Compression Transmission Collar for Fastening

A compression transmission collar apparatus (20) for implantation into a bone (22) with a hole (28) having a hole wall (32) comprising an intramedullary nail (34) defining a bore (40) and a threaded fastener (42) and a compression transmission collar (58) including an exterior face (64) and a top edge (60) and a bottom edge (62) and a first end (70) intersecting the top edge (60) at an acute angle and the bottom edge (62) at an obtuse angle and a second end (72) intersecting the top edge (60) at an obtuse angle and the bottom edge (62) at an acute angle and the first end (70) partially overlapping and opposing the second end (72) to define a slit (74) such that applying a compressional load to the top edge (60) causes the first end (70) to slide relative to and along the second end (72) causing the compression transmission collar (58) to compress axially and expand radially pressing the exterior face (64) against the hole wall (32)

Easily Implantable and Stable Nail-Fastener for Skeletal Fixation and Method

An intramedullary nail (20) for insertion into the medullary canal (26) in a bone (24) surrounded by the cortex (28) and defines a bore (34) extending transverse to the intramedullary nail (20). A threaded fastener (22) extends along a fastener axis (A) and has a compression portion (48) having a compression portion diameter (DCP), and a threaded portion (50) having a threaded portion diameter (DTP) extending through a near cortex hole (40) and a far cortex hole (42), both holes (40, 42) radially overlapping the bore (34) and the threaded portion diameter (DTP) threadedly engaging the bore (34). A compression transmission device (54) has an exterior (56) and an interior (58) and defines an interior space for transmitting the compressional load of the threaded fastener (22) to the intramedullary nail (20). The threaded fastener (22) extends through the compression transmission device (54) and the intramedullary nail (20) and the far cortex hole (42) for threadedly engaging the bore (34) and fixating the intramedullary nail (20) within the medullary canal (26). The interior space of the compression transmission device (54) is greater than the compression portion diameter (DCP) of the fastener (22) for providing space at least partially about the threaded fastener (22) for allowing the fastener axis (A) to be variously disposed relative to the interior space

Compression Transmission Collar for Fastening

A compression transmission collar apparatus for implantation into a bone with a hole having a hole wall comprising an intramedullary nail defining a bore and a threaded fastener and a compression transmission collar including an exterior face and a top edge and a bottom edge and a first end interstcting the top edge at an acute angle and the bottom edge at an obtuse angle and a second end intersecting the top edge at an obtuse angle and the bottom edge at an acute angle and the first end partially overlapping and opposing the second end to define a slit such that applying a compressional load to the top edge causes the first end to slide relative to and along the second end causing the compression transmission collar to compress axially and expand radially pressing the exterior face against the hole wall

4. LITERATURA Y SOCIEDAD I: LITERATURA Y MARXISMO

La literatura nace en una sociedad y, obviamente, es consumida por ella. Desde los orígenes de la teoría literaria se ha tenido en cuenta esta función social, y en el s. XX R.Wellek y A.Warren (1949) establecen tres puntos de esta relación entre literatura y sociedad:-la sociología del escritor, de la profesión de escritor y de las instituciones literarias -el fondo social de las obras -la influencia real de la literatura y su público Como siempre, el enfoque de las relaciones entre la liter..

A Modified Intramedullary Nail Interlocking Design Yields Improved Stability for Fatigue Cycling in a Canine Femur Fracture Model

Intramedullary nailing has evolved to become the standard of care for most diaphyseal femoral and tibial fractures, as well as an expanding number of metaphyseal fractures. Owing to the unstable nature of some fractures, the intramedullary device may be subjected to significant stresses owing to a lack of solid cortical contact after nailing. In such cases, excessive interfragmentary motion (due to construct toggle) has been shown to occur. Such motion increases the likelihood of a non- or delayed-union. In the current study, two versions of a modified, angle stable interlocking design were subjected to fatigue testing in a segmental defect fracture model representing a canine femur. As a control, a third group of constructs were stabilized with a traditional nail that allowed a small amount of toggle. All constructs were subjected to 50,000 fatigue cycles representing 12 weeks of cage activity at physiologic levels of combined axial-torsional loading. Torsional testing pre- and post-fatigue revealed 4.6 ± 1.3° of toggle in the traditional nail and no toggle with the angle stable nail designs. The stable nails were also significantly stiffer in axial compression and torsion before and after cycling. These data indicate that the enhanced stability of the modified interlocking designs can be maintained throughout fatigue cycling in a challenging fracture model

