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Polomeni MM, Huguet T, Mariotti M, Larcher C, Delort F, Minville V, Kern D. Avoiding pain during propofol injection in pediatric anesthesia: Hypnoanalgesia of the hand versus intravenous lidocaine. Paediatr Anaesth 2024. [PMID: 38693886 DOI: 10.1111/pan.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Pain related to injection of propofol during induction of anesthesia decreases from 66.8% without prevention, to 22-31% of cases when lidocaine is associated. Hypnoanalgesia of the hand is currently used for painful procedures in children but has never been evaluated in this indication. The primary aim of this prospective randomized single-blind study was to evaluate the efficacy of hypnoanalgesia of the hand for the prevention of moderate to severe pain during intravenous injection of propofol alone in comparison to lidocaine admixture. The secondary aim was to compare the global satisfaction of children in both methods. PATIENTS AND METHODS One hundred patients aged 7-14 years, ASA 1-2, admitted for scheduled surgery under general anesthesia were randomized into two groups. Group L received a mixture of 1% propofol (3 mg/kg) and 1% Lidocaine (0.3 mg/kg). Group H received 1% propofol (3 mg/kg) after hypnoanalgesia of the hand realized by a single experimented operator. A video was made in order to evaluate the pain related to propofol injection by a blinded observer using the 4-point score of Cameron (painful ≥ 2). The global satisfaction of children was evaluated in postanesthesia care unit and documented if visual analog score was <7/10. RESULTS Ninety-six patients were analyzed. The rate of painful patients did not differ significantly between groups (8.5% in group H [n = 47] vs 6.1% in group L [n = 49], OR= 0.70; 95% CI [0.13-3.35], p = 0.65), nor did the rate of nonsatisfied patients (10.6 in group H vs. 12.2% in group L, OR = 0.85; 95% CI [0.19-3.65], p = 1). CONCLUSIONS Our results suggest that hypnoanalgesia of the hand alone is effective to prevent the pain related to propofol injection in children. No significant difference was found in comparison with lidocaine admixture nor for pain or satisfaction.
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Affiliation(s)
- Marie-Madeleine Polomeni
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
- Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
| | - Thomas Huguet
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
| | - Maryline Mariotti
- Department of Pediatric Analgesia and Palliative Care, Children Hospital of Toulouse, Toulouse, France
| | - Claire Larcher
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
- Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
| | - François Delort
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
- Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
| | - Vincent Minville
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
| | - Delphine Kern
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
- Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
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Kim C, Ludewig H, Hadzipasic A, Kutter S, Nguyen V, Kern D. A biophysical framework for double-drugging kinases. bioRxiv 2023:2023.03.17.533217. [PMID: 36993258 PMCID: PMC10055307 DOI: 10.1101/2023.03.17.533217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Orthosteric inhibition of kinases has been challenging due to the conserved active site architecture of kinases and emergence of resistance mutants. Simultaneous inhibition of distant orthosteric and allosteric sites, which we refer to as "double-drugging", has recently been shown to be effective in overcoming drug resistance. However, detailed biophysical characterization of the cooperative nature between orthosteric and allosteric modulators has not been undertaken. Here, we provide a quantitative framework for double-drugging of kinases employing isothermal titration calorimetry, Förster resonance energy transfer, coupled-enzyme assays, and X-ray crystallography. We discern positive and negative cooperativity for Aurora A kinase (AurA) and Abelson kinase (Abl) with different combinations of orthosteric and allosteric modulators. We find that a conformational equilibrium shift is the main principle governing this cooperative effect. Notably, for both kinases, we find a synergistic decrease of the required orthosteric and allosteric drug dosages when used in combination to inhibit kinase activities to clinically relevant inhibition levels. X-ray crystal structures of the doubledrugged kinase complexes reveal the molecular principles underlying the cooperative nature of double-drugging AurA and Abl with orthosteric and allosteric inhibitors. Finally, we observe the first fully-closed conformation of Abl when bound to a pair of positively cooperative orthosteric and allosteric modulators, shedding light onto the puzzling abnormality of previously solved closed Abl structures. Collectively, our data provide mechanistic and structural insights into rational design and evaluation of doubledrugging strategies.
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Affiliation(s)
- C. Kim
- Department of Biochemistry, Brandeis University and Howard Hughes Medical Institute, Waltham, MA 02454, USA
| | - H. Ludewig
- Department of Biochemistry, Brandeis University and Howard Hughes Medical Institute, Waltham, MA 02454, USA
| | - A. Hadzipasic
- Department of Biochemistry, Brandeis University and Howard Hughes Medical Institute, Waltham, MA 02454, USA
| | - S. Kutter
- Department of Biochemistry, Brandeis University and Howard Hughes Medical Institute, Waltham, MA 02454, USA
| | - V. Nguyen
- Department of Biochemistry, Brandeis University and Howard Hughes Medical Institute, Waltham, MA 02454, USA
| | - D. Kern
- Department of Biochemistry, Brandeis University and Howard Hughes Medical Institute, Waltham, MA 02454, USA
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Kern D, Bourdaud N, Jaber H, Ezzitouni M, Alacoque X, Larcher C, Sabourdin N, Minville V. Teleconsultation in pediatric anesthesia: first assessment of feasibility, quality and satisfaction in France. Paediatr Anaesth 2023. [PMID: 36929280 DOI: 10.1111/pan.14663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has prompted the development of anesthesia teleconsultation in many countries. In pediatric anesthesia, data about anesthesia teleconsultation are scarce. The main objective of this prospective descriptive study was to provide an evaluation of the feasibility of pediatric anesthesia teleconsultation. Perception of the safety and quality, parental and medical satisfaction were also assessed. METHODS From September to December 2020, patients undergoing a pediatric anesthesia teleconsultation in Toulouse University Hospital, using the Teleo™ dedicated teleconsultation platform were prospectively included. Feasibility was defined as the rate of anesthesia teleconsultations successfully performed using the TeleO™ platform alone. Questionnaires regarding the quality, safety and satisfaction were filled out by physicians and families. RESULTS 114 children (3 months - 17 years) were included in the study. Feasibility was 82%, failure was mainly caused by technical issues. Physicians estimated that the safety and quality of anesthetic preparation were optimal in 100% of cases. Anesthetists were satisfied (VAS ≥ 70/100) with the medical, technical, and relational (child / parents) aspects of anesthesia teleconsultation in 91%, 64%, and 84% / 90% of cases respectively. Almost all parents (97%) stated that they would agree to anesthesia teleconsultation for a future procedure. CONCLUSION In this first assessment, pediatric anesthesia teleconsultation appears to be feasible, with high rates of medical and parental satisfaction. Physicians' perception of the safety and quality of this process were positive. Improving the technical process might be a key determinant to promote further development of pediatric anesthesia teleconsultation.
