Sternal reentry in a patient with previous deep sternal wound infection managed with horizontal titanium plate fixation

Redo open-heart surgery and sternal reentry in patients with previous deep sternal wound infection (DSWI) and absence of sternal integrity can be a delicate and morbid task due the lack of a dissection plane between the heart and the surrounding soft tissues. Delayed sternal reconstruction and osteosynthesis with horizontal titanium plating fixation (Synthes) following vacuum assisted therapy (KCI) has recently been proposed and adopted for the treatment of DSWI. We present such a case of a patient who was successfully reoperated for valve replacement three years after coronary artery bypass grafting complicated by DSWI and initially treated with titanium plate fixation

A combined numerical and experimental study of the 3D tumble structure and piston boundary layer development during the intake stroke of a gasoline engine

Due to its positive effect on flame propagation in the case of a well-defined breakdown, the formation of a large-scale tumble motion is an important goal in engine development. Cycle-to-cycle variations (CCV) in the tumble position and strength however lead to a fluctuating tumble breakdown in space and time and therefore to combustion variations, indicated by CCV of the peak pressure. This work aims at a detailed investigation of the large-scale tumble motion and its interaction with the piston boundary layer during the intake stroke in a state-of-the-art gasoline engine. To allow the validation of the flow near the piston surface obtained by simulation, a new measurement technique called “Flying PIV” is applied. A detailed comparison between experimental and simulation results is carried out as well as an analysis of the obtained flow field. The large-scale tumble motion is investigated based on numerical data of multiple highly resolved intake strokes obtained using scale-resolving simulations. A method to detect the tumble center position within a 3D flow field, as an extension of previously developed 2D and 3D algorithms, is presented and applied. It is then used to investigate the phase-averaged tumble structure, its characteristics in terms of angular velocity and the CCV between the individual intake strokes. Finally, an analysis is presented of the piston boundary layer and how it is influenced by the tumble motion during the final phase of the intake stroke

IFNAR1-Signalling Obstructs ICOS-mediated Humoral Immunity during Non-lethal Blood-Stage Plasmodium Infection

Funding: This work was funded by a Career Development Fellowship (1028634) and a project grant (GRNT1028641) awarded to AHa by the Australian National Health & Medical Research Council (NHMRC). IS was supported by The University of Queensland Centennial and IPRS Scholarships. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Recurrent post-partum coronary artery dissection

Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD) dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA) dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view

An application of tomographic PIV to investigate the spray-induced turbulence in a direct-injection engine

Fuel sprays produce high-velocity, jet-like flows that impart turbulence onto the ambient flow field. The spray-induced turbulence augments fuel-air mixing, which has a primary role in controlling pollutant formation and cyclic variability in engines. This paper presents tomographic particle image velocimetry (TPIV) measurements to analyse the 3D spray-induced turbulence during the intake stroke of a direct-injection engine. The spray produces a strong spray-induced jet in the far field, which travels through the cylinder and imparts turbulence onto the surrounding flow. Planar high-speed PIV measurements at 4.8 kHz are combined with TPIV at 3.3 Hz to evaluate spray particle distributions and validate TPIV measurements in the particle-laden flow. An uncertainty analysis is performed to assess the uncertainty associated with vorticity and strain rate components. TPIV analyses quantify the spatial domain of the turbulence in relation to the SIJ and describe how turbulent flow features such as turbulent kinetic energy, strain rate and vorticity evolve into the surrounding flow field. Access to the full tensors facilitate the evaluation of turbulence for individual spray events. TPIV images reveal the presence of strong shear layers (visualized by high S magnitudes) and pockets of elevated vorticity along the immediate boundary of the SIJ. Values are extracted from spatial domains extending in 1mm increments from the SIJ. Turbulence levels are greatest within the 0-1mm region from the SIJ boarder and dissipate with radial distance. Individual strain rate and vorticity components are analyzed in detail to describe the relationship between local strain rates and 3D vortical structures produced within strong shear layers of the SIJ. Analyses are intended to understand the flow features responsible for rapid fuel-air mixing and provide valuable data for the development of numerical models

Constitutive Expression of TNF-Related Activation-Induced Cytokine (TRANCE)/Receptor Activating NF-κB Ligand (RANK)-L by Rat Plasmacytoid Dendritic Cells

Plasmacytoid dendritic cells (pDCs) are a subset of DCs whose major function relies on their capacity to produce large amount of type I IFN upon stimulation via TLR 7 and 9. This function is evolutionary conserved and place pDC in critical position in the innate immune response to virus. Here we show that rat pDC constitutively express TNF-related activation-induced cytokine (TRANCE) also known as Receptor-activating NF-κB ligand (RANKL). TRANCE/RANKL is a member of the TNF superfamily which plays a central role in osteoclastogenesis through its interaction with its receptor RANK. TRANCE/RANK interaction are also involved in lymphoid organogenesis as well as T cell/DC cross talk. Unlike conventional DC, rat CD4high pDC were shown to constitutively express TRANCE/RANKL both at the mRNA and the surface protein level. TRANCE/RANKL was also induced on the CD4low subsets of pDC following activation by CpG. The secreted form of TRANCE/RANKL was also produced by rat pDC. Of note, levels of mRNA, surface and secreted TRANCE/RANKL expression were similar to that observed for activated T cells. TRANCE/RANKL expression was found on pDC in all lymphoid organs as well blood and BM with a maximum expression in mesenteric lymph nodes. Despite this TRANCE/RANKL expression, we were unable to demonstrate in vitro osteoclastogenesis activity for rat pDC. Taken together, these data identifies pDC as novel source of TRANCE/RANKL in the immune system