[PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study]. / Bloqueio PECS I para analgesia pós­operatória em pacientes submetidos a mamoplastia de aumento: estudo randomizado, duplo­cego, controlado por placebo.

BACKGROUND AND OBJECTIVES: PECS I block was first described for surgery involving the pectoralis muscles. No randomized clinical trial has been conducted on surgeries that directly involve these muscles, such as subpectoral breast augmentation. We hypothesized that PECS I block would decrease pain in the postoperative period in this population. METHODS: This was a randomized, double-blind, placebo-controlled trial in women undergoing subpectoral breast augmentation surgery. PECS I block was performed using 0.4 mL.kg-1 of 0.9% saline on one side and bupivacaine (0.25%) on the other side, each patient being her own control. Numeric Rating Scale (NRS) pain scores (0-10) were measured at rest and during movement. The primary outcome was pain score at rest 30 minutes after arrival in the PACU. To detect a clinically significant difference of 50% in pain reduction, 14 volunteers were enrolled (power of 90% and alpha<0.05). RESULTS: In the PACU, three patients had no difference in pain between sides, five had reduced pain on the placebo side, and six had reduced pain on the bupivacaine side. In the bupivacaine group, pain scores at rest at 5, 30 and 60 minutes and 24 hours were 4.89 (4.23-5.56; mean 95% CI), 3.75 (3.13-4.37), 3.79 (2.93-4.64), and 2.29 (1.56-3.01), respectively, whereas in the placebo group, they were 4.96 (4.32-5.60), 4.00 (3.50-4.49), 3.93 (3.12-4.73), and 2.29 (1.56-3.01), respectively. CONCLUSIONS: PECS I block in patients undergoing breast augmentation surgery does not provide better pain relief than placebo. Therefore, the indications for PECS I block in breast augmentation surgery should be reconsidered.

PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study / Bloqueio PECS I para analgesia pós-operatória em pacientes submetidos a mamoplastia de aumento: estudo randomizado, duplo-cego, controlado por placebo

Abstract Background and objectives: PECS I block was first described for surgery involving the pectoralis muscles. No randomized clinical trial has been conducted on surgeries that directly involve these muscles, such as subpectoral breast augmentation. We hypothesized that PECS I block would decrease pain in the postoperative period in this population. Methods: This was a randomized, double-blind, placebo-controlled trial in women undergoing subpectoral breast augmentation surgery. PECS I block was performed using 0.4 mL.kg-1 of 0.9% saline on one side and bupivacaine (0.25%) on the other side, each patient being her own control. Numeric Rating Scale (NRS) pain scores (0 - 10) were measured at rest and during movement. The primary outcome was pain score at rest 30 minutes after arrival in the PACU. To detect a clinically significant difference of 50% in pain reduction, 14 volunteers were enrolled (power of 90% and alpha < 0.05). Results: In the PACU, three patients had no difference in pain between sides, five had reduced pain on the placebo side, and six had reduced pain on the bupivacaine side. In the bupivacaine group, pain scores at rest at 5, 30 and 60 minutes and 24 hours were 4.89 (4.23 - 5.56; mean 95% CI), 3.75 (3.13 - 4.37), 3.79 (2.93 - 4.64), and 2.29 (1.56 - 3.01), respectively, whereas in the placebo group, they were 4.96 (4.32 - 5.60), 4.00 (3.50 - 4.49), 3.93 (3.12 - 4.73), and 2.29 (1.56 - 3.01), respectively. Conclusions: PECS I block in patients undergoing breast augmentation surgery does not provide better pain relief than placebo. Therefore, the indications for PECS I block in breast augmentation surgery should be reconsidered.