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Affiliation(s)
- Delphine Kern
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France. CHRU Toulouse Purpan. Place du Dr Baylac. TSA 40031, 31059, Toulouse Cedex, 9, France.,Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France. Hôpital des Enfants. CHRU Toulouse Purpan. Place du Dr Baylac. TSA 40031, 31059, Toulouse Cedex, 9, France
| | - Nathalie Bourdaud
- Department of Paediatric Anaesthesia and Intensive Care, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Lyon, France. HFME, 59 Bd Pinel, 69500, Bron, France
| | - Haithem Jaber
- Department of Anaesthesia and Intensive Care, Caen University Hospital, Caen, France. Avenue de la Côte de Nacre CS, 30001 14033, Caen, cedex 9, France
| | - Mounir Ezzitouni
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France. CHRU Toulouse Purpan. Place du Dr Baylac. TSA 40031, 31059, Toulouse Cedex, 9, France
| | - Xavier Alacoque
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France. CHRU Toulouse Purpan. Place du Dr Baylac. TSA 40031, 31059, Toulouse Cedex, 9, France.,Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France. Hôpital des Enfants. CHRU Toulouse Purpan. Place du Dr Baylac. TSA 40031, 31059, Toulouse Cedex, 9, France
| | - Claire Larcher
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France. CHRU Toulouse Purpan. Place du Dr Baylac. TSA 40031, 31059, Toulouse Cedex, 9, France.,Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France. Hôpital des Enfants. CHRU Toulouse Purpan. Place du Dr Baylac. TSA 40031, 31059, Toulouse Cedex, 9, France
| | - Nada Sabourdin
- Université de Paris EA 7323 : Pharmacologie et Evaluation des thérapeutiques chez l'enfant et la femme enceinte.,CHU Armand Trousseau, Département d'Anesthésie-Réanimation, DMU DREAM, GRC 29, Sorbonne Université, AP-, HP, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Vincent Minville
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France. CHRU Toulouse Purpan. Place du Dr Baylac. TSA 40031, 31059, Toulouse Cedex, 9, France
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Mengkun C, Hashemidehaghi M, King J, Potdar A, Tunnell J, Diwakar G, Kern D. 341 Validation of detection of ceramides in topical solutions by Raman Spectroscopy. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jia W, Diwakar G, Kata N, Kern D, Milner T. 516 Quantitation of blue light irradiation dose emitted by electronic communication devices and its potential impact on human skin. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lebossé M, Kern D, De Queiroz M, Bourdaud N, Veyckemans F, Chassard D, Baudin F. Ventilation in pediatric anesthesia: A French multicenter prospective observational study (PEDIAVENT). Paediatr Anaesth 2020; 30:912-921. [PMID: 32500930 DOI: 10.1111/pan.13909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Protective ventilation is now a standard of care in adults. However, management of ventilation is heterogeneous in children and little is known regarding the mechanical ventilation parameters actually used during pediatric anesthesia. AIM The aim of the study was to assess current ventilatory practices during pediatric anesthesia in France and to compare them with pediatric experts' statements, with a specific focus on tidal volume. PATIENTS AND METHODS We conducted a prospective multicenter observational study, regarding the ventilatory management and the mechanical ventilation parameters, over two days (21 and 22 June 2017) in 29 pediatric centers in France. All children undergoing general anesthesia during these 2 days were eligible; those who required extracorporeal circulation or one-lung ventilation were excluded. RESULTS A total of 701 children were included; median [IQR] age was 60 [24-120] months. Among the patients in whom controlled ventilation was used, 254/515 (49.3%) had an expired tidal volume >8 mL/kg and 44 children (8.8%) an expired tidal volume ≥10 mL/kg. Lower weight and use of a supraglottic airway device were significantly associated with provision of a tidal volume ≥10 mL/kg (odds ratio 0.94, 95% confidence interval [0.92; 0.97], P < .001 and 2.28 [1.20; 4.31], P = .012, respectively). The positive end-expiratory pressure was set at a median [IQR] of 4 [3-5] cmH2 O; it was <3 cmH2 O in 15.7% of children and not used in 56/499 (9.3%). Among intubated children, 57 (18.3%) received a tidal volume < 10 mL/kg with a positive end-expiratory pressure ≥3 cmH2 O in association with recruitment maneuvers. CONCLUSIONS Ventilatory practices in children were heterogenous, and a large proportion of children were not ventilated as it is currently recommended by some experts.
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Affiliation(s)
- Marion Lebossé
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Delphine Kern
- Pôle Anesthésie-Réanimation, Hôpitaux de Toulouse, Hôpital des enfants, Toulouse, France
| | - Mathilde De Queiroz
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Nathalie Bourdaud
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Francis Veyckemans
- Département d'Anesthésie-Réanimation, Clinique d'Anesthésie-Réanimation pédiatrique, Hôpital Jeanne de Flandre, CHRU Lille, Lille, France
| | - Dominique Chassard
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France.,Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), VetAgro Sup, Université de Lyon, Lyon, France
| | - Florent Baudin
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France.,Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), VetAgro Sup, Université de Lyon, Lyon, France
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Cook B, Namkoong J, Riggs M, Holley K, Kern D, Knaggs H. 496 Evaluation of extracts containing red clover using dermal papilla cells in the development of a scalp treatment system targeting hair loss and hair damage. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Velly L, Gayat E, Quintard H, Weiss E, De Jong A, Cuvillon P, Audibert G, Amour J, Beaussier M, Biais M, Bloc S, Bonnet MP, Bouzat P, Brezac G, Dahyot-Fizelier C, Dahmani S, de Queiroz M, Di Maria S, Ecoffey C, Futier E, Geeraerts T, Jaber H, Heyer L, Hoteit R, Joannes-Boyau O, Kern D, Langeron O, Lasocki S, Launey Y, le Saché F, Lukaszewicz AC, Maurice-Szamburski A, Mayeur N, Michel F, Minville V, Mirek S, Montravers P, Morau E, Muller L, Muret J, Nouette-Gaulain K, Orban JC, Orliaguet G, Perrigault PF, Plantet F, Pottecher J, Quesnel C, Reubrecht V, Rozec B, Tavernier B, Veber B, Veyckmans F, Charbonneau H, Constant I, Frasca D, Fischer MO, Huraux C, Blet A, Garnier M. Guidelines: Anaesthesia in the context of COVID-19 pandemic. Anaesth Crit Care Pain Med 2020; 39:395-415. [PMID: 32512197 PMCID: PMC7274119 DOI: 10.1016/j.accpm.2020.05.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. METHODS The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. RESULTS The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. CONCLUSION We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.
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Affiliation(s)
- Lionel Velly
- Aix-Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, 13005 Marseille, France; Aix-Marseille University, CNRS, Institut Neuroscience Timone, UMR7289, Marseille, France.
| | - Etienne Gayat
- Department of Anaesthesiology and Critical Care, Lariboisière Hospital, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Hervé Quintard
- Intensive Care Unit, Centre Hospitalier Universitaire de Nice, Pasteur 2 Hospital, Nice, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris, France; Inserm UMR_S1149, Inserm, Université de Paris, Paris, France
| | - Audrey De Jong
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Éloi Hospital, Montpellier, France; PhyMedExp, University of Montpellier, Inserm U1046, CNRS UMR, 9214, Montpellier, France
| | - Philippe Cuvillon
- Department of Anaesthesiology, Beaujon Hospital, CHU Carémeau, Nîmes, France
| | - Gérard Audibert
- Department of Anaesthesia and Intensive Care, Lorraine University, Nancy University Hospital, 54000 Nancy, France
| | - Julien Amour
- Cardiovascular and Thoracic Surgery Department, Hôpital Privé Jacques-Cartier, 91300 Massy, France
| | - Marc Beaussier
- Département d'Anesthésie, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Matthieu Biais
- Department of Anaesthesiology and Critical Care, Pellegrin Hospital, CHU de Bordeaux, Bordeaux, France; Inserm UMR-S 1034, Biology of Cardiovascular Diseases, Bordeaux University, Bordeaux, France
| | - Sébastien Bloc
- CMC Ambroise-Paré, Département d'anesthésie, 92200 Neuilly-sur-Seine, France
| | - Marie Pierre Bonnet
- Department of Anaesthesiology and Critical Care, Armand-Trousseau University Hospital, Assistance publique-Hôpitaux de Paris, Paris, France; Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), Inserm INRA, Paris, France; Department of Anaesthesiology and Critical Care, Cochin-Port Royal University Hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Pierre Bouzat
- Department of Anaesthesiology and Intensive Care Medicine, Grenoble University Hospital, 38000 Grenoble, France
| | - Gilles Brezac
- Anaesthesiology, Lenval Children's Hospital, 06200 Nice, France
