Complexation of Nickel Ions by Boric Acid or (Poly)borates

International audienc

Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery†

Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most devastating complication. The aim of this position paper is to provide physicians with broad information regarding spinal cord blood supply, to share strategies for shortening intraprocedural spinal cord ischaemia and to increase spinal cord tolerance to transitory ischaemia through detection of ischaemia and augmentation of spinal cord blood perfusion. This study is meant to support physicians caring for patients in need of any kind of thoracic or thoracoabdominal aortic repair in decision-making algorithms in order to understand, prevent or reverse ischaemic SCI. Information has been extracted from focused publications available in the PubMed database, which are cohort studies, experimental research reports, case reports, reviews, short series and meta-analyses. Individual chapters of this position paper were assigned and after delivery harmonized by Christian D. Etz, Ernst Weigang and Martin Czerny. Consequently, further writing assignments were distributed within the group and delivered in August 2014. The final version was submitted to the EJCTS for review in September 201

Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?

Thoracic endovascular aortic repair (TEVAR) has emerged as a promising therapeutic alternative to conventional open aortic replacement but it requires suitable proximal and distal landing zones for stent-graft anchoring. Many aortic pathologies affect in the immediate proximity of the left subclavian artery (LSA) limiting the proximal landing zone site without proximal vessel coverage. In patients in whom the distance between the LSA and aortic lesion is too short, extension of the landing zone can be obtained by covering the LSA's origin with the endovascular stent graft (ESG). This manoeuvre has the potential for immediate and delayed neurological and vascular symptoms. Some authors, therefore, propose prophylactic revascularisation of the LSA by transposition or bypass, while others suggest prophylactic revascularisation only under certain conditions, and still others see no requirement for prophylactic revascularisation in anticipation of LSA ostium coverage. In this review about LSA revascularisation in TEVAR patients with coverage of the LSA, we searched the electronic databases MEDLINE and EMBASE historically until the end date of May 2010 with the search terms left subclavian artery, covering, endovascular, revascularisation and thoracic aorta. We have gathered the most complete scientific evidence available used to support the various concepts to deal with this issue. After a review of the current available literature, 23 relevant articles were found, where we have identified and analysed three basic treatment concepts for LSA revascularisation in TEVAR patients (prophylactic, conditional prophylactic and no prophylactic LSA revascularisation). The available evidence supports prophylactic revascularisation of the LSA before ESG LSA coverage when preoperative imaging reveals abnormal supra-aortic vascular anatomy or pathology. We further conclude that elective patients undergoing planned coverage of the LSA during TEVAR should receive prophylactic LSA transposition or LSA-to-left-common-carotid-artery (LCCA) bypass surgery to prevent severe neurological complications, such as paraplegia or brain stem infarctio

The future of aortic surgery in Europe†

At least every ten years, each specialty should reflect upon its past, its present and its future, in order to be able to reconfirm the direction in which it is headed, to adopt suggestions from inside and outside and, consequently, to improve. As such, the aim of this manuscript is to provide the interested reader with an overview of how aortic surgery and (perhaps more accurately) aortic medicine has evolved in Europe, and its present standing; also to provide a glimpse into the future, trying to disseminate the thoughts of a group of people actively involved in the development of aortic medicine in Europe, namely the Vascular Domain of the European Association of Cardio-Thoracic Surgery (EACTS

Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS†

The implementation of new surgical techniques offers chances but carries risks. Usually, several years pass before a critical appraisal and a balanced opinion of a new treatment method are available and rely on the evidence from the literature and expert's opinion. The frozen elephant trunk (FET) technique has been increasingly used to treat complex pathologies of the aortic arch and the descending aorta, but there still is an ongoing discussion within the surgical community about the optimal indications. This paper represents a common effort of the Vascular Domain of EACTS together with several surgeons with particular expertise in aortic surgery, and summarizes the current knowledge and the state of the art about the FET technique. The majority of the information about the FET technique has been extracted from 97 focused publications already available in the PubMed database (cohort studies, case reports, reviews, small series, meta-analyses and best evidence topics) published in Englis

Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?

