External iliac artery thrombosis associated with the ilio-inguinal approach in the management of acetabular fractures: a case report

<p>Abstract</p> <p>Introduction</p> <p>The ilio-inguinal approach has come to be used routinely in the management of acetabular fractures involving the anterior wall. Thrombotic complications following surgery via this route are a serious, but rare, complication.</p> <p>Case presentation</p> <p>We report the case of a 66-year-old male patient who slipped on an icy pavement and fell on his left hip. He sustained a comminuted acetabular fracture (a transtectal T-fracture with an incomplete posterior stem through the ischial tuberosity), and was operated on five days later, via an ilio-inguinal approach. In the recovery room, his left lower limb was found to be cool and pale. Immediate re-exploration showed a left external iliac artery thrombosis, and thrombectomy was performed. In the surgical management of acetabular fractures, thrombosis of a major pelvic artery is a rare but potentially devastating complication. We discuss the possible aetiology (initial vessel trauma versus iatrogenic, intraoperative arterial injury) and pathomechanism, and wish to draw attention to this complication and to recommend ways in which it can be prevented.</p> <p>Conclusion</p> <p>We recommend circulation monitoring in patients with acetabular fractures, especially where nerve blocks and/or deep sedation/analgesia have been used. High-risk patients should be identified and subjected to intensive preoperative screening, including ultrasonography and if necessary angiography.</p

OH+ in astrophysical media: state-to-state formation rates, Einstein coefficients and inelastic collision rates with He

The rate constants required to model the OH$^+$ observations in different regions of the interstellar medium have been determined using state of the art quantum methods. First, state-to-state rate constants for the H$_2(v=0,J=0,1)$+ O$^+$($^4S$) $\rightarrow$ H + OH$^+(X ^3\Sigma^-, v', N)$ reaction have been obtained using a quantum wave packet method. The calculations have been compared with time-independent results to asses the accuracy of reaction probabilities at collision energies of about 1 meV. The good agreement between the simulations and the existing experimental cross sections in the $0.01-$1 eV energy range shows the quality of the results. The calculated state-to-state rate constants have been fitted to an analytical form. Second, the Einstein coefficients of OH$^+$ have been obtained for all astronomically significant ro-vibrational bands involving the $X^3\Sigma^-$ and/or $A^3\Pi$ electronic states. For this purpose the potential energy curves and electric dipole transition moments for seven electronic states of OH$^+$ are calculated with {\it ab initio} methods at the highest level and including spin-orbit terms, and the rovibrational levels have been calculated including the empirical spin-rotation and spin-spin terms. Third, the state-to-state rate constants for inelastic collisions between He and OH$^+(X ^3\Sigma^-)$ have been calculated using a time-independent close coupling method on a new potential energy surface. All these rates have been implemented in detailed chemical and radiative transfer models. Applications of these models to various astronomical sources show that inelastic collisions dominate the excitation of the rotational levels of OH$^+$. In the models considered the excitation resulting from the chemical formation of OH$^+$ increases the line fluxes by about 10 % or less depending on the density of the gas

The use of a retrograde fixed-angle intramedullary nail for tibiocalcaneal arthrodesis after severe loss of the talus

