[Service rendered's assessment of a pharmaceutical information center on patients care]. / Évaluation du service rendu d'un centre d'information pharmaceutique sur la prise en charge des patients.

The Question-Answer (Q/R) service of Lyon's teaching hospital, offers reliable and updated information for healthcare professionals (HP). The impact of Q/R activity on patient outcome was measured by using a survey to assess user's satisfaction and impact on HP knowledge and/or patients cares. The compatibility of this tool with daily use had been assessed too. MATERIALS AND METHODS: The survey was sent prospectively, for 9 months in 2018, to all HP whose enquiry was linked to a particular patient's care. The survey was posted 24-48h after the answer had been provided. RESULTS: 41 survey over 55 sent were returned (74.5%). The level of satisfaction measured is mostly good or excellent on all evaluated items. The HP surveyed consider that the responses provided have a potential positive impact on their professional knowledge and practices (97.6%), on the patient's care (n=36/37) and patient outcome (n=22/23). CONCLUSION: High level of satisfaction with the Q/R service and positive impact of this specialized Q/R service on improvement of HP knowledge and patient's care. This tool can be used in daily practice.

Immunomodulatory effects of probiotics in the intestinal tract.

The intestinal microbiota is the largest source of microbial stimulation that exerts both harmful and beneficial effects on human health. The interaction between probiotic and enterocytes is the initiating event in immunomodulation and merits particular attention. The effects of probiotic is strain dependent and for each new probiotic strain, profiles of cytokines secreted by lymphocytes, enterocytes or dendritic cells that come in contact with the strain should be systematically established. To evaluate the effects of probiotics on the immune system, models that mimic the mucosa, and thus the physiological reality, should be preferred whenever it is possible. Then, the in vitro observed effects should be backed up by properly conducted randomized double bind clinical studies. More detailed studies are needed to determine the precise action mode of probiotics on both mucosal and systemic immunity.

Extraction and characterization of collagen with or without telopeptides from chicken skin.

Poultry by-products are not often processed into high-value products. Rather than being transformed into meal for animal feed, a large quantity of chicken skin could be used to produce collagen, which is valued for its unique functional properties. The purpose of this research project was to extract and characterize collagen from chicken skin. Skins were first ground and then were heated to 40 or 60 degrees C to extract the fat. After mechanical separation, the collagen contained in the resulting solid phase was extracted with pepsin or ethylene diamine. Types I and III collagen were then isolated and characterized by SDS PAGE, antigen labeling, determination of tyrosine residues, and transmission electron microscopy. The total collagen content of the skin was recovered from the solid phase following heat treatment at 40 degrees C. Extraction yields varied with the solubilization process: 38.9% of the collagen content in the solid phase was extracted with pepsin and 25.1% with ethylene diamine. Ratios of type I to type III collagen fractionated using NaCl were 74.4:19.8% with pepsin and 62.4:31.7% with ethylene diamine. Characterization tests further revealed the presence of telopeptides solely on ethylene diamine-solubilized collagen. Chicken skin thus appears to be a good alternative source of high-quality collagen.

The effects of alpha-lactalbumin and whey protein concentrate on alpha-amino acids, calcium and phosphorus levels in blood and gastrointestinal tract of rats.

The effects of two dietary proteins on alpha-amino acids, calcium and phosphorus concentrations in plasma, stomach and intestine were investigated in rats trained to consume, in a single two-hour daily meal, diets containing a-lactalbumin (alpha-la) or whey protein concentrate (WPC) for two weeks. The results indicated that the concentrations of calcium and phosphorus in the gastrointestinal tract and that of a-amino acids in portal vein were not significantly influenced by the nature of diets. The amount of alpha-amino acids in the gastrointestinal tract of rats fed on WPC diet was significantly (p < 0.001) higher than that of alpha-la group. The levels of insoluble calcium and insoluble phosphorus in the small intestine were significantly (p < 0.001) higher in alpha-la group than in WPC group. These results indicated that the kinetics of alpha-amino acids, calcium and phosphorus were differently influenced by the nature of diet ingested, the sampling time and the sites of sample collections.

