One hundred twenty-five concomitant endovascular and open procedures for lower extremity arterial disease

AbstractObjective: Although the results of staged endovascular and open surgical reconstructions have been well documented, the safety and efficacy of concomitant procedures in the operating room are less well defined. Suboptimal performance of endovascular procedures in an operative setting, or inappropriate reliance on endovascular techniques, might theoretically compromise graft patency. We questioned whether late graft thrombosis is frequently attributable to failure at the endovascularly treated site in this setting. Materials and Methods: Between May 1, 1993, and June 30, 2001, we performed 125 concomitant endovascular and open arterial reconstructions (73 primary reconstructions, 52 graft revisions) in 106 patients. Endovascular techniques were used to treat inflow lesions in 72 cases, outflow lesions in 14 cases, both in four cases, and the graft itself in 35 cases. Fifty-five iliac, 18 femoral, 13 popliteal, six tibial, and 35 graft lesions were treated. For primary bypasses, 33 were to the popliteal level (21 prosthetic, 12 autogenous), 19 were to the tibial or pedal arteries (16 autogenous, three prosthetic or composite), and 12 were to the femoral arteries (one autogenous, 11 prosthetic). Nine patch angioplasties (eight femoral, one popliteal) were performed. For graft revisions, endovascular intervention was for inflow in 13 cases, outflow in three cases, both in one case, and of the graft itself in 35 cases. Surgical revisions involved segmental grafts in 33 cases, patch angioplasty in 18 cases, and both in one case. Results: In the primary group, the initial technical success rate of the endovascular procedure was 93% (68/73), with five patients needing open conversion. The 30-day mortality rate was 1.4%, and the morbidity rate was 11.0%. Of the 19 grafts in the primary group that occluded during the follow-up period (mean, 11.9 months), five thromboses could possibly be attributed to failure at the endovascular site. In the revision group, the initial technical success rate of the endovascular procedure was 88% (46/52), with six patients undergoing conversion to open procedure. The 30-day mortality rate was 0%, and the morbidity rate was 15.4%. Of 22 late graft occlusions in the revision group, only three were attributed to failure at the endovascular site. Conclusion: This largest report to date of concomitant lower extremity endovascular and open revascularization procedures shows the approach to be safe. Few late graft occlusions were attributable to failure at the endovascularly treated site. The concomitant approach offers the efficiency and convenience of single stage therapy and allows immediate treatment for inadequate endovascular results or their complications and potential cost savings. (J Vasc Surg 2003;37:316-22.

Self-adaptive high-frequency injection based sensorless control for interior permanent magnet synchronous motor drives \u2020

Abstract: An auto-tuning and self-adaptation procedure for High Frequency Injection (HFI) based position and speed estimation algorithms in Interior Permanent Magnet Synchronous Motor (IPMSM) drives is proposed in this paper. Analytical developments show that, using conventional approaches, the dynamics of the high-frequency tracking loop varies with differential inductances, which in turn depend on the machine operating point. On-line estimation and adaptation of the small signal gain of the loop is proposed here, allowing accurate auto-tuning of the sensorless control scheme which does not rely on a priori knowledge of the machine parameters. On-line adaptation of Phase-Locked Loop (PLL) gains and of the injected voltage magnitude is also possible, leading to important advantages from the performance, loss and acoustic point of view. The theoretical basis of the method has been introduced first and the main concept demonstrated by means of simulations. Implementation has been carried out using the hardware of a commercial industrial drive and two Interior Permanent Magnet Synchronous Motors, namely a prototype and an off-the-shelf machine. Experimental tests demonstrate the feasibility and effectiveness of the proposal

TERRESTRIAL LASER SCANNER DATA TO SUPPORT COASTAL EROSION ANALYSIS: THE CONERO CASE STUDY

In this work a detailed TLS survey was carried out in summer 2012, in the Conero Regional Park (Marche, province of Ancona), along the "spiaggia San Michele" and "spiaggia Sassi Neri". These areas present several sections affected by erosion, rock falls and slope failures. They also belong to a very prestigious place for tourism during the summer season; therefore, deriving a risk map for these areas is really useful. Thanks to the TLS survey, it was possible to obtain a centimetre resolution DTM covering a reach of about 1.5 km of the coast. This high resolution DTM was used to derive some primary topographic attributes that allowed to arrange a preliminary discussion about the likely unstable areas. These topographic information and results will also serve as the reference point for future yearly TLS surveys, which will absolutely help in recognizing any micro changes and slope failures, improving the risk maps

Phospholipid hydroperoxide glutathione peroxidase of rat testis. Gonadotropin dependence and immunocytochemical identification.