| | - Claire Dahyot-Fizelier
- Anaesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France; Inserm UMR1070, Pharmacology of Anti-infective Agents, University of Poitiers, Poitiers, France
| | - Souhayl Dahmani
- Department of Anaesthesia and Intensive Care, Robert-Debré University Hospital, AP-HP, DHU PROTECT, Inserm U1141, Paris, France
| | - Mathilde de Queiroz
- Department of Paediatric Anaesthesia and Intensive Care, Femme-Mère-Enfant Hospital, Lyon, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Claude Ecoffey
- Department of Anaesthesia and Intensive Care, CHU de Rennes, Inserm UMR 991, CIC 1414, Rennes 1 University, Rennes, France
| | - Emmanuel Futier
- Department of Anaesthesiology and Critical Care, Estaing Hospital, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS, Inserm U-1103, Clermont-Ferrand, France
| | - Thomas Geeraerts
- Pôle Anesthésie-Réanimation, Inserm, UMR 1214, Toulouse Neuroimaging Centre (ToNIC), université Toulouse 3 - Paul-Sabatier, CHU de Toulouse, 31059 Toulouse, France
| | - Haithem Jaber
- Departments of Anaesthesia and Intensive Care, Caen University Hospital, Caen, France
| | - Laurent Heyer
- Intensive Care Unit, Department of Anaesthesiology and Intensive Care Medicine, Croix-Rousse Hospital, Lyon, France
| | - Rim Hoteit
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Éloi Hospital, Montpellier, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000 Bordeaux, France
| | - Delphine Kern
- Departments of Anaesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
| | - Olivier Langeron
- Department of Anaesthesiology and Critical Care Medicine, Henri-Mondor University Hospital, University Paris-Est Créteil (UPEC), Assistance publique-Hôpitaux de Paris, Paris, France
| | - Sigismond Lasocki
- Department of Anaesthesiology and Critical Care Medicine, UBL Université d'Angers, CHU d'Angers, Angers, France
| | - Yoan Launey
- Department of Anaesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Frederic le Saché
- Department of Anaesthesiology and Intensive Care, DMU DREAM, AP-HP, 6 Sorbonne Université, Paris, France; Clinique Remusat, 75016 Paris, France; Clinique Jouvenet, 75016 Paris, France
| | - Anne Claire Lukaszewicz
- University of Lyon, EA 7426: Pathophysiology of Injury-Induced Immunosuppression (PI3), Lyon, France; Department of Anaesthesiology and Critical Care, Neurological hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Nicolas Mayeur
- Anaesthesiology and intensive care medicine, Clinique Pasteur, 31076 Toulouse, France
| | - Fabrice Michel
- Department of Paediatric Intensive Care Unit, Assistance publique-Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Vincent Minville
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, 31432 Toulouse, France; Inserm, U1048, Université Paul-Sabatier, Institute of Metabolic and Cardiovascular Diseases, I2MC, 31432 Toulouse, France
| | - Sébastien Mirek
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, 21079 Dijon, France; U-SEEM, Healthcare Simulation Centre of University Hospital of Dijon, 21079 Dijon, France
| | - Philippe Montravers
- Department of Anaesthesiology and Critical Care, CHU Bichat-Claude-Bernard, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France
| | - Estelle Morau
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Universitaire Arnaud-de-Villeneuve, Montpellier, France
| | - Laurent Muller
- Department of Anaesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Université Montpellier, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France; Physiology Department, EA 2992, Faculty of Medicine, Université Montpellier, Montpellier-Nimes University, Nîmes, France
| | - Jane Muret
- Institut Curie PSL Research University, 75005 Paris, France
| | - Karine Nouette-Gaulain
- Department of Anaesthesiology, Intensive Care and Pain, Institut Curie, 75005 Paris, France
| | - Jean Christophe Orban
- Department of Anaesthesiology and Intensive Care Medicine, Nice University Hospital, Nice, France
| | - Gilles Orliaguet
- Surgical Paediatric Intensive Care Unit, Universitary Hospital Necker-Enfants-Malades, Paris, France; EA08 Pharmacologie et Évaluation des Thérapeutiques chez l'Enfant et la Femme Enceinte, Paris Descartes University (Paris V), Paris, France
| | - Pierre François Perrigault
- Department of Anaesthesia and Critical Care Medicine, Montpellier University, Gui-de-Chauliac Hospital, Montpellier, France
| | - Florence Plantet
- Service d'Anesthésie-Réanimation, Clinique Générale, 4, chemin de la Tour-la-Reine, Annecy, France
| | - Julien Pottecher
- Department of Anaesthesiology and Critical Care, Les Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Christophe Quesnel
- Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France; Department of Anaesthesiology and Critical Care, Tenon Hospital, DMU DREAM, AP-HP, 6 Sorbonne Université School of Medicine, Paris, France
| | - Vanessa Reubrecht
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Bertrand Rozec
- Anesthésie-Réanimation, CHU Nantes, Hôpital Laennec, 1, boulevard Jacques-Monod, 44093 Nantes cedex, France
| | - Benoit Tavernier
- Department of Anaesthesiology and Critical Care, CHU de Lille, Pôle d'Anesthésie-Réanimation, 59000 Lille, France
| | - Benoit Veber
- Department of Anaesthesiology and Critical Care, Université de Rouen Normandie, Rouen, France
| | - Francis Veyckmans
- Department of Paediatric Anaesthesia, Jeanne-de-Flandre Hospital, University Hospitals of Lille, Lille, France
| | - Hélène Charbonneau
- Anaesthesiology and intensive care medicine, Clinique Pasteur, 31076 Toulouse, France
| | - Isabelle Constant
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, DMU DREAM, Sorbonne Université, Paris, France
| | - Denis Frasca
- Department of Anaesthesiology and Critical Care, Poitiers University, CHU de Poitiers, Poitiers, France
| | - Marc-Olivier Fischer
- Department of Anaesthesiology and Critical Care, Normandie Université, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - Catherine Huraux
- Department of Anaesthesiology, Clinique des Cèdres, 38130 Échirolles, France
| | - Alice Blet
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France; Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Garnier
- Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France; Department of Anaesthesiology and Critical Care, Saint-Antoine Hospital, DMU DREAM, AP-HP, 6 Sorbonne Université, Paris, France; Sorbonne Université School of Medicine, Paris, France
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Kern D, Riggs M, Knaggs H. 667 A Novel Microcurrent Device to Improve Skin Structure and Appearance. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Guan L, Zhao L, Xu J, Li R, Kern D, Knaggs H, Chang A. 683 Exploratory study to examine the gene expression effects of topical retinol on aging-related pathways in individuals of East Asian descent. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dadure C, Sabourdin N, Veyckemans F, Babre F, Bourdaud N, Dahmani S, Queiroz MD, Devys JM, Dubois MC, Kern D, Laffargue A, Laffon M, Lejus-Bourdeau C, Nouette-Gaulain K, Orliaguet G, Gayat E, Velly L, Salvi N, Sola C. Management of the child's airway under anaesthesia: The French guidelines. Anaesth Crit Care Pain Med 2019; 38:681-693. [PMID: 30807876 DOI: 10.1016/j.accpm.2019.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide French guidelines about "Airway management during paediatric anaesthesia". DESIGN A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie-Réanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association Des Anesthésistes Réanimateurs Pédiatriques d'Expression Francophone, ADARPEF) was convened. The entire process was conducted independently of any industry funding. The authors followed the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to assess the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations were not graded. METHODS The panel focused on 7 questions: 1) Supraglottic Airway devices 2) Cuffed endotracheal tubes 3) Videolaryngoscopes 4) Neuromuscular blocking agents 5) Rapid sequence induction 6) Airway device removal 7) Airway management in the child with recent or ongoing upper respiratory tract infection. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the redaction of the recommendations were then conducted according to the GRADE® methodology. RESULTS The SFAR Guideline panel provides 17 statements on "airway management during paediatric anaesthesia". After two rounds of discussion and various amendments, a strong agreement was reached for 100% of the recommendations. Of these recommendations, 6 have a high level of evidence (Grade 1 ± ), 6 have a low level of evidence (Grade 2 ± ) and 5 are experts' opinions. No recommendation could be provided for 3 questions. CONCLUSIONS Substantial agreement exists among experts regarding many strong recommendations for paediatric airway management.
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Affiliation(s)
- Christophe Dadure
- Département d'anesthesiologie réanimation femme-mère-enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS - U 1191 Inserm, université de Montpellier, 34285 Montpellier, France.