Effect of added salt and increase in ionic strength on skim milk electroacidification performances.

Bipolar-memibrane electroacidification (BMEA) technology which uses the property of bipolar membranes to split water and the demineralization action of cation-exchange membranes (CEM), was tested for the production of acid casein. BMEA has numerous advantages in comparison with conventional isoelectric precipitation processes of proteins used in the dairy industry. BMEA uses electricity to generate the desired ionic species to acidify the treated solutions. The process can be precisely controlled, as electro-acidification rate is regulated by the effective current density in the cell. Water dissociation at the bipolar membrane interface is continuous and avoids local excess of acid. In-situ generation of dangerous chemicals (acids and bases) reduces the risks associated with the handling, transportation, use and elimination of these products. The aim of this study was to evaluate the performance of BMEA in different conditions of added ionic strength (p(added) = 0, 0.25, 0.5 and 1.0 M) and added salt (CaCl2, NaCl and KCl). The combination of KCl and p(added) = 0.5 M gave the best results with a 45% decrease in energy consumption. The increased energy efficiency was the result of a decrease in the anode/cathode voltage difference. This was due to an increase of conductivity, produced by addition of salt, necessary to compensate for the lack of sufficiently mobile ions in the skim milk. However, the addition of salts, irrespective of type or ionic strength, increased the required operation time. The protein profile of isolates were similar under all experimental conditions, except at 1.0 M-CaCl2.

Bipolar membrane electroacidification of demineralized skim milk.

The aim of this study was to evaluate the effect of decreasing the mineral content of skim milk by electrodialysis (ED) prior to electroacidification with bipolar membrane (BMEA) on the performance of the process, the chemical composition, and the physicochemical and functional properties of the isolates produced. ED used to demineralize the skim milk solution was very efficient. However, the electroacidification parameters were influenced by the demineralization level of the skim milk solution: the energy efficiency was decreased with an increase in demineralization, but it was still possible to perform BMEA at a very low conductivity level. Moreover, the isolates produced by BMEA after electrodialysis demineralization at different rates showed similar chemical composition, except on potassium and lactose contents for 75% demineralized isolate. These isolates, except on protein load for 75% demineralization rate, showed similar physicochemical and functional properties, whatever the demineralization rate.

The effects of alpha-lactabumin and whey protein concentrate on dry matter recovery, TCA soluble protein levels, and peptide distribution in the rat gastrointestinal tract.

The effects of two dietary proteins on dry matter recovery, trichloroacetic acid (TCA) soluble protein concentration, and peptide distribution in gastrointestinal contents were investigated in rats trained to consume, in a single 2-hour daily meal, diets containing alpha-lactalbumin (alpha-LA) or whey protein concentrate (WPC) for two weeks. Compared with the WPC diet, the alpha-LA diet emptied faster from the stomach. Dry matter recovery was higher in the stomach contents of rats fed the WPC diet than in those given the alpha-LA diet, but dry matter content in the small intestine was comparable. TCA soluble protein levels in the stomach and the small intestinal contents were also significantly (P < 0.001) higher in rats fed the WPC diet. The concentration of peptides having molecular weights (MW) ranging from 12,500-30,000 daltons (Da) was higher in the stomach contents of rats fed the WPC diet. Conversely, the level of peptides ranging from 5000-12,500 Da was higher in the stomach contents of rats fed the alpha-LA diet. For both diets, the small intestinal contents were characterized by high levels of amino acids and small peptides. These results suggest that the hydrolysis and absorption of alpha-LA is faster than that of WPC.

Effect of cationic membrane permselectivity on the efficiency of skim milk electroacidification.