Tibiocalcaneal arthrodesis may be the only means of obtaining a painless and stable limb when there is loss of the talus. We present the early results of a prospective study on tibiocalcaneal arthrodesis using a latest-generation retrograde intramedullary nail. In the period 2006–2007, nine patients underwent tibiocalcaneal arthrodesis with retrograde intramedullary nailing. Five of these patients had infection-related loss of the talus. SF-36, AOFAS ankle-hindfoot, and Mazur Ankle Arthrodesis scores were obtained pre-fusion, and at 6 weeks, 6 months and 1 year post-fusion. The patients were also followed up clinically and radiologically. Previous surgical procedures, chronic musculoskeletal problems and other comorbidities, and complications were recorded and analyzed. All patients were available for initial follow-up and were subjectively satisfied with their outcomes. Solid fusion was achieved and fully confirmed in nine cases. One subject died 8 weeks postoperatively of a pulmonary embolism. One patient had recurrent infection. At 1 year, only one patient still needed NSAIDs regularly for pain relief. The AOFAS score improved significantly (P = 0.012) from 32.1 pre-fusion to 71.5 points at 1 year as did the Mazur score, which rose by 31.2 to 72.5 points at 1 year (P = 0.012). The SF-36 score improved significantly in the domains physical functioning, role limitations due to physical problems, bodily pain, vitality, social functioning and mental health, as did the Physical Component Summary Score. Retrograde intramedullary nailing for tibiocalcaneal arthrodesis can produce a good outcome. However, in the presence of infection, patient selection for intramedullary procedures must be carefully considered on a case-by-case basis

AWARENESS OF LYME BORRELIOSIS OF THE PATIENTS OF TERNOPIL REGIONAL TB DISPENSARY

Background. Lyme disease has many clinical features similar tothose in sarcoidosis and tuberculosis. Epidemiological data in the world, in particular in Ukraine, proves the increase in Lyme borreliosis incidence. Ternopil region is endemic with Lyme borreliosis. Objective. The research was aimed to investigate the prevalence of infection with Borrelia burgdorferi and epidemiology features of borreliosis among the patients of Ternopil Regional TB Dispensary. Methods. In total, 29 patients were admitted to Departments of Differential Diagnostic, TB Therapy and TB Surgery of Ternopil Regional TB Dispensary in October 2016-January 2017. All the surveyed answered the questions of an integrated international questionnaire, where they noted the area and a number of tick bites, described the removal method, noted the survey for borreliosis pathogen and complaints after tick bites. Results. It was established that 5 respondents had a history of tick bites episodes, but only in one case the patient was examined of borreliosis. Tick bites were noticed in 3 patients with sarcoidosis and 1 with tuberculosis (TB) and exudative pleurisy, respectively. Conclusions. The absence of appeals for medical care, lack of sufficient information on Lyme borreliosis and disuse of preventive measures for tick bites by the interviewed patients of Ternopil regional TB dispensary departments proves the need of improvement of health education on Lyme borreliosis (LB) among this category of population. 24 (82.7%) of 29 respondents did not remember the tick bite. The symptoms of (LB) are similar to those in sarcoidosis and tuberculosis (pleural lesions, heart, joints, nervous system, skin), and the presence of tick bites gives the reasons to examine these patients of Borrelia burgdorferi senso lato

