque est le traitement principal de l'insuffisance cardiaque.L'amélioration de l'évaluation de la fonction cardiaque du patient en état de mort encéphalique est donc une priorité. Apres un rappel des recommandations actuelles de la physiopathologie et de la prise en charge des patients en état de mort encéphalique, nous présentons les résultats de notre étude, réalisée du 1 octobre 1998 au 30 septembre 2003. Nos résultats montrent que les valeurs de la troponine Ic chez le donneur sont corrélées avec l'altération de la fraction d'éjection ventriculaire gauche. Les valeurs de la troponinie ne sont pas liées à la survenue d'un rejet aigu et à la survie à un an des patients transplantés.NANCY1-SCD Medecine (545472101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Association of Automated Text Messaging With Patient Response Rate After Same-Day Surgery

International audienceThis quality improvement study assesses the association of automated text messaging follow-up with the patient response rate after same-day surgery

Characterization of carbon monolith for wastewater treatment under flow.

International audienc

Opioid-related genetic polymorphisms do not influence postoperative opioid requirement

International audienceBACKGROUND: Among the various factors that may influence the pharmacological response to opioids, genetic polymorphisms [single nucleotide polymorphisms (SNP)] have generated some interest.OBJECTIVES: To examine the influence on morphine dose requirements and adverse events in the postoperative period of four SNP [opioid receptor mu1 (OPRM1), ATP-binding cassette subfamily B, member 1 (ABCB1) ex-21 and ex-26, catechol-o-methyltransferase (COMT)] in candidate genes involved in morphine pharmacodynamics and pharmacokinetics.DESIGN: A single centre prospective study.SETTING: University Hospital, Paris, France, from 2 January 2007 to 15 November 2011.PATIENTS: A total of 438 white adults scheduled for major orthopaedic surgery (spine, hip and knee) under general anaesthesia. The main exclusion criteria were receiving opioids for chronic pain, nonopioid drugs within 2 days prior to surgery, pregnancy, renal insufficiency, sleep apnoea obstruction syndrome, morbid obesity, severe hepatic impairment, cognitive dysfunction.INTERVENTIONS: Assays of plasma concentrations of morphine and metabolites (morphine 3-glucuronide and morphine 6-glucuronide) were performed and common polymorphisms in four candidate genes [OPRM1 A118G rs1799971; P-glycoprotein (ABCB1) T3435C (rs1045642) and G2677T/A (rs2032582); COMT Val 158 Met (rs4680)] were analysed.Morphine was titrated by staff in the postanaesthesia care unit (PACU) and in the ward patient-controlled intravenous analgesia was used for 24 h.MAIN OUTCOME MEASURES: The dose of morphine required to achieve pain relief and the influence of SNP in genes involved in morphine pharmacodynamics and kinetics on morphine dose requirements. Secondary endpoints were the concentrations of morphine, morphine 6-glucuronide and morphine 3-gluguronide, the proportion of patients requiring a rescue analgesic and the proportion of morphine-related adverse events.RESULTS: A total of 404 patients completed the study to final analysis. The mean ± SD morphine dose to achieve pain relief was 15.8 ± 8.8 mg in the PACU and 22.7 ± 18.6 mg during patient-controlled intravenous administration. Morphine-related adverse events were observed in 37%. There was no relationship between any genetic polymorphisms and morphine dose, morphine 3-gluguronide and morphine 6-glucuronide concentration, morphine-related adverse events or pain level. In the PACU only, P-glycoprotein polymorphisms (ex-21; ex-26) were significantly associated with morphine concentration but the prediction of the model was poor (R2 = 0.04)CONCLUSION: No major relationship has been demonstrated between SNP of OPRM1, ABCB1, COMT and morphine requirement, pain level or adverse effects in the postoperative period.TRIAL REGISTRATION: NCT00822549 (www.clinicaltrials.gov)

Biocatalytic Elimination of Pharmaceutics Found in Water With Hierarchical Silica Monoliths in Continuous Flow