Bipolar membrane electroacidification (BMEA) uses the property of bipolar membranes to split water and the demineralization action of cation-exchange membranes (CEM). As milk mineral salt content is very sensitive to ionic strength and pH changes, the aim of this study was to better understand the effect of changes in mineral content during pH decrease and demineralization of skim milk. The objectives were to investigate the effect of different cationic permselective membranes (CSV and CMX membranes) on skim milk cation migration and protein precipitation during BMEA. The permselectivity of both membranes tested does not influence the final efficiency of BMEA. The purity of the bovine milk casein isolates produced was similar to or higher (97-98% versus 93.4-96.7) than those of commercial isolates, due to a reduced ash content (1.2 versus 2.0-3. 8%) resulting from the CEM demineralizing phenomenon. For both membranes, the main ionic species to migrate was the potassium ions.

Bipolar membrane electroacidification to produce bovine milk casein isolate.

Bipolar membrane electroacidification (BMEA) has been developed previously (Bazinet et al., Report for the Canadian Electricity Association 9326 U 987, 1996; Bazinet et al., J. Agric. Food Chem. 1997, 45, 2419-2425, 3788-3794) and has been used for isoelectric precipitation of soybean proteins. The purpose of this study was to validate the feasibility of BMEA for the precipitation of milk casein and to investigate the effect of flow rate. High-purity isolates containing 1.23 and 2.00% ash and 85.4 and 91.6% total protein were obtained with flow rates of 0.2 and 1.2 gal/min. The molecular composition profiles of the isolates obtained by HPLC showed that only caseins were precipitated. However, except for protein precipitation curves, the flow rate did not influence the final composition and purity of the isolates. These results showed that BMEA is a new alternative process for the production of high-purity bovine milk casein isolate.

Adverse reactions to food constituents: allergy, intolerance, and autoimmunity.

Food allergies and intolerance represent important health concerns to consumers who are predisposed to these illnesses. Unlike many current food safety issues, food sensitivities are complicated by both complex and multiple individual adverse reactions, which can vary from emotional to pathophysiological ailments. In some instances, the underlying mechanisms that result in the development of food allergies or intolerance have marked differences but produce common symptoms. The present-day diagnosis of these disorders can be impeded by intrinsic limitations in generating accurate information from patient history and biochemical, physicochemical, and immunochemical tests. Oral challenge tests represent effective methods for confirming and testing food allergens and food intolerance; however, these procedures are often restricted to clinical trials. It is important to be able to distinguish among food allergy, intolerance, and autoimmune disease in the management of these disorders. The role of food in the development of autoimmune disease may be exemplified by celiac disease, a food-induced enteropathy, requiring exposure to prolamins in wheat, rye, and barley. Various wheat and soy protein sources, including the soy protein isolates used to make infant formulas, have been related to juvenile or insulin-dependent diabetes mellitus (IDDM), a common chronic disease of childhood. Employing food process technologies to eliminate food constituents with potential for intolerance in some individuals is a potentially viable approach for reducing risk to food-related disorders. Finally, the development of food labelling regulations that require the identification of potential food allergens or agents for intolerance in the ingredient declaration on prepackaged food is a positive step toward the prevention of severe adverse reactions in hypersensitive individuals.

The effect of milk fermentation by Lactobacillus helveticus on the release of peptides during in vitro digestion.

This study evaluated the effect of protein hydrolysis by lactic acid bacteria during milk fermentation on the release of amino acids and peptides duing subsequently simulated peptic and pancreatic digestion. After digestion with trypsin, we compared the elution patterns of proteins and peptides obtained from unfermented milk and from milk fermented by Lactobacillus helveticus under pH control, using HPLC gel filtration and reverse-phase HPLC. The results indicate that milk fermentation affects the release of some amino acids during simulated gastrointestinal digestion and has a major impact on the modification of protein elution profiles obtained after digestion with trypsin. We conclude that proteolysis during fermentation may lead to the formation of novel peptides during gastrointestinal digestion.

[Anaphylactoid shock due to metabisulfites during cesarean section under peridural anesthesia]. / Choc anaphylactoïde aux métabisulfites au cours d'une césarienne sous anesthésie péridurale.

Sulfiting agents are antioxidants widely used in both food and pharmaceutical industries. They have been identified as responsible for adverse severe reactions. A case is reported of anaphylactoid shock during epidural anaesthesia for caesarean section. The responsible agent was metabisulfite, additive agent of local anesthetics containing epinephrine.