Діагностика цитолітичного синдрому у хворих на туберкульоз легень

Introduction. The liver is one of the most important organs of the human body, performing a number of important functions. Among the common liver diseases, infiltrative pathologies we distinguished: fatty degeneration, lymphomas, amyloidosis, sarcoidosis and tuberculosis. Characterizing liver disease, the manifestations of disorders are divided into syndromes that help to diagnose a particular disease of the liver and determine its causes. In particular – the cytolytic syndrome (CS).The aim of the study – to examine the CS markers in the case of liver dysfunction in patients with newly diagnosed lung tuberculosis prior to treatment and after two months of therapy with first-line anti-tuberculosis drugs.Methods of the research. Two groups of people were examined: the 1st control group of practically healthy donors – 34 people; and the 2nd – patients with newly diagnosed pulmonary tuberculosis prior to treatment and after two months of therapy with first-line anti-tuberculosis drugs (31 people). All patients underwent standard biochemical blood tests, ultrasound of the liver in dynamics. The spectrum of biochemical blood test parameters included determination of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and γ-glutamyltranspeptidase (GGTP).Results and Discussion. The obtained data testifying to occurrence of CS in newly diagnosed tuberculosis patients before the start of treatment are confirmed by the tendency to increase the levels of AST and GGTP. Especially such changes are observed after intensive therapy with antituberculous drugs. There are likely changes in such markers as ALT, LDH and GGTP.Conclusions. It is established that tuberculous intoxication can affect the functional state of the liver. After prolonged treatment of patients with pulmonary tuberculosis, an increase in the indices of such markers of cytolysis as ALT, LDH and GGTP is observed. Disturbance of liver function during therapy may be due to the hepatotoxic effect of anti-tuberculosis drugs, which necessitates the appointment for patients hepatoprotectors.Вступление. Печень является одним из важнейших органов тела человека и выполняет ряд важнейших функций. Среди распространенных заболеваний печени выделяют инфильтративные патологии: жировую дистрофию, лимфомы, амилоидоз, саркоидоз и туберкулез. Характеризуя болезни печени, проявления расстройств принято разделять на синдромы, которые помогают диагностировать то или иное заболевание этого органа и определить его причины. В частности, выделяют цитолитический синдром (ЦС).Цель исследования – изучить маркеры ЦС при нарушении функции печени у больных с впервые диагностированным туберкулезом легких до лечения и через два месяца терапии противотуберкулезными препаратами первого ряда.Методы исследования. Было обследовано две группы лиц: 1-я (контрольная) – практически здоровые доноры (34 человека); 2-я – больные с впервые диагностированным туберкулезом легких до лечения и через два месяца терапии противотуберкулезными препаратами первого ряда (31 человек). Всем пациентам проводили стандартные биохимические исследования крови, УЗИ печени в динамике. Спектр показателей биохимического исследования крови включал определение аланинаминотрансферазы (АлАТ), аспартатаминотрансферазы (АсАТ), лактатдегидрогеназы (ЛДГ) и γ-глутамилтранспептидазы (ГГТП).Результаты и обсуждение. Полученные данные, свидетельствующие о возникновении ЦС у больных с впервые диагностированным туберкулезом до начала лечения, подтверждаются тенденцией к увеличению уровней АсАТ и ГГТП. Особенно такие изменения наблюдали после интенсивной терапии противотуберкулезными препаратами. Отмечали вероятные изменения таких маркеров, как АлАТ, ЛДГ и ГГТП.Выводы. Установлено, что туберкулезная интоксикация может влиять на функциональное состояние печени. После длительного лечения больных туберкулезом легких отмечают увеличение показателей таких маркеров цитолиза, как АлАТ, ЛДГ и ГГТП. Нарушения функции печени во время терапии могут быть вызваны гепатотоксическим действием противотуберкулезных препаратов, что обусловливает необходимость назначения больным гепатопротекторов.Вступ. Печінка є одним із найважливіших органів тіла людини і виконує низку надзвичайно важливих функцій. Серед поширених захворювань печінки виділяють інфільтративні патології: жирову дистрофію, лімфоми, амілоїдоз, саркоїдоз і туберкульоз. Характеризуючи хвороби печінки, прояви розладів прийнято розділяти на синдроми, які допомагають діагностувати те чи інше захворювання цього органа та визначити його причини. Зокрема, виділяють цитолітичний синдром (ЦС).Мета дослідження – вивчити маркери ЦС при порушенні функції печінки у хворих на вперше діагностований туберкульоз легень до лікування і через два місяці терапії протитуберкульозними препаратами першого ряду.Методи дослідження. Було обстежено дві групи осіб: 1-ша контрольна – практично здорові донори – (34 особи); 2-га – хворі на вперше діагностований туберкульоз легень до лікування і через два місяці терапії протитуберкульозними препаратами першого ряду (31 особа). Усім пацієнтам проводили стандартні біохімічні дослідження крові, УЗД печінки в динаміці. Спектр показників біохімічного дослідження крові включав визначення аланінамінотрансферази (АлАТ), аспартатамінотрансферази (АсАТ), лактатдегідрогенази (ЛДГ) та γ-глутамілтранспептидази (ГГТП).Результати й обговорення. Отримані дані, які свідчили про виникнення ЦС у хворих на вперше діагностований туберкульоз до початку лікування, підтверджувалися тенденцією до збільшення рівнів АсАТ і ГГТП. Особливо такі зміни спостерігали після інтенсивної терапії протитуберкульозними препаратами. Відмічали вірогідні зміни таких маркерів, як АлАТ, ЛДГ і ГГТП.Висновки. Встановлено, що туберкульозна інтоксикація може впливати на функціональний стан печінки. Після тривалого лікування хворих на туберкульоз легень відмічають збільшення показників таких маркерів цитолізу, як АлАТ, ЛДГ і ГГТП. Порушення функції печінки під час терапії можуть бути спричинені гепатотоксичною дією протитуберкульозних препаратів, що зумовлює необхідність призначення хворим гепатопротекторів.

