Fabrication of low-cost Mod-OA wood composite wind turbine blades

The wood composite blades were fabricated by using epoxy resin-bonded laminates of Douglas fir veneers for the leading edge spar sections and honeycomb-cored birch plywood panels for the blade trailing edge or afterbody sections. The blade was joined to the wind turbine hub assembly by epoxy resin-bonded steel load take-off studs. The wood composite blades were installed in the Mod-OA wind turbine test facility at Kahuku, Hawaii. The wood composite blades have successfully completed high power (average of 150 kW) operations for an eighteen month period (nearly 8,000 hr) before replacement with another set of wood composite blades. The original set of blades was taken out of service because of the failure of the shank on one stud. An inspection of the blades at NASA-Lewis showed that the shank failure was caused by a high stress concentration at a corrosion pit on the shank fillet radius which resulted in fatigue stresses in excess of the endurance limit

Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix™) and early weight-bearing: Prospective evaluation of bone union, precision and maintenance of correction in 51 cases

SummaryIntroductionA medial opening wedge high tibial osteotomy (HTO), where the osteotomy site is filled, is often preferred to a lateral closing osteotomy, but filling the defect can lead to certain complications.HypothesisA medial opening HTO can be performed without filling the bone defect if fixation is carried out with a specially-designed stiff locking plate.Patients and methodsFifty-one patients, 37 to 72 years of age where followed prospectively and continuously from 2003 to 2006. A single surgical technique was used: medial opening HTO with locked plate fixation (TomoFix™, Synthes) but without filling the defect. The preoperative genu varum could not exceed 15°. The following were evaluated: time to return to weight-bearing, IKS functional score, long-leg standing film performed preoperative, postoperative and at follow-up to evaluate limb alignment and validate the precision of the correction and its stability over time. A measurement of the area of bone union in the osteotomy site was used to quantify the rate of union.ResultsBone union occurred at 4.5 months on average; two cases of incomplete union (7%) were found and revised with an autograft at 7 and 9 months. Lower-limb alignment was 7.5° of varus on average before surgery (3° to 15° varus, SD=2.85) and 1.2° of valgus on average after the surgery (4° varus to 5° valgus, SD=1.78). The correction was maintained at 1 year post-surgery. The average IKS knee score went from 69±15.5 (range 25 to 96) before surgery to 90±7.4 (range 66 to 98) at follow-up (P=0.0001). Full weight-bearing without assistance was possible after 3 months on average (range 1.5 to 8, SD=1.21). Forty-seven patients (92%) were fully weight-bearing after 2 months. Forty-eight patients were able to return to work and sporting activities at the same or a higher level than before the procedure.DiscussionBone union seems to happen more slowly when the defect is filled; however, there are doubts about radiological evaluation of bone union in different published studies. When osteotomy defect was left unfilled in this study, union and filling of 4/5 of the osteotomy site was obtained in 4.2 months for 49 of the 51 cases. Fixation with the locking plate is reliable and provides stable correction and the option for early weight-bearing.Level of proofLevel IV, prospective cohort study

