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La thérapie cellulaire est au centre de la médecine régénérative, une nouvelle avenue thérapeutique en constante évolution depuis les 2 dernières décennies, particulièrement pour les maladies touchant les organes avec très faible potentiel de régénération. Parmi les nombreuses populations de cellules souches identifiées jusqu’à présent, les cellules souches mésenchymateuses (MSC) offrent plusieurs avantages, notamment en cardiopathie ischémique. Les MSC originalement isolées de la moelle osseuse (MO) sont à présent isolées de plusieurs autres organes dont le tissu adipeux (cellules souches mésenchymateuses dérivées du tissu adipeux ASC), un organe facile d’accès et disponible en grande quantité chez l’humain. Les évidences précliniques et cliniques des MSC et ASC pointent vers une efficacité thérapeutique qui demeure limitée et nécessite une optimisation pour atteindre le potentiel de guérison et de réparation myocardique post injure ischémique. Malgré un potentiel de différenciation in vitro et in vivo, l’effet thérapeutique des cellules souches est lié aux nombreux médiateurs constituant leur sécrétome. Ainsi, afin d’optimiser l’impact thérapeutique, plusieurs méthodes ont été utilisées pour enrichir le sécrétome. Une de ces méthodes est la culture des cellules souches sous forme 3-D. Nous avons donc testé le potentiel thérapeutique des ASC sous forme de monocouche (ML pour Monolayer) et sous forme de sphéroïdes (SB pour spheroid bodies) dans deux modèles animaux différents. Ceci a été fait en testant l’efficacité d’une transplantation à distance sous cutanée. En utilisant un modèle de péritonite, les ASC sous forme SB et ML ont démontré un effet antiinflammatoire en réduisant l’infiltration de cellules inflammatoires, plus spécifiquement les neutrophiles et les macrophages. Dans un modèle d’ischémie reperfusion (I/R) du myocarde chez le rat, les ASC sous forme ML et SB ont diminué la cicatrice du myocarde. Les deux formes injectées ont réduit la présence de macrophages dans le myocarde, augmenté les cellules progénitrices endogènes c-kit+ ainsi que la densité vasculaire. Les SB ont démontré un impact plus significatif sur certains paramètres évalués tels la densité vasculaire et le recrutement de cellules progénitrices endogènes c-kit+. En conclusion, ces deux études ont permis de démontrer un potentiel pro-guérison des cellules souches, par l’entremise d’un effet endocrinien anti-inflammatoire. / The therapeutic potential of regenerative medicine and cell-based strategies have been in constant evolution for the last 2 decades, especially for the repair and healing of organs with minimal regenerative capacity such as the heart. Mesenchymal stem cells (MSC) represent a population of stem cells with great advantages. First isolated from bone marrow, they can now be readily isolated from different organs including adipose tissue. Adipose derived stem cells (ASC) are easily accessible, which is of great interest for clinical application. Beside their differentiation potential, the main therapeutic impact attributed to MSC and ASC has been through their secreted mediators i.e. via a paracrine phenomenon. Different strategies have been used to enhance the therapeutic impact of ASC, one of which consists of enriching the latter’s secretome by producing 3-D structures such as spheroid bodies. Monolayer (ML) and spheroid bodies (SB) were both used in two different animal models through remote (subcutaneous) transplantation. First, on a rat peritonitis model that proved that subcutaneous injection of the two forms reduced inflammation through decreased neutrophil and macrophage infiltration. Second, ML and SB were remotely transplanted on a rat myocardial ischemia reperfusion (I/R) model. The two forms reduced infarct scar, reduced macrophages, increased endogenous progenitor c-kit+ cells and enhanced vascular density in the infarct and peri-infarct area. SBs showed better impact on vascularization and endogenous progenitor cells recruitment compared to ML. Briefly, our studies demonstrated the efficacy of a remote ASC transplantation through an endocrine-like effect against inflammation, collagen deposition and vascularization.

