First results of clampless distal anastomosis in peripheral vascular bypass with LeGoo, a thermoreversible polymer

BackgroundWe report our initial experience with LeGoo (Pluromed Inc, Woburn, Mass), a temporary thermoreversible occlusive gel, in peripheral vascular revascularization.MethodsBetween 2007 and 2010, LeGoo was used to occlude target vessels during bypass surgery in 14 patients who required infrainguinal revascularization.ResultsProximal occlusion of the target vessel was obtained with a mean quantity of 0.25 mL of LeGoo. Distal occlusion of the vessel was obtained with a mean quantity of 0.28 mL. One injection of LeGoo was sufficient to prevent backbleeding in 11 of 14 patients. The mean occlusion time was 13.4 ± 3.3 minutes. An injection of saline through the graft or better directly into the arteries was used to dissolve the gel. For our first case, a Fogarty catheter was used to remove residual gel from the anterior tibial artery.ConclusionsLeGoo gel can be used to stop blood flow in small-bore arteries in the lower limbs to allow anastomoses to be performed

Global gene expression profiling in human lung cells exposed to cobalt.

International audienceBACKGROUND: It has been estimated that more than 1 million workers in the United States are exposed to cobalt. Occupational exposure to 59 Co occurs mainly via inhalation and leads to various lung diseases. Cobalt is classified by the IARC as a possible human carcinogen (group 2B). Although there is evidence for in vivo and in vitro toxicity, the mechanisms of cobalt-induced lung toxicity are not fully known. The purpose of this work was to identify potential signatures of acute cobalt exposure using a toxicogenomic approach. Data analysis focused on some cellular processes and protein targets that are thought to be relevant for carcinogenesis, transport and biomarker research. RESULTS: A time course transcriptome analysis was performed on A549 human pulmonary cells, leading to the identification of 85 genes which are repressed or induced in response to soluble 59 Co. A group of 29 of these genes, representing the main biological functions, was assessed by quantitative RT-PCR. The expression profiles of six of them were then tested by quantitative RT-PCR in a time-dependent manner and three modulations were confirmed by Western blotting. The 85 modulated genes include potential cobalt carriers (FBXL2, ZNT1, SLC12A5), tumor suppressors or transcription factors (MAZ, DLG1, MYC, AXL) and genes linked to the stress response (UBC, HSPCB, BNIP3L). We also identified nine genes coding for secreted proteins as candidates for biomarker research. Of those, TIMP2 was found to be down-regulated and this modulation was confirmed, in a dose-dependent manner, at protein level in the supernatant of exposed cells. CONCLUSION: Most of these genes have never been described as related to cobalt stress and provide original hypotheses for further study of the effects of this metal ion on human lung epithelial cells. A putative biomarker of cobalt toxicity was identified

Practical guidelines for the treatment of patellar fractures in adults.

The role of the patella is paramount in the transmission of the quadriceps muscle forces, the increase of the lever arm, the distribution of the forces on the trochlea and the centring of the extensor apparatus. Despite the low incidence of patellar factures in comparison with other lower limb fractures, the painful and functional complications, such as knee stiffness, loss of extension and patellofemoral osteoarthritis, can be very disabling and will often compromise the return to a professional or recreational activity and induce falls in the elderly population. Treatment can be conservative or surgical, provided that it is adapted to the type of fracture. Undisplaced fractures with an intact extensor mechanism can be treated nonoperatively. Surgical treatment is recommended for fractures that either disrupt the extensor mechanism or have more than 2 to 3 mm of step-off and more than 1 to 4 mm of displacement. Tension band fixation is the most commonly employed surgical technique. In most cases, hardware has to be removed after fracture healing because of implant-related pain. Operative treatment of comminuted patellar fractures presents a significant challenge to surgeons. Failure to restore the articular surface contour results in posttraumatic arthritis. Anatomical reconstruction of the articular surface is the only way to prevent the development of posttraumatic osteoarthritis. Typically, fracture classification and thus treatment choice are based on anteroposterior and lateral radiographs of the knee, but when computed tomography of the knee was performed pre-operatively, both the classification and treatment were modified thanks to a better understanding of the fracture complexity. The purpose of this article is to review current treatment strategies and optimise the management of adult patients with patellar fractures

Results of open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable pelvic ring injuries: retrospective study of 36 patients.