Knee arthodesis using a modular customized intramedullary nail

SummaryIntroductionArthrodesis of the knee, particularly in infectious situations, can be achieved using either an external fixator or an intramedullary device. The objective of this study is to report the clinical, functional, and radiographic outcomes of a continuous series of 19 cases of knee arthrodesis using a customized modular intramedullary nailing system.HypothesisThe modular intramedullary nail offers a satisfactory functional result while maintaining limb length, in spite of a nonunion risk, since acting like a true endoprosthesis.Material and methodsIn our retrospective series of 19 patients, the main source of patients were infected total knee replacements. The nail was customized from assembling a dual surface-sanded titanium component (femoral and tibial). The Lequesne Algofunctional score and the WOMAC score were recorded, as well as the length discrepancy between the lower extremities. Arthrodesis consolidation and the nail's fit in the shaft were verified on anterior-posterior (AP) and lateral radiographs.ResultsFive complications were observed: one anterior cortical break, one excessive tibial rotation, two cases of delayed union, and one nail revision due to residual nail instability. The postoperative Lequesne Algofunctional score was 13/24 and the WOMAC score 57/100. The nonunion rate was 32%. From a functional point of view, the patients who did not achieve complete union and those who did had similar scores. The subjective results were not as good in patients who did not achieve final consolidation.DiscussionModular intramedullary nailing simplifies the technique, shortens the procedure, and reduces the amount of blood loss at surgery. Our nonunion rate was high, although the functional result did not seem compromized by such nonunion. The risk of long-term implant failure was not studied and requires longer follow-up studies.Level of evidenceLevel IV therapeutic study

En reconstruction mammaire : intérêt du dépistage du portage de Staphylococcus aureus dans la prévention de l’infection du site opératoire

National audienceThe incidence of prosthesis infections after breast reconstruction is of the order of 4% to 13% according to the literature. In surgical patients, Staphylococcus aureus (S. aureus) is the bacterial species most often responsible for surgical site infections. In cardiac surgery, screening for carriage of S. aureus and preoperative decontamination are carried out routinely before prosthetic surgery. We retrospectively reviewed data from patients at our institution between January 2011 and December 2013. Our series showed that the prosthesis infection rates were in the range of 5.92% in 2008 with an ISO rate of S. aureus 3.61%. Routine screening for prosthetic reconstructions was performed to assess the impact of preoperative decontamination patients in carriers of S. aureus. This screening was done in 381 patients: 17.8% of patients were carriers of S. aureus ; 11 patients have an ISO (or an incidence rate of 2.88%) ; 5 patients have an ISO S. aureus (an incidence of S. aureus ISO 1.3%). The introduction of the screening process, allowed a drop of 5.92% ISO rate at 1.46% with a passage of S. aureus SSI rates of 3, 60% to 0.72%. In the near future, studies are needed to confirm these encouraging results, to demonstrate the efficacy of preoperative decontamination in carriers of S. aureus patients before laying prosthesis

C4d-expressing glomerulopathy and proteinuria post transplantation of a too-big-for-size mismatched kidney allograft: An unusual case with good outcome

A 5-year-old severely growthretarded child with tubulointerstitial, oliguric end-stage renal disease received an adult-size kidney transplant. Three years post grafting under standard triple immunosuppression (mycophenolate mofetil, tacrolimus, and prednisone) de novo nephrotic range proteinuria without the nephrotic syndrome developed. Graft function was normal (serum creatinine: 0.2 - 0.3 mg/dL), there were no donor-specific HLA antibodies (DSA), and the urine sediment was inactive. Two biopsies collected 3 and 4 years post-transplantation showed severe glomerular capillary wall remodeling and associated pseudolinear C4d staining as morphologic correlates for the proteinuria. Changes resembled those seen in so-called "size-mismatch transplant glomerulopathies". There was no evidence of a glomerulonephritis, acute or chronic rejection including transplant glomerulopathy, interstitial fibrosis, peritubular capillary C4d deposits, or multilamination of peritubular capillary basement membranes. The glomerular changes were not detected in the implantation zero-hour biopsy or the recipient's native renal biopsy. At the end of follow-up 64 months post transplantation, proteinuria persisted at subnephrotic levels in the setting of stable graft function and undetectable DSAs. This unique case adds to the list of causes of nonrejection-associated post-transplant proteinuria. It demonstrates for the first time that a too-large-for-body-size mismatched graft is associated with a presumably sheer stressinduced C4d expressing glomerulopathy, severe proteinuria, and favorable outcome