Immunohistological (IHC) stained images occupy a fundamental role in the pathologist¿s diagnosis and monitoring of cancer development. The manual process of monitoring such images is a subjective, time consuming process that typically relies on the visual ability and experience level of the pathologist. A novel and comprehensive system for the automated quantification of antibody inside stained cell nuclei in immunohistochemistry images is proposed and demonstrated in this research. The system is based on a cellular level approach, where each nucleus is individually analyzed to observe the effects of protein antibodies inside the nuclei. The system provides three main quantitative descriptions of stained nuclei. The first quantitative measurement automatically generates the total number of cell nuclei in an image. The second measure classifies the positive and negative stained nuclei based on the nuclei colour, morphological and textural features. Such features are extracted directly from each nucleus to provide discriminative characteristics of different stained nuclei. The output generated from the first and second quantitative measures are used collectively to calculate the percentage of positive nuclei (PS). The third measure proposes a novel automated method for determining the staining intensity level of positive nuclei or what is known as the intensity score (IS). The minor intensity features are observed and used to classify low, intermediate and high stained positive nuclei. Statistical methods were applied throughout the research to validate the system results against the ground truth pathology data. Experimental results demonstrate the effectiveness of the proposed approach and provide high accuracy when compared to the ground truth pathology data.

Le neuroblastome à haut risque est caractérisé par un faible taux de survie (~30%) et des récidives fréquentes, malgré les traitements multimodaux existants. Généralement, les études d’évaluation des médicaments utilisent la culture cellulaire en 2D, mais elle ne reflète pas la biologie tumorale du neuroblastome in situ, incluant les caractéristiques associées à l’hypoxie et la densité cellulaire. En comparaison aux patients, la culture cellulaire conventionnelle semble altérer le phénotype cellulaire du neuroblastome, le transcriptome et l’épigénome qui affecteront, à leur tour, les résultats des études pharmacologiques. Ainsi, un nouveau modèle de culture cellulaire en 3D a été développé avec plusieurs lignées cellulaires de neuroblastome afin d’atteindre une culture de sphéroïdes à long terme (un mois) avec un taux de viabilité convenable. L’hypothèse de recherche est que les changements épigénétiques et transcriptionnels seront induits par l’adaptation en 3D et vont s’amplifier dans le temps lors de la culture en 3D. Ces changements ont été mesurés en 3D dans le temps pour identifier le moment où l’épigénome des sphéroïdes ressemble le plus à celui des patient à haut risque. Le changement de l’expression des régulateurs épigénétiques survient 24 jours après la mise en sphéroïde, ce qui se traduit par une différence dans la sensibilité aux médicaments épigénétiques par rapport à la culture 2D. En conclusion, notre étude nous a permis de dériver des nouveaux modèles de neuroblastome qui sont plus représentatifs des patients d’un point de vue épigénétique et pharmacologique. / High-risk neuroblastoma is characterized by a low survival rate (~30%) and frequent recurrences, despite all the multimodal treatments available to date. Typically, drug evaluation studies use 2D cell culture which does not reflect well the tumor biology of neuroblastoma in situ, including features associated with hypoxia and cell density. Thus, compared to patients data, the conventional 2D cell culture seems to alter the neuroblastoma cell phenotype, transcriptome and epigenome which in turn will affect the results of pharmacological studies. A new 3D cell culture model was developed with several neuroblastoma cell lines to achieve long term spheroid culture (up to one month) with a suitable viability rate. We hypothesized that transcriptional and epigenetic changes will be induced by 3D adaptation and will amplify over time in the cells cultured in 3D. All these changes were measured by Western Blot in 2D, in short term 3D and in long term 3D to identify the timepoint when the epigenome of the spheroids most closely resembles that of the patient. We found that the occurrence of changes in epigenetic regulator expression occurs after 24 days of spheroid culture, resulting in a difference in a drug sensitivity compared to 2D culture. In summary, we developed new neuroblastoma models that are more representative of patient’s epigenome and pharmacological sensitivity.