AWARENESS OF LYME BORRELIOSIS OF THE PATIENTS OF TERNOPIL REGIONAL TB DISPENSARY

Background. Lyme disease has many clinical features similar tothose in sarcoidosis and tuberculosis. Epidemiological data in the world, in particular in Ukraine, proves the increase in Lyme borreliosis incidence. Ternopil region is endemic with Lyme borreliosis.Objective. The research was aimed to investigate the prevalence of infection with Borrelia burgdorferi and epidemiology features of borreliosis among the patients of Ternopil Regional TB Dispensary.Methods. In total, 29 patients were admitted to Departments of Differential Diagnostic, TB Therapy and TB Surgery of Ternopil Regional TB Dispensary in October 2016-January 2017. All the surveyed answered the questions of an integrated international questionnaire, where they noted the area and a number of tick bites, described the removal method, noted the survey for borreliosis pathogen and complaints after tick bites.Results. It was established that 5 respondents had a history of tick bites episodes, but only in one case the patient was examined of borreliosis. Tick bites were noticed in 3 patients with sarcoidosis and 1 with tuberculosis (TB) and exudative pleurisy, respectively.Conclusions. The absence of appeals for medical care, lack of sufficient information on Lyme borreliosis and disuse of preventive measures for tick bites by the interviewed patients of Ternopil regional TB dispensary departments proves the need of improvement of health education on Lyme borreliosis (LB) among this category of population. 24 (82.7%) of 29 respondents did not remember the tick bite. The symptoms of (LB) are similar to those in sarcoidosis and tuberculosis (pleural lesions, heart, joints, nervous system, skin), and the presence of tick bites gives the reasons to examine these patients of Borrelia burgdorferi senso lato

Search for eta-mesic 4He in the dd->3He n pi0 and dd->3He p pi- reactions with the WASA-at-COSY facility

The search for 4He-eta bound states was performed with the WASA-at-COSY facility via the measurement of the excitation function for the dd->3He n pi0 and dd->3He p pi- processes. The beam momentum was varied continuously between 2.127 GeV/c and 2.422 GeV/c, corresponding to the excess energy for the dd->4He eta reaction ranging from Q=-70 MeV to Q=30 MeV. The luminosity was determined based on the dd->3He n reaction and quasi-free proton-proton scattering via dd->pp n_spectator n_spectator reactions. The excitation functions determined independently for the measured reactions do not reveal a structure which could be interpreted as a narrow mesic nucleus. Therefore, the upper limits of the total cross sections for the bound state production and decay in dd->(4He-eta)_bound->3He n pi0 and dd->(4He-eta)_bound->3He p pi- processes were determined taking into account the isospin relation between both the channels considered. The results of the analysis depend on the assumptions of the N* momentum distribution in the anticipated mesic-4He. Assuming as in the previous works, that this is identical with the distribution of nucleons bound with 20 MeV in 4He, we determined that (for the mesic bound state width in the range from 5 MeV to 50 MeV) the upper limits at 90% confidence level are about 3 nb and about 6 nb for npi0 and ppi- channels, respectively. However, based on the recent theoretical findings of the N*(1535) momentum distribution in the N*-3He nucleus bound by 3.6 MeV, we find that the WASA-at-COSY detector acceptance decreases and hence the corresponding upper limits are 5 nb and 10 nb for npi0 and ppi- channels respectively.Comment: This article will be submitted to JHE