| | - Nada Sabourdin
- Département d'anesthésiologie-réanimation hôpital Armand Trousseau, AP-HP, 26, avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Francis Veyckemans
- Department of paediatric anaesthesia, Jeanne de Flandre hospital, university hospitals of Lille, 59037 Lille, France
| | - Florence Babre
- Department of anaesthesia, Bergonié institute, 33000 Bordeaux, France
| | - Nathalie Bourdaud
- Département d'Anesthésiologie Réanimation Pédiatrique, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Souhayl Dahmani
- Department of anaesthesia and intensive care. Robert-Debré university hospital, assistance publique Hôpitaux de Paris, Paris Diderot University, Paris Sorbonne Cité, Paris, Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Mathilde De Queiroz
- Département d'Anesthésiologie Réanimation Pédiatrique, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Jean-Michel Devys
- Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France
| | - Marie-Claude Dubois
- Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France
| | - Delphine Kern
- Departments of anaesthesia and intensive care, university hospital of Toulouse, place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Anne Laffargue
- Department of paediatric anaesthesia, Jeanne de Flandre hospital, university hospitals of Lille, 59037 Lille, France
| | - Marc Laffon
- Department of anesthesia and intensive care, university hospital and medical university François-Rabelais, Tours, France
| | - Corinne Lejus-Bourdeau
- Service d'anesthesie réanimation chirurgicale, Hôtel Dieu, Hôpital Mère Enfant, CHU de Nantes, 44093 Nantes cedex, France
| | - Karine Nouette-Gaulain
- Service d'anesthésie réanimation Pellegrin, hôpital Pellegrin, CHU de Bordeaux, place Amélie Raba Léon, 33000 Bordeaux, France; Université Bordeaux, Inserm U12-11, laboratoire de maladies rares: génétique et métabolisme (MRGM), 176, rue Léo-Saignat, 33000 Bordeaux, France
| | - Gilles Orliaguet
- Department of anaesthesia and intensive care, assistance publique Hôpitaux de Paris, Necker-Enfants Malades hospital, EA08 pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Paris Descartes University (Paris V), PRES Paris Sorbonne Cité, 75743 Paris, France
| | - Etienne Gayat
- Department of anesthesiology and Intensive care, Saint Louis, Lariboisière university hospital, université Paris Diderot, BioCANVAS, UMR-S 942, Inserm, 75010 Paris, France
| | - Lionel Velly
- Service d'anesthesie réanimation, CHU de Timone adultes, 264, rue St Pierre, 13005 MeCA, institut de neurosciences de la Timone, UMR 7289, Aix Marseille université, Marseille, France
| | - Nadège Salvi
- Department of anaesthesia and intensive care, assistance publique Hôpitaux de Paris, Necker-Enfants Malades Hospital, 75743 Paris, France
| | - Chrystelle Sola
- Département d'anesthesiologie réanimation femme-mère-enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS - U 1191 Inserm, université de Montpellier, 34285 Montpellier, France
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Philip P, Kern D, Goldmanns J, Seiler F, Schulte A, Habicher T, Büchs J. Parallel substrate supply and pH stabilization for optimal screening of E. coli with the membrane-based fed-batch shake flask. Microb Cell Fact 2018; 17:69. [PMID: 29743073 PMCID: PMC5941677 DOI: 10.1186/s12934-018-0917-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 05/03/2018] [Indexed: 11/16/2022] Open
Abstract
Background Screening in the fed-batch operation mode is essential for biological cultivations facing challenges as oxygen limitation, osmotic inhibition, catabolite repression, substrate inhibition or overflow metabolism. As a screening tool on shake flask level, the membrane-based fed-batch shake flask was developed. While a controlled supply of a substrate was realized with the in-built membrane tip, the possibilities for replenishing nutrients and stabilizing pH values was not yet exploited. High buffer concentrations were initially used, shifting the medium osmolality out of the biological optimum. As the growth rate is predefined by the glucose release kinetics from the reservoir, the resulting medium acidification can be compensated with a controlled continuous supply of an alkaline compound. The focus of this research is to establish a simultaneous multi-component release of glucose and an alkaline compound from the reservoir to enable cultivations within the optimal physiological range of Escherichia coli. Results In combination with the Respiratory Activity MOnitoring System, the membrane-based fed-batch shake flask enabled the detection of an ammonium limitation. The multi-component release of ammonium carbonate along with glucose from the reservoir resulted not only in the replenishment of the nitrogen source but also in the stabilization of the pH value in the culture medium. A biomass concentration up to 25 g/L was achieved, which is one of the highest values obtained so far to the best of the author’s knowledge with the utilization of a shake flask and a defined synthetic medium. Going a step further, the pH stabilization allowed the decrease of the required buffer amount to one-fourth establishing an optimal osmolality range for cultivation. As optimal physiological conditions were implemented with the multi-component release fed-batch cultivation, the supply of 0.2 g glucose in a 10 mL initial culture medium volume with 50 mM MOPS buffer resulted in a twofold higher biomass concentration than in a comparable batch cultivation. Conclusions The newly introduced multi-component release with the membrane-based fed-batch shake flask serves a threefold purpose of replenishing depleted substrates in the culture medium, stabilizing the pH throughout the entire cultivation time and minimizing the necessary amount of buffer to maintain an optimal osmolality range. In comparison to a batch cultivation, these settings enable to achieve higher biomass and product concentrations.![]() Electronic supplementary material The online version of this article (10.1186/s12934-018-0917-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Philip
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074, Aachen, Germany
| | - D Kern
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074, Aachen, Germany
| | - J Goldmanns
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074, Aachen, Germany
| | - F Seiler
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074, Aachen, Germany
| | - A Schulte
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074, Aachen, Germany
| | - T Habicher
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074, Aachen, Germany
| | - J Büchs
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074, Aachen, Germany.
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Guan L, Zhu G, Li S, Montana M, Kern D, Knaggs H, Chang A. 1272 Differences in skin aging characteristics in women of East Asian versus European descent residing in the same geographic location. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Namkoong J, Kern D, Riggs M, Holley K, Knaggs H. 667 A facial treatment cleansing device enhanced delivery of topical skin care products. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kern D, Namkoong J, Riggs M, Cook B, Draelos Z, Knaggs H. 698 A novel device for skin type-based treatment while cleansing. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Philip P, Meier K, Kern D, Goldmanns J, Stockmeier F, Bähr C, Büchs J. Systematic evaluation of characteristics of the membrane-based fed-batch shake flask. Microb Cell Fact 2017; 16:122. [PMID: 28716035 PMCID: PMC5514527 DOI: 10.1186/s12934-017-0741-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/11/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The initial part of process development involves extensive screening programs to identify optimal biological systems and cultivation conditions. For a successful scale-up, the operation mode on screening and production scale must be as close as possible. To enable screening under fed-batch conditions, the membrane-based fed-batch shake flask was developed. It is a shake flask mounted with a central feed reservoir with an integrated rotating membrane tip for a controlled substrate release. Building on the previously provided proof of principle for this tool, this work extends its application by constructive modifications and improved methodology to ensure reproducible performance. RESULTS The previously limited operation window was expanded by a systematic analysis of reservoir set-up variations for cultivations with the fast-growing organism Escherichia coli. Modifying the initial glucose concentration in the reservoir as well as interchanging the built-in membrane, resulted in glucose release rates and oxygen transfer rate levels during the fed-batch phase varying up to a factor of five. The range of utilizable membranes was extended from dialysis membranes to porous microfiltration membranes with the design of an appropriate membrane tip. The alteration of the membrane area, molecular weight cut-off and liquid volume in the reservoir offered additional parameters to fine-tune the duration of the initial batch phase, the oxygen transfer rate level of the fed-batch phase and the duration of feeding. It was shown that a homogeneous composition of the reservoir without a concentration gradient is ensured up to an initial glucose concentration of 750 g/L. Finally, the experimental validity of fed-batch shake flask cultivations was verified with comparable results obtained in a parallel fed-batch cultivation in a laboratory-scale stirred tank reactor. CONCLUSIONS The membrane-based fed-batch shake flask is a reliable tool for small-scale screening under fed-batch conditions filling the gap between microtiter plates and scaled-down stirred tank reactors. The implemented reservoir system offers various set-up possibilities, which provide a wide range of process settings for diverse biological systems. As a screening tool, it accurately reflects the cultivation conditions in a fed-batch stirred tank reactor and enables a more efficient bioprocess development.
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Affiliation(s)
- P. Philip
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074 Aachen, Germany
| | - K. Meier
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074 Aachen, Germany
| | - D. Kern
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074 Aachen, Germany
| | - J. Goldmanns
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074 Aachen, Germany
| | - F. Stockmeier
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074 Aachen, Germany
| | - C. Bähr
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074 Aachen, Germany
| | - J. Büchs
- AVT-Biochemical Engineering, RWTH Aachen University, Forckenbeckstraße 51, 52074 Aachen, Germany
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Gormezano NWS, Kern D, Pereira OL, Esteves GCX, Sallum AME, Aikawa NE, Pereira RMR, Silva CA, Bonfá E. Autoimmune hemolytic anemia in systemic lupus erythematosus at diagnosis: differences between pediatric and adult patients. Lupus 2016; 26:426-430. [PMID: 27821514 DOI: 10.1177/0961203316676379] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective To determine the overall prevalence of autoimmune hemolytic anemia (AIHA), and to compare clinical and laboratory features in a large population of children and adult lupus patients at diagnosis. Methods This retrospective study evaluated the medical charts of 336 childhood-onset systemic lupus erythematosus (cSLE) and 1830 adult SLE (aSLE) patients followed in the same tertiary hospital. Demographic data, clinical features and disease activity were recorded. AIHA was defined according to the presence of anemia (hemoglobin <10 g/dL) and evidence of hemolysis (reticulocytosis and positive direct antiglobulin test (DAT)/Coombs test) at SLE diagnosis. Evans syndrome (ES) was defined by the combination of immune thrombocytopenia (platelet count <100,000/mm3) and AIHA. Results The frequency of AIHA at diagnosis was significantly higher in cSLE patients compared to aSLE (49/336 (14%) vs 49/1830 (3%), p = 0.0001), with similar frequency of ES (3/336 (0.9%) vs 10/1830 (0.5%), p = 0.438). The median of hemoglobin levels was reduced in cSLE vs aSLE patients (8.3 (2.2-10) vs 9.5 (6.6-10) g/dL, p = 0.002) with a higher frequency of multiple hemorrhagic manifestations (41% vs 7%, p = 0.041) and erythrocyte transfusion due to bleeding (24% vs 5%, p = 0.025). cSLE patients also had more often constitutional involvement (84% vs 31%, p < 0.001), fever (65% vs 26%, p < 0.001), weight loss > 2 kg (39% vs 6%, p < 0.001), reticuloendothelial manifestations (48% vs 8%, p < 0.001), hepatomegaly (25% vs 2%, p < 0.001) and splenomegaly (21% vs 2%, p = 0.004). Other major organ involvements were common but with similar frequencies in cSLE and aSLE ( p > 0.05). Median systemic lupus erythematosus disease activity index 2000 (SLEDAI-2 K) was comparable in cSLE and aSLE (p = 0.161). Conclusions We identified that AIHA was not a common condition in cSLE and aSLE, with distinct features characterized by a higher prevalence/severity in children and concomitant constitutional symptoms in the majority of them.