During the last decade, ultrasonic manipulation has matured into an important tool with a wide range of applications, from fundamental cell biological research to clinical and industrial implementations. The contactless nature of ultrasound makes it possible to manipulate living cells in a gentle way, e.g., for positioning, sorting, and aggregation. However, when manipulating cells using ultrasound, especially using high acoustic amplitudes, a great deal of heat can be generated. This constitutes a challenge, since the viability of cells is dependent on a stable physiological temperature around 37°C.      In this Thesis we present applications of ultrasonic manipulation of fluids, particles, and cells in temperature-controlled micrometer-sized devices fabricated using well established etching techniques, directly compatible with high-resolution fluorescence microscopy. Furthermore, we present ultrasonic manipulation in larger up to centimeter-sized devices optimized for fluid mixing and cell lysis. In the present work, two new ultrasonic manipulation platforms have been developed implementing temperature control. These platforms are much improved with increased performance and usability compared to previous platforms. Also, two new ultrasonic platforms utilizing low-frequency ultrasound for solubilization and cell lysis of microliter-volumed and milliliter-volumed samples have been designed and implemented.      We have applied ultrasound to synchronize the interaction between large numbers of immune, natural killer cells, and cancer cells to study the cytotoxic response, on a single cell level. A heterogeneity was found among the natural killer cell population, i.e., some cells displayed high cytotoxic response while others were dormant. Furthermore, we have used temperature-controlled ultrasound to form up to 100, in parallel, solid cancer HepG2 tumors in a glass-silicon multi-well microplate. Next, we investigated the immune cells cytotoxic response against the solid tumors. We found a correlation between the number of immune cells compared to the size of the tumor and the cytotoxic outcome, i.e., if the tumor could be defeated.             Finally, the effect of high acoustic pressure amplitudes in the MPa-range on cell viability has been studied in a newly developed platform optimized for long-term stable temperature control, independent on the applied ultrasound power. Lastly, we present two applications of ultrasonic fluid mixing and lysis of cells. One platform is optimized for small microliter-sized volumes in plastic disposable chips and another is optimized for large milliliter-sized volumes in plastic test tubes. The latter platform has been implemented for clinical sputum sample solubilization and cell lysis for genomic DNA extraction for subsequent pathogen detection / Ultraljudsmanipulering har under de senaste tio åren mognat och utvecklats till ett verktyg med ett brett användningsområde. Idag kan man finna applikationer inom allt från cellbiologisk grundforskning till industri samt sjukvård. Ultraljudsmanipuleringens kontaktlösa natur gör det till en varsam metod för att manipulera celler, till exempel inom positionering, sortering och aggregering. När ultraljud med hög amplitud används kan värmeutvecklingen, som är oundviklig, bli ett problem. För att kunna säkerställa hög cellviabilitet krävs temperaturkontroll som kan hålla en fysiologisk, stabil temperatur på 37°C.      I denna avhandling presenterar vi tillämpningar av temperaturkontrollerad ultraljudsmanipulering i mikrometerstora anordningar fabricerade med väletablerade etsningstekniker.  Dessa anordningar är optimerade för att vara fullt kompatibla med högupplöst fluorescensmikroskopi.  Vi demonstrerar även ultraljudsmanipulering i centimeterstora anordningar optimerade för omrörning och blandning av vätskor samt lysering av celler. Två nya plattformar för ultraljudsmanipulering med inbyggd temperaturkontroll har utvecklats. Dessa två plattformar erbjuder ökad prestanda, flexibilitet samt även användarvänlighet. Utöver dessa plattformar har ytterligare två anordningar för lågfrekvent ultraljudssolubilisering och cellysering av mikroliter- och milliliterstora prover konstruerats.      I denna avhandling har vi tillämpat ultraljud för att synkronisera interaktionen mellan populationer utav immunceller (natural killer-celler) och cancerceller för att på cellnivå studera det cytotoxiska gensvaret. Vi fann en heterogenitet hos immuncellspopulationen. Det manifesterade sig i en fördelning av immuncellerna, från celler med stort cytotoxiskt gensvar till inaktiva immunceller. Vi har dessutom använt temperaturkontrollerad ultrasljudsmanipulering för att skapa solida cancertumörer utav HepG2-cancerceller, upp till 100 stycken parallellt, i en multihåls-mikrotiterplatta bestående av glas och kisel. Med hjälp av dessa tumörer har vi studerat det cytotoxiska gensvaret från immuncellerna. Vi fann att förhållandet mellan antalet immunceller och storleken på tumören bestämde utfallet, det vill säga om tumören kunde bekämpas.      Vi presenterar dessutom effekten utav högamplitudsultraljudsexponering av cancerceller i en plattform speciellt designad för höga tryckamplituder med implementerad ultraljudseffektsoberoende temperaturkontroll. Slutligen presenterar vi två tillämpningar av ultraljud för vätskeblandning och cellysering. Den första tillämpningen är anpassad för små volymer i plastchip för engångsbruk och den andra är optimerad för större volymer i plastprovrör. Den senare tillämpningen är speciellt framtagen för ultraljudssolubilisering och cellysering utav kliniska sputumprover för att möjliggöra DNA-extrahering för detektion av smittämnen. / <p>QC 20150522</p>