Far-infrared study of the Jahn-Teller distorted C60 monoanion in C60 tetraphenylphosphoniumiodide

We report high-resolution far-infrared transmission measurements on C(60)-tetraphenylphosphoniumiodide as a function of temperature. In the spectral region investigated (20-650 cm(-1)), we assign intramolecular modes of the C(60) monoanion and identify low-frequency combination modes. The well-known F(1u)(1) and F(1u)(2) modes are split into doublers at room temperature, indicating a D(5d) or D(3d) distorted ball. This result is consistent with a dynamic Jahn-Teller effect in the strong-coupling limit or with a static distortion stabilized by low-symmetry perturbations. The appearance of silent odd modes is in keeping with symmetry reduction of the hall, while activation of even modes is attributed to interband electron-phonon coupling and orientational disorder in the fulleride salt. Temperature dependences reveal a weak transition in the region 125-150 K in both C(60)(-) and counterion modes, indicating a bulk, rather than solely molecular, effect. Anomalous softening (with decreasing temperature) in several modes may correlate with the radial character of those vibrations. [S0163-1829(98)03245-7]

Magnonic Metamaterials

A large proportion of the recent growth of the volume of electromagnetics research has been associated with the emergence of so called electromagnetic metamaterials1 and the discovered ability to design their unusual properties by tweaking the geometry and structure of the constituent “meta-atoms”. For example, negative permittivity and negative permeability can be achieved, leading to negative refractive index metamaterials. The negative permeability could be obtained via geometrical control of high frequency currents, e.g. in arrays of split ring resonators, or alternatively one could rely on spin resonances in natural magnetic materials, as was suggested by Veselago. The age of nanotechnology therefore sets an intriguing quest for additional benefits to be gained by structuring natural magnetic materials into so called magnonic metamaterials, in which the frequency and strength of resonances based on spin waves (magnons) are determined by the geometry and magnetization configuration of meta-atoms. Spin waves can have frequencies of up to hundreds of GHz (in the exchange dominated regime) and have already been shown to play an important role in the high frequency magnetic response of composites. Moreover, in view of the rapid advances in the field of magnonics, which in particular promises devices employing propagating spin waves, the appropriate design of magnonic metamaterials with properties defined with respect to propagating spin waves rather than electromagnetic waves acquires an independent and significant importance

Optimal heat release shaping in a reactivity controlled compression ignition (RCCI) engine