A high glutathione peroxidase activity toward phospholipid hydroperoxides is present in rat testis. The attribution of this activity to the selenoenzyme phospholipid hydroperoxide glutathione peroxidase (PHGPX) was supported by cross-reactivity with antibodies raised against pig heart PHGPX which had been purified and characterized. Rat testis PHGPX is partially cytosolic and partially linked to nuclei and mitochondria. The soluble and organelle-bound enzymes appear identical by Western blot analysis. PHGPX, but neither selenium-dependent nor non-selenium-dependent glutathione peroxidase activity, is expressed in testes only after puberty, disappears after hypophysectomy, and is partially restored by gonadotropin treatment. Specific immunostaining of testes by antiserum against PHGPX appears as a fine granular brown pattern localized throughout the cytoplasm in more immature cells but is confined to the peripheral part of the cytoplasm, the nuclear membrane, and mitochondria in maturating spermatogenic cells. As expected, immunostaining of spermatogenic cells in hypophysectomized animals was negative, but gonadotropin treatment only marginally increased the immunoreactivity. The expression of PHGPX in testes is consistent with the previously described specific requirement for selenium for synthesis of a 15-20-kDa selenoprotein which is related to the production of functional spermatozoa

Prolonged treatment of COVID-19 pneumonia with high-flow nasal oxygen: A story of oxygen and resilience

The COVID-19 pandemic has placed significant strain on the oxygen delivery infrastructure of health facilities in resource-constrained health systems. In this case report, we describe a patient with severe COVID-19 pneumonia who was managed with high-flow nasal oxygen for 40 days, with an eventual successful outcome. We discuss the oxygen delivery infrastructure needed to offer this intervention, as well as the psychosocial impact on those undergoing treatment

Clinical significance of fluoroscopic patterns specific for the mitotic spindle in patients with reumatic diseases

Objective: we proposed to determine the clinical significance of anti-NuMA and anti-HsEg5 antibodies in a group of patients affected with rheumatic diseases. Materials and methods: indirect immunofluorescence on HEp-2000 cells at serum dilution of 1:40 was used to examin 26 sera which had previously showed a "mitotic spindle" fluoroscopic pattern type during laboratory routine. Results: 21 sera (80,7%) were identified with NuMA and 5 (19,3%) with HsEg5 patterns alone or associated with other ANA patterns. However only patients with isolated positiveness and that is 15 with NuMA and 4 with HsEg5 stainings were included in this study. Of the NuMA positive patients 5 were affected with arthropathies associated to different forms of thyroiditis, 2 with seronegative arthritis, 2 with antiphospholipid syndrome, 1 with systemic lupus erythematosus (SLE), 1 with rheumatoid arthritis, 1 with sicca syndrome, 1 with undifferentiated connective tissue disease, 1 with Mycoplasma pneumaniae infection and 1 with retinal thrombosis. Of the HsEg5 positive patients 3 were affected with SLE and 1 with seronegative arthritis. Conclusions: NuMA does not prevail in any defined rheumatic disease, while HsEg5 staining were more frequent (75%) in patients affected with SLE all of whom showing high antibody titres

Delirium in HIV-infected patients admitted to acute medical wards post universal access to antiretrovirals in South Africa

Background. Delirium is associated with increased mortality and length of hospital stay. Limited data are available from HIV-infected acute hospital admissions in developing countries. We conducted a prospective study of delirium among acute medical admissions in South Africa (SA), a developing country with universal antiretroviral therapy (ART) access and high burdens of tuberculosis (TB) and non-communicable disease.Objectives. To identify the prevalence of, risk factors for and outcomes of delirium in HIV-infected individuals in acute general medical admissions.Methods. Three cohorts of adult acute medical admissions to Groote Schuur and Victoria Wynberg hospitals, Cape Town, SA, were evaluated for prevalent delirium within 24 hours of admission. Reference delirium testing was performed by either consultant physicians or neuropsychologists, using the Confusion Assessment Method.Results. The study included 1 182 acute medical admissions, with 318 (26.9%) HIV-infected. The median (interquartile range) age and CD4 count were 35 (30 - 43) years and 132 (61 - 256) cells/µL, respectively, with 140/318 (44.0%) using ART on admission. The prevalence of delirium was 17.6% (95% confidence interval (CI) 13.7 - 22.1) among HIV-infected patients, and delirium was associated with increased inpatient mortality. In multivariable logistic regression analysis, factors associated with delirium were age ≥55 years (adjusted odds ratio (aOR) 6.95 (95% CI 2.03 - 23.67); p=0.002), and urea ≥15 mmol/L (aOR 4.83 (95% CI 1.7 - 13.44); p=0.003), while ART use reduced risk (p=0.014). A low CD4 count, an unsuppressed viral load and active TB were not predictors of delirium; nor were other previously reported risk factors such as non-opportunistic acute infections or polypharmacy.Conclusions. Delirium is common and is associated with increased mortality in HIV-infected acute medical admissions in endemic settings, despite increased ART use. Older HIV-infected patients with renal dysfunction are at increased risk for inpatient delirium, while those using ART on admission have a reduced risk