International audiencePharmaceutical products (PPs) are considered as emerging micropollutans in wastewaters, river and seawaters, and sediments. The biodegradation of PPs, such as ciprofloxacin, amoxicillin, sulfamethoxazole, and tetracycline by enzymes in aqueous solution was investigated. Laccase from Trametes versicolor was immobilized on silica monoliths with hierarchical meso-/macropores. Different methods of enzyme immobilization were experienced. The most efficient process was the enzyme covalent bonding through glutaraldehyde coupling on amino-grafted silica monoliths. Silica monoliths with different macropore and mesopore diameters were studied. The best support was the monolith featuring the largest macropore diameter (20 µm) leading to the highest permeability and the lowest pressure drop and the largest mesopore diameter (20 nm) ensuring high enzyme accessibility. The optimized enzymatic reactor (150 mg) was used for the degradation of a PP mixture (20 ppm each in 30 ml) in a continuous recycling configuration at a flow rate of 1 ml/min. The PP elimination efficiency after 24 h was as high as 100% for amoxicillin, 60% for sulfamethoxazole, 55% for tetracycline, and 30% for ciprofloxacin

Treatment of Wastewater Containing Pharmaceutical Micropollutants by Adsorption under Flow in Highly Porous Carbon Monoliths

Flow-through reactors made of highly porous hierarchical micro/meso/macroporous carbon monoliths (CM) were developed to decontaminate water containing pharmaceutical micropollutants (antibiotics). CM were prepared from hierarchical meso/macroporous silica monoliths as sacrificial templates after impregnation with sucrose as a carbon precursor, hydrothermal carbonization, and subsequent pyrolysis and dissolution of silica by NaOH. CM were fully characterized by nitrogen sorption at 77 K, Hg porosimetry, scanning electron microscopy, transmission electron microscopy, microtomography, permeability measurements, X-ray photoelectron spectroscopy, and chemical analysis. CM exhibit a large surface area (1058 m2 g–1), a large pore volume (6.5 mL g–1), high permeability, a homogeneous interconnected macropore network (22 μm), bimodal mesopores (6 and 15 nm), micropores (0.85 nm), and a large number of C═O and COO– groups. They are basic in water (pH 9) and negatively charged. First, adsorption of a single pharmaceutical molecule, tetracycline (TC), was studied. Isotherms of adsorption, kinetics, and diffusion were used to study the mechanism of adsorption on CM, and the process was found to be governed by electrostatic interactions. Then, a mixture of several antibiotics (ciprofloxacin, amoxicillin, sulfamethoxazole, and TC, 20 mg L–1 each) was used. The sorption capacity for antibiotics peaked at 815 mg g–1. In a recirculation flow configuration, with a flow rate of 1 mL min–1, CM could remove 93% of the antibiotics. These CM could represent a highly efficient solution for the purification of real wastewater containing pharmaceutical molecules, which are generally found at much lower concentrations (from a few nanograms per liter to micrograms per liter). Regeneration of CM was successfully achieved by washing with HCl (0.1 M)

Treatment of Wastewater Containing Pharmaceutical Micropollutants by Adsorption under Flow in Highly Porous Carbon Monoliths

Flow-through reactors made of highly porous hierarchical micro/meso/macroporous carbon monoliths (CM) were developed to decontaminate water containing pharmaceutical micropollutants (antibiotics). CM were prepared from hierarchical meso/macroporous silica monoliths as sacrificial templates after impregnation with sucrose as a carbon precursor, hydrothermal carbonization, and subsequent pyrolysis and dissolution of silica by NaOH. CM were fully characterized by nitrogen sorption at 77 K, Hg porosimetry, scanning electron microscopy, transmission electron microscopy, microtomography, permeability measurements, X-ray photoelectron spectroscopy, and chemical analysis. CM exhibit a large surface area (1058 m2 g–1), a large pore volume (6.5 mL g–1), high permeability, a homogeneous interconnected macropore network (22 μm), bimodal mesopores (6 and 15 nm), micropores (0.85 nm), and a large number of CO and COO– groups. They are basic in water (pH 9) and negatively charged. First, adsorption of a single pharmaceutical molecule, tetracycline (TC), was studied. Isotherms of adsorption, kinetics, and diffusion were used to study the mechanism of adsorption on CM, and the process was found to be governed by electrostatic interactions. Then, a mixture of several antibiotics (ciprofloxacin, amoxicillin, sulfamethoxazole, and TC, 20 mg L–1 each) was used. The sorption capacity for antibiotics peaked at 815 mg g–1. In a recirculation flow configuration, with a flow rate of 1 mL min–1, CM could remove 93% of the antibiotics. These CM could represent a highly efficient solution for the purification of real wastewater containing pharmaceutical molecules, which are generally found at much lower concentrations (from a few nanograms per liter to micrograms per liter). Regeneration of CM was successfully achieved by washing with HCl (0.1 M)