Standardization of the psychometric hepatic encephalopathy score in a French population

The Psychometric Hepatic Encephalopathy Score (PHES) has previously been standardized in thirteen countries on three continents, confirming its status of gold standard test to detect minimal hepatic encephalopathy (MHE). In the meantime, performance has also been shown to vary with variables such as age, education, and barely sex. The present study aimed at standardizing the PHES in a French population. One hundred and ninety-six French healthy participants completed a French version of the paper-and-pencil PHES, involving five tests and six measures. Importantly, the balance was perfect between all levels of the three controlled factors, which were sex, age (seven decade-levels from 20–29 to 80–89 years), and education (two levels below or above 12 years of education). Raw measures were transformed to fit the normal distribution. ANOVAs on transformed variables showed no effect of sex, but an effect of age on all measures, and of education on five measures. Multiple or simple regressions were completed to build up normograms. Thorough analysis of variability within each test failed to find outliers that may bias the results. Comparison between French and seminal German data showed that they highly fitted though cultural and cognitive style specificities could be observed. This is the first study to standardize the PHES in a French population and to extensively explore the effects of sex, age and education using perfectly balanced samples. Subtle differences between countries of the same continent emphasize the need to build up normative data in each country to get accurate PHES in patients.

Educating the blind brain: a panorama of neural bases of vision and of training programs in organic neurovisual deficits

Vision is a complex function, which is achieved by movements of the eyes to properly foveate targets at any location in 3D space and to continuously refresh neural information in the different visual pathways. The visual system involves five main routes originating in the retinas but varying in their destination within the brain: the occipital cortex, but also the superior colliculus (SC), the pretectum, the supra-chiasmatic nucleus, the nucleus of the optic tract and terminal dorsal, medial and lateral nuclei. Visual pathway architecture obeys systematization in sagittal and transversal planes so that visual information from left/right and upper/lower hemi-retinas, corresponding respectively to right/left and lower/upper visual fields, is processed ipsilaterally and ipsialtitudinally to hemi-retinas in left/right hemispheres and upper/lower fibers. Organic neurovisual deficits may occur at any level of this circuitry from the optic nerve to subcortical and cortical destinations, resulting in low or high-level visual deficits. In this didactic review article, we provide a panorama of the neural bases of eye movements and visual systems, and of related neurovisual deficits. Additionally, we briefly review the different schools of rehabilitation of organic neurovisual deficits, and show that whatever the emphasis is put on action or perception, benefits may be observed at both motor and perceptual levels. Given the extent of its neural bases in the brain, vision in its motor and perceptual aspects is also a useful tool to assess and modulate central nervous system (CNS) in general.

Stimuli-Responsive Triblock Polymers for Multipulse Drug Delivery

Temperature and pH-sensitive ABC triblock polymers were prepared to form hydrogel membranes capable of changing their structure in response to environmental stimuli, allowing drug release, from a micro implantable device, in short and repetitive pulses. We have previously investigated the capacity of hydrogels to sustain open loop oscillatory behavior, with application in rhythmic hormone release. This novel oscillator is mediated by feedback instability between swelling/shrinking of the hydrogel and an enzyme reaction, whose product modifies pH in the hydrogel. The objective of this work was to prepare and characterize triblock polymer-based hydrogels, to overcome limitations of conventional hydrogels. Our strategy involves reversible arrangement of A and C thermosensitive domains within a strong network, whereas B block is also pH-sensitive. The triblock was mainly based on the use of NIPAAm (N, isopropylacrylamide) and AA (acrylic acid) monomers. Polymers were synthesized by reversible addition fragmentation chain transfer (RAFT) polymerization. Polymers molecular weight (Mn) and polydispersity index (PDI) were determined by matrix-assisted laser desorption ionization/mass spectrometry (MALDI). Monomers conversion was assessed by NMR and copolymers composition by NMR and pH-titration. Temperature and pH responsiveness was studied by turbidity and light scattering experiments. ABC triblock presented Mn close to 40,000 Da and was nearly monodisperse (PDI<1.1). The monomers conversion was 92%, 97% and 39% for A, B and C blocks, respectively. The opposing effects of hydrophobicity and ionization on the aggregation behavior of the diblock have been highlighted through the turbidity and light scattering data. AB diblock cloud points were 32, 34, 35.5 and 37°C for 3, 5, 10 and 20% of AA, respectively. Micelles or aggegrates were observed depending on pH and temperature. ABC triblock polymers with controlled architecture and Mn distribution were synthesized and fully characterized. The results suggest that these block polymers are promising materials for stimul-responsive hydrogel membranes applied to medical devices. Work supported by the Swiss National Fund for Scientific Research and an NSF-funded MRSEC (DMR#0819885) at the University of Minnesota.