O presente estudo comparou os efeitos da ativação e inibição do EGFR em duas linhagens de câncer de pulmão, cultivadas em monocamada ou esferoides. Os esferoides foram cultivados sem elementos de matriz extracelular. As células A549 e HK2 apresentaram, respectivamente, 3 e 6 cópias do gene ErbB1 por núcleo, embora a expressão de EGFR seja menor nas células HK2. A ativação de EGFR por EGF ou inibição por AG1478 não promoveu mudanças na proliferação celular. Entretanto, as células cultivadas em monocamada, estimuladas com EGF, exibiram alterações na disposição dos microfilamentos de actina e aumento na velocidade de migração celular. UO126 e LY294002 foram adicionados às culturas para inibir, respectivamente, as vias ERK e Akt. A linhagem A549, cultivada em monocamada, não apresentou envolvimento das vias de sinalização de ERK e Akt na migração celular induzida por EGF, mas foi observado o envolvimento dessas vias nos esferoides. Já a linhagem HK2 apresentou o envolvimento de Akt para promover a migração celular após estímulo com EGF nas duas formas de cultivo. / This study compared the effects of activation and inhibition of EGFR in two cell lines of lung cancer, grown in monolayer or spheroids. Spheroids were cultured without extracellular matrix components. HK2 and A549 cells showed, respectively, 3 and 6 ErbB1 gene copies per nucleus, while EGFR expression is lower in the HK2 cells. The activation by EGF or EGFR inhibition by AG1478 did not cause changes in cell proliferation. However, cells cultured in monolayers stimulated with EGF, showed changes in the arrangement of actin microfilaments and increased the speed of cell migration. UO126 and LY294002 were added to the cultures to inhibit, respectively, the ERK and Akt pathways. A549 cells grown in monolayer did not show involvement of ERK and Akt signaling pathways in the cell migration induced by EGF, but was observed involvement of such pathways in the spheroids. HK2 cells showed involvement of Akt to promote cell migration after EGF stimulation in monolayers and in spheroids.

L’adénocarcinome pancréatique (AP) connaît une forte augmentation d’incidence, qui en fait la quatrième cause de mortalité par cancer avec un pronostic extrêmement sombre, moins de 5% des patients étant en vie à 5 ans. De nombreuses avancées dans la compréhension de l’oncogénèse pancréatique notamment sur les aspects génétiques, immunitaires et sur les interactions cellulaires du stroma tumoral ont permis d’envisager le développement de nouvelles stratégies de traitement. Cependant malgré des résultats pré-cliniques très encourageants aucune de ces stratégies n’a encore permis l’émergence d’un traitement plus efficace que la chimiothérapie standard. Ce travail de thèse a abordé 2 approches thérapeutiques innovantes distinctes mais potentiellement complémentaires dans le traitement de l’adénocarcinome pancréatique en étudiant in vitro (cultures cellulaire 2D et 3D) et in vivo (modèles ectopiques et orthotopiques) les effets sur la croissance tumorale de l’inhibition d’un acteur important du stress oxydant (la voie Nrf2) d’une part, de la combinaison d’une chimiothérapie liposomale et d’un agent physique, la cavitation ultrasonore, d’autre part. La cavitation ultrasonore est un effet mécanique des ultrasons permettant d’augmenter l’internalisation de molécules ou de gènes dans les cellules. Dans cette thèse, la faisabilité et l'efficacité de la combinaison d’une chimiothérapie liposomale ciblée par la cavitation ultrasonore a été évaluée dans des modèles murins orthotopiques d’AP. Un système de délivrance d’ultrasons a été adapté afin d’appliquer une cavitation inertielle focalisée sur des xénogreffes d’AP créées après l'injection de doxorubicine liposomale (L-DOX) selon une étude pharmacocinétique préliminaire réalisée dans un modèle murin. La L-DOX, conçue à base de phospholipides non saturés de dioleoylphosphatidyléthanolamine, connue pour être stable dans la circulation sanguine, a été choisie afin de maximiser son accumulation et le relargage du principe actif lors de la délivrance des ultrasons. Nous montrons que l’association de la L-DOX à la cavitation inertielle permet de réduire in vivo le volume tumoral dans un modèle orthotopique d’AP chez la souris nude. La cavitation inertielle peut donc augmenter l'effet