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Affiliation(s)
- N W S Gormezano
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil.,2 Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - D Kern
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - O L Pereira
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - G C X Esteves
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - A M E Sallum
- 2 Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - N E Aikawa
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil.,2 Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - R M R Pereira
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - C A Silva
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil.,2 Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - E Bonfá
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
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Wood S, Gray R, Hester S, Mastaloudis A, Kern D, Namkoong J, Draelos Z. 581 Nutritional supplement improves skin health. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kern D, Lamouret O, Kurrek M, Gallix D, Requis J, Blais T, Laur JB, Visnadi G, Minville V, Fourcade O. Efficacité des filtres à charbon actif (Vapor Clean, Dynasthetics) pour la préparation de 7 respirateurs d’anesthésie avant ventilation de patients adultes et enfants suspect d’hyperthermie maligne. Anesthésie & Réanimation 2015. [DOI: 10.1016/j.anrea.2015.07.594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wilson C, Agafonov RV, Hoemberger M, Kutter S, Zorba A, Halpin J, Buosi V, Otten R, Waterman D, Theobald DL, Kern D. Kinase dynamics. Using ancient protein kinases to unravel a modern cancer drug's mechanism. Science 2015; 347:882-6. [PMID: 25700521 PMCID: PMC4405104 DOI: 10.1126/science.aaa1823] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Macromolecular function is rooted in energy landscapes, where sequence determines not a single structure but an ensemble of conformations. Hence, evolution modifies a protein's function by altering its energy landscape. Here, we recreate the evolutionary pathway between two modern human oncogenes, Src and Abl, by reconstructing their common ancestors. Our evolutionary reconstruction combined with x-ray structures of the common ancestor and pre-steady-state kinetics reveals a detailed atomistic mechanism for selectivity of the successful cancer drug Gleevec. Gleevec affinity is gained during the evolutionary trajectory toward Abl and lost toward Src, primarily by shifting an induced-fit equilibrium that is also disrupted in the clinical T315I resistance mutation. This work reveals the mechanism of Gleevec specificity while offering insights into how energy landscapes evolve.
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Affiliation(s)
- C. Wilson
- Howard Hughes Medical Institute and Department of Biochemistry, Brandeis University, Waltham, MA 02452, USA
| | - R. V. Agafonov
- Howard Hughes Medical Institute and Department of Biochemistry, Brandeis University, Waltham, MA 02452, USA
| | - M. Hoemberger
- Howard Hughes Medical Institute and Department of Biochemistry, Brandeis University, Waltham, MA 02452, USA
| | - S. Kutter
- Howard Hughes Medical Institute and Department of Biochemistry, Brandeis University, Waltham, MA 02452, USA
| | - A. Zorba
- Howard Hughes Medical Institute and Department of Biochemistry, Brandeis University, Waltham, MA 02452, USA
| | - J. Halpin
- Howard Hughes Medical Institute and Department of Biochemistry, Brandeis University, Waltham, MA 02452, USA
| | - V. Buosi
- Howard Hughes Medical Institute and Department of Biochemistry, Brandeis University, Waltham, MA 02452, USA
| | - R. Otten
- Howard Hughes Medical Institute and Department of Biochemistry, Brandeis University, Waltham, MA 02452, USA
| | - D. Waterman
- Howard Hughes Medical Institute and Department of Biochemistry, Brandeis University, Waltham, MA 02452, USA
| | - D. L. Theobald
- Department of Biochemistry, Brandeis University, Waltham, MA 02452, USA
| | - D. Kern
- Howard Hughes Medical Institute and Department of Biochemistry, Brandeis University, Waltham, MA 02452, USA
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Zhdanov RI, Kern D, Lorenz W, Ibragimova MY. Lipid and fatty acid profiles of Pseudomonas aurantiaca DNA-bound lipids determined by mass spectrometry. Microbiology (Reading) 2015. [DOI: 10.1134/s0026261714060228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Zhdanov RI, Kern D, Lorents V, Ibragimova MI. [Lipid and fatty acid profiles of Pseudomonas aurantiaca DNA-bound lipids determined by mass spectrometry]. Mikrobiologiia 2015; 84:50-57. [PMID: 25916147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An approach used on investigation of the lipid composition of loosely (fraction 1) and tightly (fraction 2) DNA-bound lipids of Pseudomonas aurantiaca cells by electrospray ionization using mass spectrometry (ESI-LC-MS) was used for determination of the lipidom of a prokaryotic cell. Free fatty acids C16:0, C18:1 (fraction 1), C14:0, C16:0, and C18:2 (fraction 2) were detected. Both fractions of DNA-bound lipids were characterized by the presence of phosphatidylglycerol, phosphatidylserine, and lyso-phosphatidylinositol. The alcohol-soluble fraction 1 could also contain phosphatidylcholine and phosphatidylinositol, while fraction 2 probably contained triacylglycerides. Compared to gas chromatography, ESI-LC-MS provides new possibilities for investigation of the nucleoid lipidome, providing for more detailed investigation of DNA-bound lipids in bacterial cells.
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Fesseau R, Alacoque X, Larcher C, Morel L, Lepage B, Kern D. An ADARPEF survey on respiratory management in pediatric anesthesia. Paediatr Anaesth 2014; 24:1099-105. [PMID: 25139622 DOI: 10.1111/pan.12499] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND There have been recent changes with regard to tools and concepts for respiratory management of children undergoing general anesthesia. OBJECTIVES To determine the practice of pediatric anesthetists concerning: preoxygenation, breathing systems, ventilation modes, anesthetic agent and airway device, strategies for a general anaesthetic of less than 30 min using spontaneous respiration, and opinion about technical aspects of ventilation. METHODS Online questionnaire sent by e-mail to all the anesthetists registered on the mailing list of the French-speaking Pediatric Anesthetists and Intensivists Association (ADARPEF). RESULTS 232 questionnaires (46%) were returned. More than 25% of anesthetists surveyed declared that they do not perform preoxygenation before induction for children <15 years old, apart from neonates and clinical specific situations. When performed, <65% chose a FiO2 higher than 80%. Inhalational induction with sevoflurane is the preferred mode of induction set at 6% or 8%, respectively, 69% [62-75] vs 25% [18-31]. For induction, the circle system was the most popular circuit used in all ages. The accessory breathing system-Mapleson B type-was predominantly used for neonates (44% [37-54]). For maintenance of an anesthesia lasting <30 min in spontaneous breathing, the use of laryngeal mask increased with age, and the endotracheal tube was reserved for neonates (40% [33-48]). Pressure support ventilation was rarely used from the beginning of induction but was widely used for maintenance, whatever the age-group. Results differed according to the type of institution. CONCLUSION Ventilation management depends on the age and institutions in terms of circuit, airway device or ventilation mode, and specific differences exist for neonates.
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Affiliation(s)
- Roselyne Fesseau
- Department of Anesthesiology and Intensive Care, EA 4564 MATN, IFR 150, Pediatric Unit, University Public Hospital, Toulouse, France
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Bourgain JL, Coisel Y, Kern D, Nouette-Gaulain K, Panczer M. What are the main "machine dysfunctions" to know? ACTA ACUST UNITED AC 2014; 33:466-71. [PMID: 25172192 DOI: 10.1016/j.annfar.2014.07.744] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/11/2014] [Indexed: 11/16/2022]
Abstract
The incidents related to the medical devices are common during anesthesia and in intensive care unit. These incidents are rarely the cause of complications because monitoring detects them early; alternative scenarios allow bearing these problems. Although the incidence of these complications has much declined, these incidents are serious adverse events and at the origin of life-threatening complications. Improper use of medical devices is the main factor that promotes the onset of these complications. To maintain a high level of security, it is necessary to use and control procedures according to the manufacturer recommendations. This is part of a strategy involving users, biomedical engineers and manufacturers. Several actions are effective in preventing the occurrence of these incidents: the control before use, the continuation of the performance of the equipment, use based on the recommendations of the experts and manufacturers and appropriate training. This strategy is best applied by a clinical expert who has extensive technical knowledge. This expert is a key player for users learning and allows establishing and maintaining rules of use in collaboration with medical staff and biomedical engineers and manufacturers.
