Management and Outcome of Prosthetic Patch Infection after Carotid Endarterectomy: A Single-centre Series and Systematic Review of the Literature

AbstractObjectivesOutcomes following prosthetic patch infection after carotid endarterectomy (CEA).MethodsRetrospective audit and systematic review.Results22 patients were treated between January 1992 and April 2012, 5 having undergone their original CEA at another institution. The commonest infecting organism was Staphylococcus. One patient was treated by antibiotic irrigation, one was stented, while 20 underwent debridement and patch excision plus; carotid ligation (n = 3), vein patching (n = 3) or vein bypass (n = 14). There was one peri-operative stroke, but no peri-operative deaths. There were no reinfections at a median follow-up of 54 months.A systematic review identified 123 patients with prosthetic patch infection in the world literature. Thirty-six (29%) presented <2 months, 78 (63%) presented >6 months after the original CEA. Seventy-nine of/87 patients (91%) with a positive culture yielded Staphylococci or Streptococci. Seventy-four patients were treated by patch excision and autologous reconstruction. Four (5%) developed reinfection <30 days, but later reinfections have been reported. Seven of nine patients (78%) undergoing prosthetic reconstruction either died or suffered reinfection. Five patients were treated with a covered stent, none developing reinfection (median followup 12 months).ConclusionPatch infection following CEA is rare. Few have undergone stenting and long term data are awaited. For now, patch excision and autologous reconstruction remains the ‘gold standard’

Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction

BACKGROUND. Patients with acute myocardial infarction who were treated with accelerated tissue plasminogen activator (t-PA) (given over a period of 1 1/2 hours rather than the conventional 3 hours, and with two thirds of the dose given in the first 30 minutes) had a 30-day mortality that was 15 percent lower than that of pati

Multiwavelength Studies of Young OB Associations

We discuss how contemporary multiwavelength observations of young OB-dominated clusters address long-standing astrophysical questions: Do clusters form rapidly or slowly with an age spread? When do clusters expand and disperse to constitute the field star population? Do rich clusters form by amalgamation of smaller subclusters? What is the pattern and duration of cluster formation in massive star forming regions (MSFRs)? Past observational difficulties in obtaining good stellar censuses of MSFRs have been alleviated in recent studies that combine X-ray and infrared surveys to obtain rich, though still incomplete, censuses of young stars in MSFRs. We describe here one of these efforts, the MYStIX project, that produced a catalog of 31,784 probable members of 20 MSFRs. We find that age spread within clusters are real in the sense that the stars in the core formed after the cluster halo. Cluster expansion is seen in the ensemble of (sub)clusters, and older dispersing populations are found across MSFRs. Direct evidence for subcluster merging is still unconvincing. Long-lived, asynchronous star formation is pervasive across MSFRs.Comment: 22 pages, 9 figures. To appear in "The Origin of Stellar Clusters", edited by Steven Stahler, Springer, 2017, in pres

Fluctuations, dissipation and the dynamical Casimir effect

Vacuum fluctuations provide a fundamental source of dissipation for systems coupled to quantum fields by radiation pressure. In the dynamical Casimir effect, accelerating neutral bodies in free space give rise to the emission of real photons while experiencing a damping force which plays the role of a radiation reaction force. Analog models where non-stationary conditions for the electromagnetic field simulate the presence of moving plates are currently under experimental investigation. A dissipative force might also appear in the case of uniform relative motion between two bodies, thus leading to a new kind of friction mechanism without mechanical contact. In this paper, we review recent advances on the dynamical Casimir and non-contact friction effects, highlighting their common physical origin.Comment: 39 pages, 4 figures. Review paper to appear in Lecture Notes in Physics, Volume on Casimir Physics, edited by Diego Dalvit, Peter Milonni, David Roberts, and Felipe da Rosa. Minor changes, a reference adde

Type-H endothelial cell protein Clec14a orchestrates osteoblast activity during trabecular bone formation and patterning

Type-H capillary endothelial cells control bone formation during embryogenesis and postnatal growth but few signalling mechanisms underpinning this influence have been characterised. Here, we identify a highly expressed type-H endothelial cell protein, Clec14a, and explore its role in coordinating osteoblast activity. Expression of Clec14a and its ligand, Mmrn2 are high in murine type-H endothelial cells but absent from osteoblasts. Clec14a−/− mice have premature condensation of the type-H vasculature and expanded distribution of osteoblasts and bone matrix, increased long-bone length and bone density indicative of accelerated skeletal development, and enhanced osteoblast maturation. Antibody-mediated blockade of the Clec14a-Mmrn2 interaction recapitulates the Clec14a−/− phenotype. Endothelial cell expression of Clec14a regulates osteoblast maturation and mineralisation activity during postnatal bone development in mice. This finding underscores the importance of type-H capillary control of osteoblast activity in bone formation and identifies a novel mechanism that mediates this vital cellular crosstalk

The genesis of gold mineralisation hosted by orogenic belts: A lead isotope investigation of Irish gold deposits

Lead isotope analyses have been performed on 109 gold and 23 sulphide samples from 34 Irish gold occurrences, including 27 placers, and used to shed light on the sources of mineralising fluids and metals associated with gold mineralisation hosted by orogenic belts. The Pb isotope ratios of lode and placer gold range from 206Pb/204Pb=17.287-18.679, 207Pb/204Pb=15.382-15.661, and 208Pb/204Pb=37.517-38.635, consistent with the Pb isotopic data on previously reported Irish sulphide mineralisation. There is no evidence that gold mineralisation is associated with distinctive source regions, and it appears to have been derived from similar sources to those responsible for the widespread sulphide mineralisation in Ireland. It is inferred that the principal controls on the Au mineralisation are structural and not related to the distribution of Au in their source rocks. The range of Pb isotope ratios favours the interaction of multiple source reservoirs predominantly during the Caledonian Orogeny (c. 475-380Ma). Underlying basement was the primary control on two key sources of Pb. Gold occurrences located to the south-east of the Iapetus Suture are characterised by Pb compositions that derive predominantly from the Late Proterozoic crustal basement or overlying Lower Palaeozoic sediments, whilst those located north-west of the Iapetus Suture are characterised by less radiogenic Pb signatures derived predominantly from Late Proterozoic or older crustal basement. A third source, relatively enriched in radiogenic Pb, also played a role in the formation of a number of Irish gold occurrences, and may have been associated with syn- to post-orogenic intrusives. Magmatic processes may therefore have played an important role in the formation of some orogenic gold occurrences

Measurement of the gamma ray background in the Davis Cavern at the Sanford Underground Research Facility

Deep underground environments are ideal for low background searches due to the attenuation of cosmic rays by passage through the earth. However, they are affected by backgrounds from γ-rays emitted by 40K and the 238U and 232Th decay chains in the surrounding rock. The LUX-ZEPLIN (LZ) experiment will search for dark matter particle interactions with a liquid xenon TPC located within the Davis campus at the Sanford Underground Research Facility, Lead, South Dakota, at the 4,850-foot level. In order to characterise the cavern background, in-situ γ-ray measurements were taken with a sodium iodide detector in various locations and with lead shielding. The integral count rates (0--3300~keV) varied from 596~Hz to 1355~Hz for unshielded measurements, corresponding to a total flux in the cavern of 1.9±0.4~γ cm−2s−1. The resulting activity in the walls of the cavern can be characterised as 220±60~Bq/kg of 40K, 29±15~Bq/kg of 238U, and 13±3~Bq/kg of 232Th

The Canadian medical profession and state medical care insurance Key developments, 1911-1966

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