Synovial hemangioma of the knee joint in a 12-year-old boy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Synovial hemangioma is a rare condition and is frequently misdiagnosed, leading to a diagnostic delay of many years.</p> <p>Case presentation</p> <p>We present a case of an atypical synovial hemangioma in a 12-year-old Caucasian boy with a diagnostic delay of 3 years.</p> <p>Conclusion</p> <p>It is important to know that synovial hemangioma mostly affects the knee joint, showing recurrent bloody effusions without a history of trauma. If there are no intermittent effusions, the diagnosis will be even more difficult. In cases of nonspecific symptoms and longstanding knee pain the diagnosis of a synovial hemangioma should also be considered in order to avoid diagnostic delay. Magnetic resonance imaging is the main diagnostic tool to evaluate patients with synovial hemangioma, showing characteristic lace-like or linear patterns.</p> <p>Angiography can identify feeder vessels and offers the possibility of embolisation in the same setting. Surgical excision, either done per arthroscopy or per arthrotomy, is recommended as soon as possible to avoid the risk of damage to the cartilage.</p

Clinicopathologic predictors of renal outcomes in light chain cast nephropathy: a multicenter retrospective study

Light chain cast nephropathy (LCCN) in multiple myeloma often leads to severe and poorly reversible acute kidney injury. Severe renal impairment influences the allocation of chemotherapy and its tolerability; it also affects patient survival. Whether renal biopsy findings add to the clinical assessment in predicting renal and patient outcomes in LCCN is uncertain. We retrospectively reviewed clinical presentation, chemotherapy regimens, hematologic response, and renal and patient outcomes in 178 patients with biopsy-proven LCCN from 10 centers in Europe and North America. A detailed pathology review, including assessment of the extent of cast formation, was performed to study correlations with initial presentation and outcomes. Patients presented with a mean estimated glomerular filtration rate (eGFR) of 13 ± 11 mL/min/1.73 m2, and 82% had stage 3 acute kidney injury. The mean number of casts was 3.2/mm2 in the cortex. Tubulointerstitial lesions were frequent: acute tubular injury (94%), tubulitis (82%), tubular rupture (62%), giant cell reaction (60%), and cortical and medullary inflammation (95% and 75%, respectively). Medullary inflammation, giant cell reaction, and the extent of cast formation correlated with eGFR value at LCCN diagnosis. During a median follow-up of 22 months, mean eGFR increased to 43 ± 30 mL/min/1.73 m2. Age, β2-microglobulin, best hematologic response, number of cortical casts per square millimeter, and degree of interstitial fibrosis/tubular atrophy (IFTA) were independently associated with a higher eGFR during follow-up. This eGFR value correlated with overall survival, independently of the hematologic response. This study shows that extent of cast formation and IFTA in LCCN predicts the quality of renal response, which, in turn, is associated with overall survival.info:eu-repo/semantics/publishedVersio

IL-7 Promotes CD95-Induced Apoptosis in B Cells via the IFN-γ/STAT1 Pathway

Interleukin-7 (IL-7) concentrations are increased in the blood of CD4+ T cell depleted individuals, including HIV-1 infected patients. High IL-7 levels might stimulate T cell activation and, as we have shown earlier, IL-7 can prime resting T cell to CD95 induced apoptosis as well. HIV-1 infection leads to B cell abnormalities including increased apoptosis via the CD95 (Fas) death receptor pathway and loss of memory B cells. Peripheral B cells are not sensitive for IL-7, due to the lack of IL-7Ra expression on their surface; however, here we demonstrate that high IL-7 concentration can prime resting B cells to CD95-mediated apoptosis via an indirect mechanism. T cells cultured with IL-7 induced high CD95 expression on resting B cells together with an increased sensitivity to CD95 mediated apoptosis. As the mediator molecule responsible for B cell priming to CD95 mediated apoptosis we identified the cytokine IFN-γ that T cells secreted in high amounts in response to IL-7. These results suggest that the lymphopenia induced cytokine IL-7 can contribute to the increased B cell apoptosis observed in HIV-1 infected individuals