[EN] The present paper addresses the optimal heat release (HR) law in a single cylinder engine operated under reactivity controlled compression ignition (RCCI) combustion mode to minimise the indicated specific fuel consumption (ISFC) subject to different constraints including pressure related limits (maximum cylinder pressure and maximum cylinder pressure gradient). With this aim, a 0-dimensional (0D) engine combustion model has been identified with experimental data. Then, the optimal control problem of minimising the ISFC of the engine at different operating conditions of the engine operating map has been stated and analytically solved. To evaluate the method viability a data-driven model is developed to obtain the control actions (gasoline fraction) leading to the calculated optimal HR, more precisely to the optimal ratio between premixed and diffusive combustion. The experimental results obtained with such controls and the differences with the optimal HR are finally explained and discussed.This work was supported by Ministerio de Economía y Competitividad through Project TRA2016-78717-R.Guardiola, C.; Plá Moreno, B.; García Martínez, A.; Boronat-Colomer, V. (2017). Optimal heat release shaping in a reactivity controlled compression ignition (RCCI) engine. Control Theory and Technology. 15(2):117-128. https://doi.org/10.1007/s11768-017-6155-5S117128152F. Payri, J. M. Luján, C. Guardiola, et al. A challenging future for the IC engine: New technologies and the control role. Oil & Gas Science and Technology–Revue D IFP Energies Nouvelles, 2015, 70(1): 15–30.H. Yanagihara, Y. Sato, J. Minuta. A simultaneous reduction in NOx and soot in diesel engines under a new combustion system (Uniform Bulky Combustion System–UNIBUS). Proceedings of the 17th international Vienna Motor Symposium, Vienna, 1996: 303–314.D. A. Splitter, M. L. Wissink, T. L. Hendricks, et al. Comparison of RCCI, HCCI, and CDC operation from low to full load. THIESEL 2012 conference on thermo-and fluid dynamic processes in direct injection engines. Valencia, 2012.J. Benajes, J. V. Pastor, A. García, et al. The potential of RCCI concept to meet EURO VI NOx limitation and ultra-low soot emissions in a heavy-duty engine over the whole engine map. Fuel, 2015, 159(1): 952–961.J. Benajes, A. García, J. Monsalve-Serrano, et al. An assessment of the dual-mode reactivity controlled compression ignition/conventional diesel combustion capabilities in a EURO VI medium-duty diesel engine fueled with an intermediate ethanol-gasoline blend and biodiesel. Energy Conversion and Management, 2016, 123(1): 381–391.S. Molina, A. García, J. M. Pastor, et al. Operating range extension of RCCI combustion concept from low to full load in a heavy-duty engine. Applied Energy, 2015, 143: 211–227.D. A. Splitter, R. D. Reitz. Fuel reactivity effects on the efficiency and operational window of dual-fuel compression ignition engines. Fuel, 2014, 118(5): 163–175.J. Benajes, S. Molina, A. García, et al. Effects of low reactivity fuel characteristics and blending ratio on low load RCCI (reactivity controlled compression ignition) performance and emissions in a heavy-duty diesel engine. Energy, 2015, 90: 1261–1271.J. Benajes, S. Molina, A. García, et al. An investigation on RCCI combustion in a heavy duty diesel engine using incylinder blending of diesel and gasoline fuels. Applied Thermal Engineering, 2014, 63(1): 66–76.J. Li, W. M. Yang, H. An, et al. Numerical investigation on the effect of reactivity gradient in an RCCI engine fueled with gasoline and diesel. Energy Conversion and Management, 2015, 92(1): 342–352.J. Benajes, S. Molina, A. García, et al. Effects of direct injection timing and blending ratio on RCCI combustion with different low reactivity fuels. 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Applied Thermal Engineering, 2011, 31(16): 3275–3286.C. Guardiola, J. Martín, B. Pla, et al. Cycle by cycle NOx model for diesel engine control. Applied Thermal Engineering, 2017, 110: 1011–1020.J. M. Desantes, J. J. López, P. Redón, et al. Evaluation of the Thermal NO formation mechanism under low temperature diesel combustion conditions. International Journal of Engine Research, 2012, 13(6): 531–539.O. Sundstrm, L. Guzzella. A generic dynamic programming Matlab function. IEEE International Conference on Control Applications/International Symposium on Intelligent Control, St Petersburg: IEEE, 2009: 1625–1630.J. Benajes, A. García, J. M. Pastor, et al. Effects of piston bowl geometry on reactivity controlled compression ignition heat transfer and combustion losses at different engine loads. Fuel, 2016, 98(1): 64–77.J. Benajes, J. V. Pastor, A. García, et al. An experimental investigation on the influence of piston bowl geometry on RCCI performance and emissions in a heavy-duty engine. Energy Conversion and Management, 2015, 103: 1019–1031.J. M. Desantes, J. Benajes, A. García, et al. The role of the incylinder gas temperature and oxygen concentration over low load RCCI combustion efficiency. Energy, 2014, 78(SI): 854–868