Stimuli-Responsive Triblock Polymers for Multipulse Drug Delivery

Temperature and pH-sensitive ABC triblock polymers were prepared to form hydrogel membranes capable of changing their structure in response to environmental stimuli, allowing drug release, from a micro implantable device, in short and repetitive pulses. We have previously investigated the capacity of hydrogels to sustain open loop oscillatory behavior, with application in rhythmic hormone release. This novel oscillator is mediated by feedback instability between swelling/shrinking of the hydrogel and an enzyme reaction, whose product modifies pH in the hydrogel. The objective of this work was to prepare and characterize triblock polymer-based hydrogels, to overcome limitations of conventional hydrogels. Our strategy involves reversible arrangement of A and C thermosensitive domains within a strong network, whereas B block is also pH-sensitive. The triblock was mainly based on the use of NIPAAm (N, isopropylacrylamide) and AA (acrylic acid) monomers. Polymers were synthesized by reversible addition fragmentation chain transfer (RAFT) polymerization. Polymers molecular weight (Mn) and polydispersity index (PDI) were determined by matrix-assisted laser desorption ionization/mass spectrometry (MALDI). Monomers conversion was assessed by NMR and copolymers composition by NMR and pH-titration. Temperature and pH responsiveness was studied by turbidity and light scattering experiments. ABC triblock presented Mn close to 40,000 Da and was nearly monodisperse (PDI<1.1). The monomers conversion was 92%, 97% and 39% for A, B and C blocks, respectively. The opposing effects of hydrophobicity and ionization on the aggregation behavior of the diblock have been highlighted through the turbidity and light scattering data. AB diblock cloud points were 32, 34, 35.5 and 37.5°C for 3, 5, 10 and 20% of AA, respectively. Micelles or aggegrates were observed depending on pH and temperature. ABC triblock polymers with controlled architecture and Mn distribution were synthesized and fully characterized. The results suggest that these block polymers are promising materials for stimuli-responsive hydrogel membranes applied to medical devices. Work supported by the Swiss National Fund for Scientific Research and an NSF-funded MRSEC (DMR#0819885) at the University of Minnesota.

Nanoparticles for drug delivery: the need for precision in reporting particle size parameters

Polymeric drug-loaded nanoparticles have been extensively studied in the field of drug delivery. Biodistribution depends on the physicochemical properties of particles, especially size. The global message from the literature is that small particles have an enhanced ability to reach their target. The present review highlights the difficulties in validating the data from biodistribution studies without accurate particle size determination.

Fluorescent biodegradable PLGA particles with narrow size distributions: preparation by means of selective centrifugation

Size is the most studied parameter in the field of nanoparticle characterization but few studies have been performed on biodegradable particles with well-defined sizes. The aim of this work was to prepare fluorescent biodegradable polymeric particles having well-defined sizes and well-characterized surface properties. Poly(D,L-lactide-co-glycolide acid) particles were prepared by the emulsion evaporation process. Filtration and centrifugation were used to produce particle fractions in the narrow size range from polydispersed batches, and the efficiency of separation was compared. Selective centrifugation allowed for the preparation of five classes of particles having narrow size distribution (0.1, 0.3, 0.6, 1 and 2 microm). Particles were characterized in terms of size distribution, surface morphology, charge, residual surfactant and hydrophilicity. The results showed similar surface properties for all the batches. 3,3'-Dioctadecyloxacarbo-cyanine perchlorate has been successfully incorporated as a fluorescent dye and its ability to remain associated with the particles during cell culture experiments has been proven. Such particles may be used as an adequate tool for studying cellular uptake.