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Affiliation(s)
- J L Bourgain
- Service anesthésie, institut Gustave-Roussy, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - Y Coisel
- Département d'anesthésie réanimation B, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - D Kern
- Department of Anesthesiology, and Intensive Care, University Hospital of Toulouse, EA 4564, MATN, IFR 150, CHRU Toulouse Purpan, place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - K Nouette-Gaulain
- Pôle d'anesthésie réanimation, centre François-Xavier-Michelet, laboratoire maladies rares, génétique et métabolisme (MRGM), université de Bordeaux, CHU de Bordeaux, 33076 Bordeaux, France
| | - M Panczer
- Service équipements AGEPS, 10, rue des Fossés-Saint-Marcel, 75005 Paris, France
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Zhdanov RI, Kern D, Lorents B, Ibragimova MI. [Fatty acid profile of Pseudomonas aurantiaca DNA-bound lipids according to ESI-LC-MS mass-spectrometry]. Tsitologiia 2014; 56:437-438. [PMID: 25696981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Approach to the study of prokaryotic chromatin lipidome has been realized based on analysis of fatty acid profile of DNA-bound lipids using electrospray ionization mass spectrometry ESI-LC-MS. By this method, we found 16 : 0 and 18 : 1 fatty acids, which are contained in the first fraction (weakly bound to DNA), and 14 : 0, 16 : 1 and 18 : 2 fatty acids, which are contained in the second fraction (strongly bound to DNA).
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Kern D, Larcher C, Cottron N, Ait Aissa D, Fesseau R, Alacoque X, Delort F, Masquère P, Agnès E, Visnadi G, Fourcade O. [The choice of a pediatric anesthesia ventilator]. Ann Fr Anesth Reanim 2013; 32:e199-e203. [PMID: 24209991 DOI: 10.1016/j.annfar.2013.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The technology of anesthesia ventilators has substantially progressed during last years. The choice of a pediatric anesthesia ventilator needs to be led by multiple parameters: requirement, technical (pneumatic performance, velocity of halogenated or oxygen delivery), cost (purchase, in operation, preventive and curative maintenance), reliability, ergonomy, upgradability, and compatibility. The demonstration of the interest of pressure support mode during maintenance of spontaneous ventilation anesthesia makes this mode essential in pediatrics. In contrast, the financial impact of target controlled inhalation of halogenated has not be studied in pediatrics. Paradoxically, complex and various available technologies had not been much prospectively studied. Anesthesia ventilators performances in pediatrics need to be clarified in further clinical and bench test studies.
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Affiliation(s)
- D Kern
- EA 4564 MATN, IFR 150, département d'anesthésie et de réanimation, CHRU Toulouse Purpan, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
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Tunceli O, Kern D, Ramachandran S, Pethick N. History Of Asthma Maintenance Medication Use And Asthma Exacerbation Risk Factors Before Initiation Of Inhaled Corticosteroid/long-acting β-agonist (ICS/LABA) Combination Therapy For Asthma: Comparison Of Budesonide/formoterol (BFC) And Fluticasone/salmeterol (FCS) In A US Commercially Insured Population. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Suhrmann R, Kern D, Wedler G. Einfluß des Ordnungszustandes aufgedampfter Nickelfilme auf die elektronische Wechselwirkung zwischen Ameisensäure und Nickel. Z PHYS CHEM 2011. [DOI: 10.1524/zpch.1963.36.3_4.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jehl X, Roche B, Sanquer M, Voisin B, Wacquez R, Deshpande V, Previtali B, Vinet M, Verduijn J, Tettamanzi G, Rogge S, Kotekar-Patil D, Ruoff M, Kern D, Wharam D, Belli M, Prati E, Fanciulli M. Mass Production of Silicon MOS-SETs: Can We Live with Nano-Devices’ Variability? ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.procs.2011.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lange R, Elter P, Biala K, Matschegewski C, Stählke S, Löffler R, Fleischer M, Nebe JB, Kern D, Beck U. Titanium surfaces structured with regular geometry-material investigations and cell morphology. SURF INTERFACE ANAL 2010. [DOI: 10.1002/sia.3320] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kern D, Plantevin F, Bouhassira D. Effects of morphine on the experimental illusion of pain produced by a thermal grill. Pain 2008; 139:653-659. [DOI: 10.1016/j.pain.2008.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 06/30/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
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Kern D, Fourcade O, Mazoit JX, Minville V, Chassery C, Chausseray G, Galinier P, Samii K. The relationship between bispectral index and endtidal concentration of sevoflurane during anesthesia and recovery in spontaneously ventilating children. Paediatr Anaesth 2007; 17:249-54. [PMID: 17263740 DOI: 10.1111/j.1460-9592.2006.02083.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Global inverse correlation between BIS (bispectral index) and depth of anesthesia using sevoflurane has been documented in children in several studies under experimental conditions and in steady-state conditions during mechanically controlled ventilation. Because sevoflurane mask anesthesia combined with a peripheral nerve block is widely used in children, we studied the relationship between BIS and endtidal concentration of sevoflurane (PE(sevo)) under these conditions during surgery and emergence. METHODS In this prospective blinded study of 32 children, the relationship between BIS and PE(sevo) was studied during sevoflurane anesthesia via facemask combined with peripheral nerve block. The intraoperative phase was studied during steady-state conditions (fixed PE(sevo)) and the emergence phase was studied during fast alveolar washout (FAW). BIS and PE(sevo) data fitted using the E(max) model. Coefficients of variation of BIS and PE(sevo) during the two periods were compared. RESULTS Fit was adequate with the simple E(max) model. Intraoperative variation in BIS was large (28.4%), and larger than at awakening (28.4% vs 8%). At awakening, BIS varied less than PE(sevo) (8% vs 28.5%). No difference was found between children younger and those older than 5 years. CONCLUSIONS Caution is required for intraoperative titration based on BIS when spontaneous ventilation is maintained because of the wide variability compared with PE(sevo). During emergence using FAW, BIS varied significantly less than PE(sevo), but the clinical relevance of this point could be discussed during anesthesia without tracheal intubation.
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Affiliation(s)
- Delphine Kern
- Department of Anesthesiology, Purpan Hospital, University of Toulouse, Toulouse, France.
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Abstract
BACKGROUND AND OBJECTIVE The combination of non-opioid analgesic drugs, though widely used, has been rarely evaluated. The aim of this study was to compare the efficacy of propacetamol and the non-steroidal analgesic drug ketoprofen, alone or in combination, on pain relief after thyroid surgery performed using remifentanil. METHODS Ninety-seven patients were randomly allocated to one of the three groups: propacetamol 2 g (32), ketoprofen 100 mg (33) and propacetamol 2 g + ketoprofen 100 mg (32). Each regimen was administered intravenously (i.v.) 30 min before the end of surgery and then every 6 h. If pain was not relieved, patients received an i.v. bolus of tramadol 100 mg. Tramadol consumption and pain intensity using a visual analogue scale was recorded at 1, 2, 8 and 14 h after the end of surgery. RESULTS Pain scores were significantly higher with propacetamol compared with ketoprofen 2 h after surgery (35 +/- 3.7, 21 +/- 2.6, respectively; P < 0.01). The number of patients receiving tramadol was higher with propacetamol alone compared with the two other groups, 1 h (14/32, 4/33, 2/32, respectively; P > 0.01) and 2 h (24/32, 6/33, 8/32, respectively; P < 0.01) after surgery. There was no difference between ketoprofen alone and ketoprofen plus propacetamol, and there was no difference between the three groups from the 8th hour onward. CONCLUSIONS In the immediate postoperative period after thyroid surgery performed using remifentanil, the concomitant use of propacetamol and ketoprofen does not improve analgesia compared with ketoprofen alone.
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Affiliation(s)
- O Fourcade
- University of Toulouse, Purpan Hospital, Anaesthesia Department, France.
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Bouhassira D, Kern D, Rouaud J, Pelle-Lancien E, Morain F. Investigation of the paradoxical painful sensation (‘illusion of pain’) produced by a thermal grill. Pain 2005; 114:160-7. [PMID: 15733641 DOI: 10.1016/j.pain.2004.12.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2004] [Revised: 12/06/2004] [Accepted: 12/13/2004] [Indexed: 11/22/2022]
Abstract
A paradoxical painful sensation can be elicited by the simultaneous application of innocuous warm and cold stimuli to the skin. In the present study, we analyzed the conditions of production of this unique experimental illusion of pain in 52 healthy volunteers (27 men, 25 women). The stimuli were produced by a thermode composed of six bars whose temperature was controlled by Peltier elements. The temperature of alternate (even- and odd-numbered) bars could be controlled independently to produce various patterns of the 'thermal grill'. After measuring the cold and heat pain thresholds, a series of combinations of warm and cold stimuli, whose distance to the thermal pain threshold was at least 4 degrees C, were applied on the palmar surface of the right hand during 30s. After each stimulus, the subjects had to describe and rate their sensations on visual analog scales. Paradoxical painful sensations, mostly described as burning, were reported by all the subjects but three. However, the phenomenon was less frequent in approximately one third of ('low responder') volunteers. The frequency and intensity of such painful sensations were directly related to the magnitude (i.e. 5-25 degrees C) of the difference of the temperature between the warm and cold bars of the grill. The combination of increasingly colder temperature to a given warm temperature induces similar effects as combining increasingly warmer temperature to a given cold temperature. These results suggest that pain can be the result of a simple addition of non-noxious warm and cold signals.