[A rare and serious complication of spinal anesthesia: bacterial meningitis]. / Une complication rare et grave de la rachi-anesthésie: la méningite bactérienne.

Bacterial meningitis following spinal anaesthesia is a rare but serious complication. We describe a case in which an old woman received spinal anaesthesia for hip replacement. Diagnosing the aetiologic agent is a major medical challenge. The possible aetiological causes of this complication are discussed and the difficulty in differentiation between aseptic and bacterial meningitis noted.

[Is it possible to avoid a penal offence in carrying out ambulatory anesthesia?]. / Peut-on éviter la faute pénale en réalisant une anesthésie ambulatoire?

French jurisprudence about outpatient anaesthesia is resolutely unfavorable. It is principally based on the June 22nd 1972 decision of the cessation court, the highest court of justice in France. Preoperative non hospitalisation has been considered as a fault by negligence/carelessness of the practitioners. It resulted in their penal condemnation for involuntary injuries and compensation for the harm. This decision is linked with the evolution of the fault and the responsibility share between surgeon and anaesthetist. The post-operative phase seems to involve "theory of missing luck" (causality linkage or the detriment in itself), excluding a penal condemnation but not a partial compensation. Though some new legal considerations could be put forward, a written contract between physicians and patients is necessary in outpatient surgery, whereas the medical files and the organisation of the unit can prove the quality of medical care.

[An unusual foreign body in the esophagus]. / Observation d'un corps étranger inhabituel de l'oesophage.

This is a case of oesophageal penetration by dental prosthesis probably brought on by alcoholism. No other classical complication occurred for three weeks. It was increasing dysphagia that led the patient to hospital. Endoscopy revealed an unfamiliar object and its nature, but did not enable it to be extracted. The object was taken out afterwards by cervicotomy.

[The ambulatory anesthesia unit: a problem of organization]. / L'unité d'anesthésie ambulatoire: un problème d'organisation.

A specialized unit in outpatient anaesthesia and surgery needs an adapted planning. During the preoperative period, it is particularly important to preserve the time of the patients. Different types of structures are possible for the intraoperative period depending on their degree of independence to a hospital. The hospital based unit, with independent facilities, offers various advantages. Its size and its conception must be adapted to the constraints of ambulatory technique, and to the expected needs. During the postoperative period, a special medical organization must be planned to help the patient if necessary. The part of the secretarial work is important for the success of such a unit. Its efficiency may be improved by computerised treatment of part of the information.

High-performance liquid chromatography of casein hydrolysates phosphorylated and dephosphorylated. I. Peptide mapping.

A mixture of small peptides of molecular weight averaging 1000 daltons, obtained by controlled hydrolysis of casein with proteases, chymotrypsin and trypsin, was separated by size-exclusion and reversed-phase high-performance liquid chromatography. Peptides were identified and located in the known casein structures from their amino acid content and their N- and C-terminal amino acid analyses. The primary structure of peptides identified from casein hydrolysate phosphorylated and casein hydrolysate dephosphorylated is presented.

Preparative separation of small molecular weight peptides from casein hydrolysate using gel filtration and immobilized metal ion affinity chromatography.

A two step method consisting of a gel filtration step, followed by a Immobilized Metal Affinity Chromatography (IMAC) step using a IDA-Cu coupled Sephadex G-25 column, on a preparative scale is described for the group separation of peptides from a casein hydrolysate. The 48 groups of peptides thus separated are further characterised by RP-HPLC and amino acid analysis. Some peptides after the analytical RP-HPLC step are further characterised by sequencing. An insight into the mechanism of retention on IMAC of the peptides is attempted. In such complex mixtures as casein hydrolysate, the peptide-peptide interaction can mask the potential sites of interactions in a single peptide. The results obtained using volatile buffers as eluents show the possibility of using IMAC step as an alternative to obtain gram quantities of group of peptides free of salts from complex protein hydrolysates.