Etude immunocytochimique du développement de la cavité buccale du rat

Flow cytometry and autoradiography are extensively used for the evaluation of the number of cells in S-phase in order to study the proliferative activity within tissues and organs. The recent development of a monoclonal antibody against 5-bromo-2’deoxyuridine (BrdUrd), a nonradioactive thymidine analogue that is incorporated within DNA-synthetizing cells, allows the immunochemical detection of proliferating cells. The use of this antibody allows an immunocytochemical detection of proliferating cells «in situ» on tissue sections.We have applied this new technique for the identification of proliferating cells within the tooth and other organs of rat mouth during development. We believe that this technique, for its precision and simplicity, may be a powerful tool for studying the citokinetic and the differentiation of normal and neoplastic cells within the mouth as well as in other districts of the body.Afin d’évaluer avec précision la prolifération cellulaire dans un tissu ou un organe, on emploie couramment la cytofluorimétrie en flux ainsi que les techniques autoradiographiques, qui permettent d’obtenir des informations sur le nombre de cellules en phase S et par conséquent en prolifération.Récemment, de nouvelles techniques non autoradiographiques ont été mises au point pour l’identification des cellules en prolifération. Ces techniques exploitent l’incorporation de la 5-bromo-2’déoxyuridine (BrdUrd), analogue de la thymidine, dans le DNA en voie de duplication. Ces techniques utilisent un anticorps monoclonal dirigé contre la BrdUrd pour évaluer l’incorporation de cette dernière dans les cellules en phase S. L’emploi de cet anticorps en immunocytochimie permet une facile identification «in situ», sur des coupes de tissu, des cellules en prolifération.Nous avons utilisé ce procédé immunocytochimique pour repérer et identifier les cellules en prolifération dans la dent et dans d’autres organes de la cavité buccale du rat nouveau-né, organes qui sont donc encore en cours de développement. Nous estimons que la technique utilisée dans cette recherche peut constituer, par sa précision et sa simplicité, un instrument valable pour l’étude de la prolifération cellulaire ainsi que de la différenciation cellulaire dans les tissus de la dent et de la cavité buccale, aussi bien dans le domaine de l’organogenèse que dans celui de la pathologie tumorale

Immunocytochemical labelling of Merkel cells of human oral mucosa by means of antibodies to protein gene product 9.5

Merkel cell (MC) are one of the non-keratinocyte cell populations that reside in oral epithelium. Protein gene product 9.5 (PGP 9.5) is a protein specifically present in the cytoplasm of neurons and neuroendocrine cells. It is demonstrated by immunofluorescence and immunoperoxidase that MC of oral human mucosa express PGP 9.5-like immunoreactivity. This finding is in agreement with the hypothesis that oral MC are paraneurons or neuroendocrine cells. The use of anti-PGP 9.5 serum may be of value for future studies of MC in normal and pathological oral tissues.Les cellules de Merkel (MC) représentent une des populations cellulaires différentes des Kératinocytes qui résident dans les épithéliums de la cavité orale. Le Protein Gene Product 9.5 (PGP 9.5) est une protéine présente, de façon spécifique, dans les neurones et dans les cellules neuroendocrines. On démontre ici, en utilisant les techniques d’immunofluorescence et d’immunopéroxydase, que les MC de la muqueuse orale humaine présentent une immunoréactivité au PGP 9.5. Cette observation est en accord avec l’hypothèse que les MC de la cavité orale sont des paraneurones ou cellules neuroendocrines. L’emploi d’antisérums anti PGP 9.5 peut être utile pour d’ultérieures études sur les MC dans les tissus de la cavité orale aussi bien en conditions normales qu’en conditions pathologiques