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Affiliation(s)
- Didier Bouhassira
- INSERM E-332, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, AP-HP, Boulogne and Université Versailles-Saint-Quentin, 92100 Boulogne-Billancourt, France.
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Minville V, Chassery C, Kern D, Fourcade O, Dadure C. Hyperbaric oxygen therapy and pain management in a child with continuous infraclavicular brachial plexus block. Anesth Analg 2004; 99:1878. [PMID: 15562104 DOI: 10.1213/01.ane.0000139733.19090.9e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Vincent Minville
- Department of Anesthesiology and Intensive Care; Toulouse University Hospital; Toulouse, France; (Minville, Chassery, Kern, Fourcade) Department of Anesthesiology and Intensive Care; Montpellier University Hospital; Montpellier, France (Dadure)
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Fabre S, Vaysse F, Carpentier C, Kern D, Fourcade O. [Is premixed 50% nitrous oxide and oxygen an alternative to general anaesthesia for dental care in children?]. ACTA ACUST UNITED AC 2004; 23:72-3. [PMID: 14980330 DOI: 10.1016/j.annfar.2003.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Hypoplastic left heart syndrome (HLHS), a complex congenital heart disease, is the most common lethal cardiac defect in neonates. Its treatment includes cardiac transplantation and/or surgical palliation. Associated extracardiac congenital abnormalities are exceptional. We report the case of a neonate with HLHS and anorectal atresia who required urgent surgical management to relieve intestinal obstruction. The surgery was successfully performed under spinal anaesthesia.
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Affiliation(s)
- S Sacrista
- Service d'Anesthésie-Réanimation and Département, Médico-Chirurgical de Pédiatrie, Hôpital des Enfants, Toulouse, France.
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Affiliation(s)
- Philippe Galinier
- Hôpital des enfants, 330, avenue de Grande-Bretagne, 31059 Toulouse Cedex 9, France.
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Abstract
Despite repeated calls to emphasize the humanistic dimensions of care during medical education, these are few known techniques for effective teaching of humanism. We describe the barriers that inhibit humanistic teaching and suggest pragmatic teaching methods to overcome such barriers and teach humanistic care in clinical settings. We began by asking participants at a conference on patient-physician communications sponsored by the American Academy on Physician and Patient in June 1998, "What can we do in the patient's presence to improve and teach the human dimensions of care? Please provide one or more examples of approaches you found to be effective." We augmented this information with suggestions from a number of colleagues in other settings. In a series of iterations, we analyzed all their suggestions to identify key teaching methods. We found that barriers to teaching humanism largely consist of elements of the informal and hidden curricula in medical schools. We then defined methods to help teachers overcome these barriers. Specific methods fall into the 3 categories of taking advantage of seminal events, role modeling, and using active learning skills. We believe that formal courses and other well-motivated endeavors that take place away from patients fail to foster humanistic care. In contrast, we present pragmatic teaching methods that can be used in the fast-paced setting of the clinical environment.
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Affiliation(s)
- W T Branch
- Division of General Medicine, Department of Medicine, Emory University School of Medicine, 1525 Clifton Rd, Atlanta, GA 30322, USA.
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Charron C, Roy H, Lorber B, Kern D, Giegé R. Crystallization and preliminary X-ray diffraction data of the second and archaebacterial-type aspartyl-tRNA synthetase from Thermus thermophilus. Acta Crystallogr D Biol Crystallogr 2001; 57:1177-9. [PMID: 11468411 DOI: 10.1107/s0907444901009611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2001] [Accepted: 06/11/2001] [Indexed: 11/10/2022]
Abstract
The archaebacterial-type aspartyl-tRNA synthetase (AspRS2) from the thermophilic eubacterium Thermus thermophilus was crystallized using the hanging-drop vapour-diffusion method. Crystals grew at pH 9.5 in the presence of PEG 8000 and NaCl. A native diffraction data set has been collected at 2.5 A resolution using synchrotron radiation and cryocooling. Crystals belong to the orthorhombic space group P2(1)2(1)2(1), with unit-cell parameters a = 57.3, b = 121.9, c = 166.9 A and V(M) = 3.03 A(3) Da(-1). There is one dimer of M(r) 96 000 per asymmetric unit. A molecular-replacement analysis gave solutions for the rotation and translation functions.
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Affiliation(s)
- C Charron
- Département "Mécanismes et Macromolécules de la Synthèse Protéique et Cristallogenèse", UPR 9002, Institut de Biologie Moléculaire et Cellulaire du CNRS, 15 Rue René Descartes, F-67084 Strasbourg CEDEX, France
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Suc A, Mariotti M, Lestrade C, Kern D, Izard P, Marmet T, Vignes M, Raynaud JP. [Children also die]. Arch Pediatr 2001; 8:751-3. [PMID: 11484460 DOI: 10.1016/s0929-693x(00)90311-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Palliative care has recently been developed in adults. However, children die as well and quite a few articles have been published on this special issue. The object of this article is to summarize the available literature in order to call for the development of clinical policies and minimum standards adapted to French pediatrics.
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Affiliation(s)
- A Suc
- Hôpital des Enfants, 330, avenue de Grande-Bretagne, BP 3119, 31026 Toulouse, France.
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Abstract
Protein actions are usually discussed in terms of static structures, but function requires motion. We find a strong correlation between phosphorylation-driven activation of the signaling protein NtrC and microsecond time-scale backbone dynamics. Using nuclear magnetic resonance relaxation, we characterized the motions of NtrC in three functional states: unphosphorylated (inactive), phosphorylated (active), and a partially active mutant. These dynamics are indicative of exchange between inactive and active conformations. Both states are populated in unphosphorylated NtrC, and phosphorylation shifts the equilibrium toward the active species. These results support a dynamic population shift between two preexisting conformations as the underlying mechanism of activation.
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Affiliation(s)
- B F Volkman
- National Magnetic Resonance Facility at Madison (NMRFAM), Department of Biochemistry, University of Wisconsin-Madison, Madison, WI 53706, USA
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Becker HD, Min B, Jacobi C, Raczniak G, Pelaschier J, Roy H, Klein S, Kern D, Söll D. The heterotrimeric Thermus thermophilus Asp-tRNA(Asn) amidotransferase can also generate Gln-tRNA(Gln). FEBS Lett 2000; 476:140-4. [PMID: 10913601 DOI: 10.1016/s0014-5793(00)01697-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Thermus thermophilus strain HB8 is known to have a heterodimeric aspartyl-tRNA(Asn) amidotransferase (Asp-AdT) capable of forming Asn-tRNA(Asn) [Becker, H.D. and Kern, D. (1998) Proc. Natl. Acad. Sci. USA 95, 12832-12837]. Here we show that, like other bacteria, T. thermophilus possesses the canonical set of amidotransferase (AdT) genes (gatA, gatB and gatC). We cloned and sequenced these genes, and constructed an artificial operon for overexpression in Escherichia coli of the thermophilic holoenzyme. The overproduced T. thermophilus AdT can generate Gln-tRNA(Gln) as well as Asn-tRNA(Asn). Thus, the T. thermophilus tRNA-dependent AdT is a dual-specific Asp/Glu-AdT resembling other bacterial AdTs. In addition, we observed that removal of the 44 carboxy-terminal amino acids of the GatA subunit only inhibits the Asp-AdT activity, leaving the Glu-AdT activity of the mutant AdT unaltered; this shows that Asp-AdT and Glu-AdT activities can be mechanistically separated.
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Affiliation(s)
- H D Becker
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT 06520-8114, USA
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Becker HD, Roy H, Moulinier L, Mazauric MH, Keith G, Kern D. Thermus thermophilus contains an eubacterial and an archaebacterial aspartyl-tRNA synthetase. Biochemistry 2000; 39:3216-30. [PMID: 10727213 DOI: 10.1021/bi992573y] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Thermus thermophilus possesses two aspartyl-tRNA synthetases (AspRSs), AspRS1 and AspRS2, encoded by distinct genes. Alignment of the protein sequences with AspRSs of other origins reveals that AspRS1 possesses the structural features of eubacterial AspRSs, whereas AspRS2 is structurally related to the archaebacterial AspRSs. The structural dissimilarity between the two thermophilic AspRSs is correlated with functional divergences. AspRS1 aspartylates tRNA(Asp) whereas AspRS2 aspartylates tRNA(Asp), and tRNA(Asn) with similar efficiencies. Since Asp bound on tRNA(Asn) is converted into Asn by a tRNA-dependent aspartate amidotransferase, AspRS2 is involved in Asn-tRNA(Asn) formation. These properties relate functionally AspRS2 to archaebacterial AspRSs. The structural basis of the dual specificity of T. thermophilus tRNA(Asn) was investigated by comparing its sequence with those of tRNA(Asp) and tRNA(Asn) of strict specificity. It is shown that the thermophilic tRNA(Asn) contains the elements defining asparagine identity in Escherichia coli, part of which being also the major elements of aspartate identity, whereas minor elements of this identity are missing. The structural context that permits expression of aspartate and asparagine identities by tRNA(Asn) and how AspRS2 accommodates tRNA(Asp) and tRNA(Asn) will be discussed. This work establishes a distinct structure-function relationship of eubacterial and archaebacterial AspRSs. The structural and functional properties of the two thermophilic AspRSs will be discussed in the context of the modern and primitive pathways of tRNA aspartylation and asparaginylation and related to the phylogenetic connexion of T. thermophilus to eubacteria and archaebacteria.