Thoracic endovascular aortic repair (TEVAR) has emerged as a promising therapeutic alternative to conventional open aortic replacement but it requires suitable proximal and distal landing zones for stent-graft anchoring. Many aortic pathologies affect in the immediate proximity of the left subclavian artery (LSA) limiting the proximal landing zone site without proximal vessel coverage. In patients in whom the distance between the LSA and aortic lesion is too short, extension of the landing zone can be obtained by covering the LSA's origin with the endovascular stent graft (ESG). This manoeuvre has the potential for immediate and delayed neurological and vascular symptoms. Some authors, therefore, propose prophylactic revascularisation of the LSA by transposition or bypass, while others suggest prophylactic revascularisation only under certain conditions, and still others see no requirement for prophylactic revascularisation in anticipation of LSA ostium coverage. In this review about LSA revascularisation in TEVAR patients with coverage of the LSA, we searched the electronic databases MEDLINE and EMBASE historically until the end date of May 2010 with the search terms left subclavian artery, covering, endovascular, revascularisation and thoracic aorta. We have gathered the most complete scientific evidence available used to support the various concepts to deal with this issue. After a review of the current available literature, 23 relevant articles were found, where we have identified and analysed three basic treatment concepts for LSA revascularisation in TEVAR patients (prophylactic, conditional prophylactic and no prophylactic LSA revascularisation). The available evidence supports prophylactic revascularisation of the LSA before ESG LSA coverage when preoperative imaging reveals abnormal supra-aortic vascular anatomy or pathology. We further conclude that elective patients undergoing planned coverage of the LSA during TEVAR should receive prophylactic LSA transposition or LSA-to-left-common-carotid-artery (LCCA) bypass surgery to prevent severe neurological complications, such as paraplegia or brain stem infarction

The future of aortic surgery in Europe

At least every ten years, each specialty should reflect upon its past, its present and its future, in order to be able to reconfirm the direction in which it is headed, to adopt suggestions from inside and outside and, consequently, to improve. As such, the aim of this manuscript is to provide the interested reader with an overview of how aortic surgery and (perhaps more accurately) aortic medicine has evolved in Europe, and its present standing; also to provide a glimpse into the future, trying to disseminate the thoughts of a group of people actively involved in the development of aortic medicine in Europe, namely the Vascular Domain of the European Association of Cardio-Thoracic Surgery (EACTS)

Modélisation par transport réactif des résines échangeuses d'ions utilisées dans les réacteurs à eau sous pression

In nuclear power plants, the water contained in different circuits is purified by passing through ion exchange resins. Prediction of the performance of these resins is an important help to the plant operators. To this end, the method of reactive transport modeling are well suited and is the basis of the OPTIPUR code that was designed to model the resins. The work presented in this manuscript covers three main aspects. The first one is the integration of a limitation to mass transfer in a ion exchange deep bed, taking into account a specific mobility for each chemical species, in the context of separated calculations for chemistry and transport. This model was shown to reproduce experimental data, without adjustable parameters. The second part of this work deals with the numerical aspects of reactive transport modelling. A method developped by Anderson was used to accelerate the convergence of the chemistry transport coupling in an iterative scheme. Using the information from previous iterations, and without major changes in the code, calculation times were largely decreased, as well as the number of calculations failures. The third topic is ion exchange equilibrium. The basis of a model that takes into account the change in the water content of the resin and its elasticity are described. The interactions between the fonctional groups, the counterions and water are considered as chemical reactions. The corresponding equilibrium constants are fitted to measurements of the water content of the resin at different relative humidity. Finaly, the selectivity coefficients can be calculated and compared to litterature values.L’eau des circuits d’une centrale nucléaire est purifiée à l’aide de résines échangeuses d’ions. La prédiction de leurs performances constitue une aide importante pour l’exploitation de ces réacteurs. Les méthodes du transport réactif sont particulièrement adaptées pour cela et constituent la base du code OPTIPUR, dédié à la modélisation de ces résines. Le travail présenté comporte trois axes principaux. Le premier est l’intégration d’une limitation au transfert de masse dans une colonne de résines échangeuses d’ions, avec une mobilité spécifique à chaque espèce chimique, dans le cadre d’un découplage des calculs de chimie et de transport. Ce modèle permet, sans paramètre ajustable, de reproduire assez fidèlement une série d’expériences réalisées précédemment par le CEA. Le second axe concerne les aspects numériques du transport réactif, avec l’utilisation de la méthode d’Anderson pour accélérer la convergence du couplage chimie-transport dans un schéma itératif. En utilisant les informations issues des itérations précédentes et sans modification majeure du code, la robustesse et les temps de calcul ont pu être nettement améliorés. La troisième thématique abordée est celle de l’équilibre d’échange d’ions. Les bases d’un modèle prenant en considération l’évolution de l’humidité de la résine, ainsi que son élasticité sont proposées ; les interactions entre groupes fonctionnels, contre-ions et eau sont considérées comme des équilibres chimiques. Les constantes d’équilibre sont ajustées à partir de mesures de la teneur en eau de la résine à différentes pressions de vapeur d’eau. Finalement, des coefficients de sélectivité apparents peuvent être calculés et comparés aux mesures disponibles