Surgical stabilization of posterior pelvic ring fractures can be achieved by closed reduction and percutaneous fixation (CRPF) or by open reduction and internal fixation (ORIF). The aim of the present study is to compare the clinical results of both methods. Medical records of 36 patients consecutively operated for unstable pelvic ring injuries were retrospectively reviewed. We compared 22 patients treated with CRPF versus 14 patients stabilized by using ORIF between 2007 and 2017. The Majeed and Pohlemann scores were used to evaluate postoperative functional outcomes. Complications like blood loss, infection rate, Neurological injury, the operative time and the length of hospital stay were analyzed. The median Majeed pelvic score was 87 points for the CRPF technique compared with 69 points for the ORIF technique. The median Pohlemann score, operative time and length of hospitalization were similar between the two groups. The median blood loss for the CRPF technique was 300 ml compared to 500 ml for the ORIF technique. CRPF and ORIF procedure had each one neurological lesion. There was one case of infection in the ORIF group and none in the CRPF group. No measurements except for the blood loss have reached the significance threshold. The CRPF technique shows a clear decrease in blood loss. There was no statistically significant difference in the functional results, infection rate, neurological injury, operative time and hospital stay between both techniques

Off-line and On-line Power Dispatching Strategies for a Grid Connected Commercial Building with Storage Unit

With the development of decentralized power sources based on renewable energy, power grids need smarter operations to be run properly. This paper refers to a microgrid with solar panels associated with an energy storage unit connected to the main grid. An off-line optimal dispatching of the storage power flows is proposed in order to minimize energy costs with regards to the daily energy rates. An on-line management strategy is also introduced so as to control in real-time the grid power predicted over the day by the off-line dispatching

Climbing to the top of the galactic mass ladder: evidence for frequent prolate-like rotation among the most massive galaxies

We present the stellar velocity maps of 25 massive early type galaxies located in dense environments observed with MUSE. Galaxies are selected to be brighter than M_K=-25.7 magnitude, reside in the core of the Shapley Super Cluster or be the brightest galaxy in clusters richer than the Virgo Cluster. We thus targeted galaxies more massive than 10^12 Msun and larger than 10 kpc (half-light radius). The velocity maps show a large variety of kinematic features: oblate-like regular rotation, kinematically distinct cores and various types of non-regular rotation. The kinematic misalignment angles show that massive galaxies can be divided into two categories: those with small or negligible misalignment, and those with misalignment consistent with being 90 degrees. Galaxies in this latter group, comprising just under half of our galaxies, have prolate-like rotation (rotation around the major axis). Among the brightest cluster galaxies the incidence of prolate-like rotation is 50 per cent, while for a magnitude limited sub-sample of objects within the Shapley Super Cluster (mostly satellites), 35 per cent of galaxies show prolate-like rotation. Placing our galaxies on the mass - size diagram, we show that they all fall on a branch extending almost an order of magnitude in mass and a factor of 5 in size from the massive end early-type galaxies, previously recognised as associated with major dissipation-less mergers. The presence of galaxies with complex kinematics and, particularly, prolate-like rotators suggests, according to current numerical simulations, that the most massive galaxies grow predominantly through dissipation-less equal-mass mergers.Comment: 11 pages, 4 figures, accepted to MNRA

Incidence and Outcomes of Acute Implant Extrusion Following Anterior Cervical Spine Surgery.

STUDY DESIGN: Multi-institutional retrospective case series of 8887 patients who underwent anterior cervical spine surgery. OBJECTIVE: Anterior decompression from discectomy or corpectomy is not without risk. Surgical morbidity ranges from 9% to 20% and is likely underreported. Little is known of the incidence and effects of rare complications on functional outcomes following anterior spinal surgery. In this retrospective review, we examined implant extrusions (IEs) following anterior cervical fusion. METHODS: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of 21 predefined treatment complications. RESULTS: Following anterior cervical fusion, the incidence of IE ranged from 0.0% to 0.8% across 21 institutions with 11 cases reported. All surgeries involved multiple levels, and 7/11 (64%) involved either multilevel corpectomies or hybrid constructs with at least one adjacent discectomy to a corpectomy. In 7/11 (64%) patients, constructs ended with reconstruction or stabilization at C7. Nine patients required surgery for repair and stabilization following IE. Average length of hospital stay after IE was 5.2 days. Only 2 (18%) had residual deficits after reoperation. CONCLUSIONS: IE is a very rare complication after anterior cervical spine surgery often requiring revision. Constructs requiring multilevel reconstruction, especially at the cervicothoracic junction, have a higher risk for failure, and surgeons should proceed with caution in using an anterior-only approach in these demanding cases. Surgeons can expect most patients to regain function after reoperation