antitumoral des liposomes porteurs de chimiothérapie avec un effet mécanique minimal sur le tissu environnant la tumeur.Des études récentes suggèrent que Nrf2 est une cible de choix pour vaincre la chimiorésistance de l’AP. Des méthodes in vitro et in vivo ont été utilisées afin d’examiner l'effet du brusatol associé à des agents chimiothérapeutiques de référence sur la mort cellulaire et son impact sur le stress oxydant. Nous montrons que l’inhibition de la voie Nrf2 par le brusatol, un composé naturel issu de Fructus Bruceae, potentialise les effets de la chimiothérapie et permet l’inhibition de la croissance tumorale in vitro sur des lignées cellulaires d’AP cultivées en 2D et 3D. Cette inhibition s’accompagne d’une modulation du stress oxydant dont témoignent l’augmentation des espèces réactives de l’oxygène (ROS) et la diminution du glutathion (GSH). In vivo, la combinaison du brusatol et de l'oxaliplatine a réduit le volume tumoral dans deux modèles murins de xénogreffe d’AP. Ces résultats suggèrent l'efficacité du brusatol pour lutter contre la chimiorésistance et renforce l’hypothèse d’un rôle clinique potentiel de l’inhibition de Nrf2 comme adjuvant à la chimiothérapie dans l’AP. Un travail clinique a également été mené en parallèle sur une modalité de traitement physique innovante, la radiofréquence endobiliaire, dans la prise en charge endoscopique de l’ampullome vatérien, tumeur rare à la croisée entre le tube digestif et le système biliopancréatique. Les résultats de cette étude prospective multicentrique seront également présentés dans cette thèse. / Pancreatic ductal adenocarcinoma (PDAC) has increased in incidence over the past decade, leading it to be the fourth lethal cause of cancer in the world with a very poor prognosis, since less than 5% of patients are alive at 5 years. Many advances in the understanding of pancreatic tumorigenesis, notably on the genetic, immune and cellular stroma interactions of the tumor, have led to the development of new treatment strategies in the last decade. However, despite very encouraging pre-clinical results, none of these strategies has yet led to the emergence of a truly effective treatment in comparison with standard chemotherapy. This thesis focused on two innovative therapeutic modalities in the treatment of PDAC at a preclinical stage by studying in vitro (2D and 3D cell cultures) and in vivo (ectopic, orthotopic xenografts) the effects on the tumor growth of an inhibitor of the Nrf2 pathway (involved in oxidative stress), on the first hand, and of a physical element, ultrasound cavitation associated with liposomal chemotherapy, on the second hand. Ultrasound cavitation is a mechanical effect of ultrasound to increase the uptake of molecules or genes in cells. The feasibility and effectiveness of the combination of liposomal chemotherapy targeted by ultrasonic cavitation was evaluated in murin orthotopic models of PDAC. An ultrasound delivery system has been adapted to apply focused inertial cavitation to PDAC xenografts created after the injection of liposomal doxorubicin (L-DOX) according to a preliminary pharmacokinetic study carried out in the murine model. L-DOX, designed on unsaturated phospholipids of dioleoylphosphatidylethanolamine, was known to be stable in the bloodstream and to maximize its accumulation and release of the active drug during ultrasound delivery. This thesis shows that this therapeutic combination (L DOX and inertial cavitation) makes it possible to reduce the tumor volume in vivo in a nude mouse orthotopic model of PDAC. Inertial cavitation may be generated to increase the therapeutic effect of chemotherapybearing liposomes accumulated in the tumor with minimal mechanical effect on the surrounding tissue. Recent studies strongly suggest that Nrf2 is an ideal target against chemoresistance of PDAC. In vitro and in vivo methods were combined to examine the effect of brusatol associated with chemotherapeutic agents on cell death in addition to its impact on oxidative stress (reactive oxygen species and gluthation levels). This thesis demonstrates that the inhibition of the Nrf2 pathway via brusatol, a natural compound derived from Fructus Bruceae, potentiates the effects of chemotherapy and allows the inhibition of tumor growth in vitro on PDAC cell lines. This inhibition is accompanied by a modulation of oxidative stress by brusatol, with increasing ROS and decreasing GSH. In vivo, the combination of brusatol and oxaliplatin reduced tumor volume in two mouse models of PDAC xenograft. These results suggest the efficacy of using brusatol to combat chemoresistance and reinforce the idea that brusatol could be developed as an adjuvant to chemotherapy in PA. Clinical work was also carried out in parallel on an innovative physical treatment modality, endobiliary radiofrequency, in the management of adenoma of the ampoule of Vater, a rare tumor located between the digestive and the bilio-pancreatic systems. The results of this work will also be presented in this thesis.