Resumo Justificativa e objetivos: O bloqueio PECS I foi descrito pela primeira vez para cirurgia envolvendo os músculos peitorais. Nenhum estudo clínico randomizado foi realizado em procedimentos envolvendo diretamente os músculos peitorais, como a mamoplastia de aumento submuscular. Nossa hipótese foi de que o bloqueio PECS I diminuiria a dor pós-operatória nessa população. Método: Realizamos estudo randomizado, duplo-cego, controlado por placebo em mulheres submetidas à mamoplastia de aumento submuscular. Realizamos o bloqueio PECS I com 0,4 mL.kg-1 de solução salina a 0,9% de um lado e bupivacaína (0,25%) do outro lado, sendo cada paciente seu próprio controle. Os escores da Escala de Avaliação Numérica (EAN) de dor (0 - 10) foram obtidos em repouso e durante movimento. O desfecho primário foi o escore de dor em repouso 30 minutos após a chegada à SRPA. Para detectar uma diferença clinicamente significante de 50% na redução da dor, 14 voluntárias foram incluídas (poder de 90% e alfa < 0,05). Resultados: Na SRPA, três pacientes não apresentaram diferença na dor entre os lados, cinco relataram menos dor no lado do placebo e seis, menos dor no lado da bupivacaína. No grupo bupivacaína, os escores de dor em repouso aos 5, 30 e 60 minutos e 24 horas foram 4,89 (4,23 - 5,56; IC médio 95%), 3,75 (3,13 - 4,37), 3,79 (2,93 - 4,64) e 2,29 (1,56 - 3,01), respectivamente, enquanto no grupo placebo foram 4,96 (4,32 - 5,60), 4,00 (3,50 - 4,49), 3,93 (3,12 - 4,73) e 2,29 (1,56 - 3,01), respectivamente. Conclusões: O bloqueio PECS I em pacientes submetidas a mamoplastia de aumento não oferece melhor alívio da dor do que o placebo. Portanto, as indicações para bloqueio de PECS I na cirurgia de aumento de mama devem ser reconsideradas.

Highly efficient evaluation of diffusion networks in Li ionic conductors using a 3D-corrugation descriptor.

A highly efficient computational approach for the screening of Li ion conducting materials is presented and its performance is demonstrated for olivine-type oxides and thiophosphates. The approach is based on a topological analysis of the electrostatic (Coulomb) potential obtained from a single density functional theory calculation augmented by a Born-Mayer-type repulsive term between Li ions and the anions of the material. This 3D-corrugation descriptor enables the automatic determination of diffusion pathways in one, two, and three dimensions and reproduces migration barriers obtained from density functional theory calculations using nudged elastic band method within approximately 0.1 eV. Importantly, it correlates with Li ion conductivity. This approach thus offers an efficient tool for evaluating, ranking, and optimizing materials with high Li-ion conductivity.

In Vitro DNase I Footprinting.

The association of proteins with the DNA double helix can interfere with the accessibility of the latter to nucleases. This is particularly true when using bulky nucleases such as DNase I. The DNase I footprinting method was developed to take advantage of this fact in the study of DNA-protein interactions: it consists in comparing the pattern of fragments generated by the partial digestion of a DNA sequence in the absence of a protein to that produced by its partial digestion in the presence of said protein. Normally, when the two sets of fragments are separated side by side on a gel, the ladder of DNase I-generated fragments produced in the presence of the protein will feature blank regions (devoid of fragments, indicating protection) and/or enhanced cleavage sites (indicating increased availability to the nuclease). This technique can furthermore reveal if multiple sites for a DNA-binding protein are present on a same fragment and in such a case will also allow the comparison of their respective affinities.

Analysis of DNA Supercoiling Induced by DNA-Protein Interactions.

Certain DNA-interacting proteins induce a pronounced bending in the double helix and cause topological stresses that are compensated by the formation of supercoils in DNA. Such supercoils, when forming on a circular plasmid, give rise to a series of topoisomers that run at different speeds during electrophoresis. The number of supercoils introduced in the plasmid can provide information on the protein; it can, for example, help determine the number of nucleosomes that are assembled on the plasmid or indicate whether the DNA-bending activity of a transcription factor is important enough to cause a topological stress. Because a DNA-protein activity can lead to either an overwinding or an underwinding of the helix, supercoiling can occur in either direction. Determining whether a plasmid contains positively or negatively supercoiled DNA is possible, thanks to an agarose gel containing an intercalating agent known to positively supercoil DNA, such as chloroquine. The speed of migration of the topoisomers varies in a characteristic way in the presence and absence of the agent. Topoisomer standards can furthermore be generated to allow the easy evaluation of the number of supercoils induced in a plasmid by a DNA-protein interaction.

Recent Canadian plastic surgery graduates: are they prepared for the real world?