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Affiliation(s)
- H D Becker
- Unité Propre de Recherche 9002, Structure des Macromolécules Biologiques et Mécanismes de Reconnaissance, Institut de Biologie Moléculaire et Cellulaire du CNRS, 15, Rue René Descartes, 67084, Strasbourg Cedex, France
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Cura V, Moras D, Kern D. Sequence analysis and modular organization of threonyl-tRNA synthetase from Thermus thermophilus and its interrelation with threonyl-tRNA synthetases of other origins. Eur J Biochem 2000; 267:379-93. [PMID: 10632708 DOI: 10.1046/j.1432-1327.2000.01011.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The gene encoding threonyl-tRNA synthetase (Thr-tRNA synthetase) from the extreme thermophilic eubacterium Thermus thermophilus HB8 has been cloned and sequenced. The ORF encodes a polypeptide chain of 659 amino acids (Mr 75 550) that shares strong similarities with other Thr-tRNA synthetases. Comparative analysis with the three-dimensional structure of other subclass IIa synthetases shows it to be organized into four structural modules: two N-terminal modules specific to Thr-tRNA synthetases, a catalytic core and a C-terminal anticodon-binding module. Comparison with the three-dimensional structure of Escherichia coli Thr-tRNA synthetase in complex with tRNAThr enabled identification of the residues involved in substrate binding and catalytic activity. Analysis by atomic absorption spectrometry of the enzyme overexpressed in E. coli revealed the presence in each monomer of one tightly bound zinc atom, which is essential for activity. Despite strong similarites in modular organization, Thr-tRNA synthetases diverge from other subclass IIa synthetases on the basis of their N-terminal extensions. The eubacterial and eukaryotic enzymes possess a large extension folded into two structural domains, N1 and N2, that are not significantly similar to the shorter extension of the archaebacterial enzymes. Investigation of a truncated Thr-tRNA synthetase demonstrated that domain N1 is not essential for tRNA charging. Thr-tRNA synthetase from T. thermophilus is of the eubacterial type, in contrast to other synthetases from this organism, which exhibit archaebacterial characteristics. Alignments show conservation of part of domain N2 in the C-terminal moiety of Ala-tRNA synthetases. Analysis of the nucleotide sequence upstream from the ORF showed the absence of both any anticodon-like stem-loop structure and a loop containing sequences complementary to the anticodon and the CCA end of tRNAThr. This means that the expression of Thr-tRNA synthetase in T. thermophilus is not regulated by the translational and trancriptional mechanisms described for E. coli thrS and Bacillus subtilis thrS and thrZ. Here we discuss our results in the context of evolution of the threonylation systems and of the position of T. thermophilus in the phylogenic tree.
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Affiliation(s)
- V Cura
- UPR 9004 du CNRS, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France.
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Kern D, Volkman BF, Luginbühl P, Nohaile MJ, Kustu S, Wemmer DE. Structure of a transiently phosphorylated switch in bacterial signal transduction. Nature 1999; 402:894-8. [PMID: 10622255 DOI: 10.1038/47273] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Receiver domains are the dominant molecular switches in bacterial signalling. Although several structures of non-phosphorylated receiver domains have been reported, a detailed structural understanding of the activation arising from phosphorylation has been impeded by the very short half-lives of the aspartylphosphate linkages. Here we present the first structure of a receiver domain in its active state, the phosphorylated receiver domain of the bacterial enhancer-binding protein NtrC (nitrogen regulatory protein C). Nuclear magnetic resonance spectra were taken during steady-state autophosphorylation/dephosphorylation, and three-dimensional spectra from multiple samples were combined. Phosphorylation induces a large conformational change involving a displacement of beta-strands 4 and 5 and alpha-helices 3 and 4 away from the active site, a register shift and an axial rotation in helix 4. This creates an exposed hydrophobic surface that is likely to transmit the signal to the transcriptional activation domain.
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Affiliation(s)
- D Kern
- Department of Biochemistry, Brandeis University, Waltham, Massachusetts 02454, USA.
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Mazauric MH, Roy H, Kern D. tRNA glycylation system from Thermus thermophilus. tRNAGly identity and functional interrelation with the glycylation systems from other phylae. Biochemistry 1999; 38:13094-105. [PMID: 10529180 DOI: 10.1021/bi991392t] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The systems of tRNA glycylation belong to the most complex aminoacylation systems since neither the oligomeric structure of glycyl-tRNA synthetases (GlyRS) nor the discriminator bases in tRNAGly are conserved in the phylae. To better understand the structure-function relationship in glycylation systems of various origins and the functional peculiarities related to their structural divergences, the elements in tRNA conferring its glycine identity in Thermus thermophilus were characterized and compared to those of other systems. Thermophilic identity is conferred by the G1-C72, C2-G71, G3-C70, and C50-G64 pairs together with the G10, U16, C35, and C36 single residues. In contrast to most other aminoacylation systems, the discriminator base is not directly involved in identity. Transplantation of these elements in tRNAAsp and tRNAPhe converts specificity toward glycine albeit conservation of nucleotide 73. Analysis of the functional interrelation of the identity elements shows coupling in synthetase recognition of the elements from anticodon and G10 whereas those from acceptor arm are recognized independently. Despite nondirect implication in identity, the discriminator base contributes cooperatively with C36 in specificity of glycylation. The link between the structural heterogeneity and the functional divergence of the glycylation systems and the phylogenic interrelation of these systems were approached by comparing the ability of GlyRSs of various phylae to glycylate heterologous tRNAGly. Dimeric GlyRSs from mammalian and archaebacteria acylate efficiently only eukaryotic and archaebacterial tRNAGly with a discriminatory A73, whereas tetrameric Escherichia coli GlyRS acylates only eubacterial tRNAGly with a discriminatory U73. In contrast, dimeric yeast GlyRS acylates efficiently both eukaryotic and archaebacterial tRNAGly as well as peculiar prokaryotic isoacceptors. Species specificity is lost with the dimeric GlyRS from Thermus thermophilus that acylates efficiently eubacterial, archaebacterial, and eukaryotic tRNAGly. These features are discussed in the context of the evolution of the glycylation systems and the phylogenic interrelation of the organisms.
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Affiliation(s)
- M H Mazauric
- Unité Propre de Recherche 9002, Institut de Biologie Moléculaire et Cellulaire, Centre National de la Recherche Scientifique, Strasbourg, France
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Sauter C, Lorber B, Kern D, Cavarelli J, Moras D, Giegé R. Crystallogenesis studies on yeast aspartyl-tRNA synthetase: use of phase diagram to improve crystal quality. Acta Crystallogr D Biol Crystallogr 1999; 55:149-56. [PMID: 10089405 DOI: 10.1107/s0907444998010890] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/1998] [Accepted: 08/14/1998] [Indexed: 11/10/2022]
Abstract
Aspartyl-tRNA synthetase (AspRS) extracted from yeast is heterogeneous owing to proteolysis of its positively charged N-terminus; its crystals are of poor quality. To overcome this drawback, a rational strategy was developed to grow crystals of sufficient quality for structure determination. The strategy is based on improvement of the protein homogeneity and optimization of crystallization, taking advantage of predictions from crystal-growth theories. An active mutant lacking the first 70 residues was produced and initial crystallization conditions searched. The shape and habit of initial crystals were improved by establishing a phase diagram of protein versus crystallizing-agent concentrations. Growth of large well faceted crystals takes place at low supersaturations near the isochronic supersolubility curve. Further refinement led to reproducible growth of two crystalline forms of bipyramidal (I) or prismatic (II) habit. Both diffract X-rays better than crystals previously obtained with native AspRS. Complete data sets were collected at 3 A resolution for form I (space group P41212) and form II (space group P3221) and molecular-replacement solutions were found in both space groups.
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Affiliation(s)
- C Sauter
- UPR 9002, Institut de Biologie Moléculaire et Cellulaire du CNRS, 15 rue René Descartes, F 67084 Strasbourg CEDEX, France
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