O presente estudo comparou os efeitos da ativação e inibição do EGFR em duas linhagens de câncer de pulmão, cultivadas em monocamada ou esferoides. Os esferoides foram cultivados sem elementos de matriz extracelular. As células A549 e HK2 apresentaram, respectivamente, 3 e 6 cópias do gene ErbB1 por núcleo, embora a expressão de EGFR seja menor nas células HK2. A ativação de EGFR por EGF ou inibição por AG1478 não promoveu mudanças na proliferação celular. Entretanto, as células cultivadas em monocamada, estimuladas com EGF, exibiram alterações na disposição dos microfilamentos de actina e aumento na velocidade de migração celular. UO126 e LY294002 foram adicionados às culturas para inibir, respectivamente, as vias ERK e Akt. A linhagem A549, cultivada em monocamada, não apresentou envolvimento das vias de sinalização de ERK e Akt na migração celular induzida por EGF, mas foi observado o envolvimento dessas vias nos esferoides. Já a linhagem HK2 apresentou o envolvimento de Akt para promover a migração celular após estímulo com EGF nas duas formas de cultivo. / This study compared the effects of activation and inhibition of EGFR in two cell lines of lung cancer, grown in monolayer or spheroids. Spheroids were cultured without extracellular matrix components. HK2 and A549 cells showed, respectively, 3 and 6 ErbB1 gene copies per nucleus, while EGFR expression is lower in the HK2 cells. The activation by EGF or EGFR inhibition by AG1478 did not cause changes in cell proliferation. However, cells cultured in monolayers stimulated with EGF, showed changes in the arrangement of actin microfilaments and increased the speed of cell migration. UO126 and LY294002 were added to the cultures to inhibit, respectively, the ERK and Akt pathways. A549 cells grown in monolayer did not show involvement of ERK and Akt signaling pathways in the cell migration induced by EGF, but was observed involvement of such pathways in the spheroids. HK2 cells showed involvement of Akt to promote cell migration after EGF stimulation in monolayers and in spheroids.

Ce travail de thèse a permis de montrer que la résolution latérale de gravure de lasers proches infrarouges nanosecondes pouvait être réduite en faisant passer le faisceau à travers des microbilles de verre ou des fibres de silice à embouts façonnés de telle manière à générer des jets photoniques. Sur du silicium la taille de gravure peut être réduite d’un facteur 44 comparée à celle d’une gravure directe sans jet photonique. Les densités de puissances atteintes permettent même d’envisager de graver le verre avec ce type de laser malgré sa très faible absorption à ces longueurs d’onde. Pour la première fois nous avons montré la possibilité d’obtenir des jets photoniques en sortie de fibre optique à embout façonné. Nous avons montré leur capacité à graver le silicium à l’échelle du micron et ce avec un laser proche infrarouge nanoseconde. La possible utilisation de fibres optiques est une condition clairement décisive à la réalisation d’un réel procédé laser capable de graver des motifs complexes et de façon répétée. / This work has shown that the lateral resolution etching using near infrared lasers nanoseconds could be reduced by passing the beam through a glass microsphere or a silica fibers with spheroid shape in such a way to generate photonic jets. Etching on silicon size with a glass microsphere can be reduced by a factor of 44 compared to that of a direct etching without photonic jet. Powers reached densities allow even consider burning the glass with this type of laser, despite its very low absorption at these wavelengths. For the first time we have shown the possibility of obtaining photonic jets coming-out of a spheroid-tip of fiber optic. We also have shown the ability to etch silicon at the micron scale using the near infrared nanosecond laser. The possible use of optical fibers is clearly a decisive condition for the realization of a laser capable of etching process real intricate designs and repeatedly.

No description available.