BACKGROUND: The purpose of this study was to evaluate the correlation between plastic surgery education received through residency in Canadian programs and perceived preparedness for independent clinical practice among recently graduated plastic surgeons. METHODS: All practicing plastic surgeons having graduated from a Canadian program between 1996 and 2006 were surveyed. An itemized Web-based questionnaire was designed and distributed by e-mail with the assistance of all program directors. RESULTS: Eighty (52 percent) of the 155 recent graduates from Canadian plastic surgery programs with valid contact information responded to the survey. The majority of respondents were satisfied with most aspects of their training. Only 22 percent of respondents had done part of their training in a foreign center, but all of them agreed that it was beneficial to their training. Clinical research was encouraged in 92 percent of the respondents' programs, but dedicated time was only allocated in 29 percent of these. At the beginning of their practice, the majority of respondents felt comfortable or very comfortable in all subspecialties with the exception of pediatric plastic surgery and ancillary procedures. CONCLUSIONS: The authors' results describe the tendencies in type and duration of the training that Canadian graduates had over the last 10 years. The majority of respondents were satisfied with most aspects of their residency programs and felt comfortable practicing different subspecialties early in their careers. Expectations during residency and the resources made available to meet these expectations are also revealed. This study will help improve residency programs by identifying existing gaps in the preparedness of surgeons.

DNase I footprinting.

The association of proteins with the DNA double helix can interfere with the accessibility of the latter to nucleases. This is particularly true when using bulky nucleases such as DNAse I. The DNAse I footprinting method was developed to make use of this phenomenon in the study of DNA-protein interactions; it consists in comparing the pattern of fragments produced by the partial digestion of DNA in the absence of a protein to that produced by partial digestion of DNA in the presence of a protein. Normally, when the two sets of fragments are separated side by side on a gel, the fragments produced in the presence of the protein will feature blank regions (indicating protection) and/or enhanced cleavage sites (indicating increased availability). This technique can furthermore reveal if multiple sites for a DNA-binding protein are present on a same fragment, and allow the comparison of their respective affinities.

Analysis of DNA supercoiling induced by DNA-protein interactions.

Certain DNA-interacting proteins induce a pronounced bending in the double helix and cause topological stresses that are compensated by the formation of supercoils in DNA. Such supercoils, when forming on a circular plasmid, give rise to a series of topoisomers that run at different speeds during electrophoresis. The number of supercoils introduced in the plasmid can provide information on the protein; it can for example help determine the number of nucleosomes that are assembled on the plasmid or indicate whether the DNA-bending activity of a transcription factor is important enough to cause a topological stress. Because a DNA-protein activity can lead to either an overwinding or an underwinding of the helix, supercoiling can occur in either direction. Determining whether a plasmid contains positively or negatively supercoiled DNA is possible, thanks to an agarose gel containing an intercalating agent known to positively supercoil DNA, such as chloroquine. The speed of migration of the topoisomers varies in a characteristic way in the presence and absence of the agent. Topoisomer standards can furthermore be generated to allow the easy evaluation of the number of supercoils induced in a plasmid by a DNA-protein interaction.

How many genes in a genome?

Despite the current good level of annotation, the Drosophila genome still holds surprises. A recent study has added perhaps 2,000 genes to the predicted total, and raises a number of questions about how genome annotation data should be stored and presented.

Targeted histone acetylation at the yeast CUP1 promoter requires the transcriptional activator, the TATA boxes, and the putative histone acetylase encoded by SPT10.

The relationship between chromatin remodeling and histone acetylation at the yeast CUP1 gene was addressed. CUP1 encodes a metallothionein required for cell growth at high copper concentrations. Induction of CUP1 with copper resulted in targeted acetylation of both H3 and H4 at the CUP1 promoter. Nucleosomes containing upstream activating sequences and sequences farther upstream were the targets for H3 acetylation. Targeted acetylation of H3 and H4 required the transcriptional activator (Ace1p) and the TATA boxes, suggesting that targeted acetylation occurs when TATA-binding protein binds to the TATA box or at a later stage in initiation. We have shown previously that induction results in nucleosome repositioning over the entire CUP1 gene, which requires Ace1p but not the TATA boxes. Therefore, the movement of nucleosomes occurring on CUP1 induction is independent of targeted acetylation. Targeted acetylation of both H3 and H4 also required the product of the SPT10 gene, which encodes a putative histone acetylase implicated in regulation at core promoters. Disruption of SPT10 was lethal at high copper concentrations and correlated with slower induction and reduced maximum levels of CUP1 mRNA. These observations constitute evidence for a novel mechanism of chromatin activation at CUP1, with a major role for the TATA box.