Routine Continuous Cold Perfusion of the Kidneys during Elective Juxtarenal Aortic Aneurysm Repair

ObjectivesSurgical treatment of JAAs (juxtarenal aortic aneurysms) requires suprarenal aortic cross-clamping, causing temporary renal artery occlusion. We implemented a standardized protocol of hypothermic renal perfusion for all elective JAA operations.DesignRetrospective study.Materials and methodsOver a period of 6 years, 23 consecutive patients received a 300ml bolus followed by an infusion (20ml/minute) of cold (4°C) saline to each kidney during suprarenal aortic clamping. We assessed outcome in terms of rise in serum creatinine, new onset of dialysis and mortality.ResultsNone of the patients suffered from postoperative acute renal failure and in-hospital mortality was zero. Five patients did not show any rise in serum creatinine level, whereas in the others rises were <25% in comparison with the admission level, except for one patient (38%). Postoperative rise in serum creatinine level was not related to renal ischemia time (Spearman rank correlation=0.24, p=0.27), preoperative renal function, total aortic clamping time or renal re-implantation. There were no renal complications at 6 months.ConclusionsOur results suggest that a standardized strategy to apply renal hypothermia during the ischemic period of elective JAA surgery may reduce postoperative renal failure

Characterization of the Pesticide Properties of Tobacco Bio-oil

Pyrolysis converts biomass such as agricultural and forestry waste into bio-oil. Our interest in the chemical analysis of bio-oil began with tobacco, which is rich in nicotine (a known pesticide). Initial inhibition assays performed with the bio-oil on the Colorado potato beetle, a pest currently resistant to all major insecticides, showed high pesticide activity as expected. Surprisingly, the nicotine-free phases of the bio-oil were also found to be highly lethal to the beetles. Thus, it was hypothesized that some of the alkaloids in plants were preserved during pyrolysis, and gave rise to the activity. Pesticide characteristics of tobacco and coffee bio-oils have been recorded on a number of insects as well as a variety of bacteria and fungi that do not currently respond well to chemical treatment; e.g., Streptomyces Scabies (a common potato scab disease). The current focus is to isolate and identify the components responsible for the pest inhibition, and in turn fully characterize their properties as a novel source of natural pesticides. The procedure begins with a crude separation or fractionation by distillation or extraction to simplify the chemical composition. The fractions are then screened by the activity assay. Analytical separation and mass spectral detection (GC-MS and LC-MS) are then used to generate chemical fingerprints for comparative analysis against libraries of known compounds to identify the active component(s). A mixture of chemical standards is generated from these identified, potentially active, components. This mixture is tested by the activity assay, and chemicals are sequentially removed from this mixture to identify the active components and potential synergistic effects between these components. Thus, a potential pesticide originating from agriculturally-based bio-oil is identified

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Juxtarenal aortic aneurysms: Aspects of treatment and reduction of postoperative complications

promotiedatum: 8-2-201

Electrical conductivity and thermoelectric power of nickel ferrous ferrite. Variable-range hopping and the Coulomb gap

Electrical conductivity and thermoelectric power measurements have been made on single crystals of nickel ferrous ferrite, NixFe3-xO4 of compositions 0x0·9, in the temperature range 10 to 300 K. The temperature and concentration dependences of the conductivity and of the thermopower at high nickel concentrations (x 0·4) are discussed in terms of variable-range hopping and of nearest-neighbour hopping in an energy distribution of localized states, or the 'Anderson band'. It is argued that there is evidence for the formation of a Coulomb gap and for many-electron hopping in samples of low nickel content (