Development of an Interlocked Nail for Segmental Defects in the Rabbit Tibia

Previous animal models have been developed to study intramedullary nailing for challenging segmental defects in the tibia. In large animals, interlocked nail fixation created a stable environment suitable to study new bone growth technologies placed in the defect. To our knowledge, there are no comparable interlocked tibial defect models for the rabbit in which new technologies could be evaluated. Such a model would be helpful since the rabbit is a popular initial model for orthopedic research studies owing to its wide availability and low cost. While numerous studies have nailed the rabbit tibia, all were non-locked implants that allowed some degree of instability between the fracture fragments. In addition, the non-locked nails were constructed of stainless steel, whereas human nails are increasingly made from titanium alloy. In the current study, an interlocked titanium nail was developed for the rabbit tibia. It was implanted in cadaver tibiae and subjected to fatigue cycling in combined compression and bending at physiologic levels to 21,061 cycles. This duration is estimated to represent 12 weeks of gait by the animal. Before and after fatigue cycling, monotonic testing was performed in compression and bending at physiologic levels. The intact contralateral limbs served as controls. All limbs completed the cycling; the instrumented limbs exhibited interfragmentary cyclic strain amplitudes during fatigue (616 ± 139 microstrain), which was significantly greater than the control limbs (136 ± 35 microstrain). Monotonic strain amplitudes for the test limbs in bending and compression were 4839 ± 1028 and 542 ± 122 microstrain, respectively; corresponding values for the control bones were 407 ± 118 and 95 ± 38 microstrain, respectively. These data are similar to those presented in prior studies in larger bone models. The current study presents one method for interlocked nail fixation for this complex tibial shaft fracture in a small animal

Removal of totally implanted venous access ports for suspected infection in the intensive care unit: a multicenter observational study

International audienceBackground: While no data support this practice, international guidelines recommend the removal of totally implanted venous access ports (TIVAPs) in patients with suspicion of TIVAP-related bloodstream infection admitted in the intensive care unit (ICU) for a life-threatening sepsis.Methods: During this multicenter, retrospective and observational study, we included all patients admitted in five ICU for a life-threatening sepsis in whom a TIVAP was removed between January 2012 and December 2014. We aimed (1) at determining the proportion of confirmed TIVAP-related infections and (2) at assessing short- and long-term survival of patients with and without TIVAP-related infections.Results: One hundred and fifty-one patients (58 ± 14 years, 62% males) were included between 2012 and 2014. TIVAP-related infections were confirmed in 68 patients (45%). Demographic characteristics were similar between patients with and without TIVAP-related infections. SOFA score on admission per point increase [odd ratio (OR), 0.86 interval confidence (IC) 95% (0.8-0.9), p < 0.01] and local signs of infection [OR 4.0, IC 95% (1.1-15.6), p = 0.04] were significantly associated with TIVAP-related infection. Patients with TIVAP-related infection had lower ICU and 6-month mortality as compared to their counterparts (9 vs. 40%, respectively, p < 0.01; and 50 vs. 66%, respectively, p = 0.04). TIVAP-related infection was significantly associated with ICU survival [OR 0.2, IC 95% (0.05-0.5), p < 0.01].Conclusions: TIVAP-related infection was confirmed in nearly one out of two cases of life-threatening sepsis in patients in whom it has been removed. TIVAP-related infection was associated with a good prognosis, as compared to patients with other causes of infection

MOESM1 of Removal of totally implanted venous access ports for suspected infection in the intensive care unit: a multicenter observational study

Additional file 1: Table 1. Complementary microbiological findings in patients with TIVAP (totally implanted venous-access ports) related infections. Table E2. Complementary microbiological findings in patients without TIVAP (totally implanted venous-access ports) related infections. Table E3. Variables associated with ICU mortality (univariate analysis). Figure E1. Flow chart of the patients. ICU: intensive care unit; TIVAP: totally implanted venous access ports

Removal of totally implanted venous access ports for suspected infection in the intensive care unit: a multicenter observational study

Abstract Background While no data support this practice, international guidelines recommend the removal of totally implanted venous access ports (TIVAPs) in patients with suspicion of TIVAP-related bloodstream infection admitted in the intensive care unit (ICU) for a life-threatening sepsis. Methods During this multicenter, retrospective and observational study, we included all patients admitted in five ICU for a life-threatening sepsis in whom a TIVAP was removed between January 2012 and December 2014. We aimed (1) at determining the proportion of confirmed TIVAP-related infections and (2) at assessing short- and long-term survival of patients with and without TIVAP-related infections. Results One hundred and fifty-one patients (58 ± 14 years, 62% males) were included between 2012 and 2014. TIVAP-related infections were confirmed in 68 patients (45%). Demographic characteristics were similar between patients with and without TIVAP-related infections. SOFA score on admission per point increase [odd ratio (OR), 0.86 interval confidence (IC) 95% (0.8–0.9), p < 0.01] and local signs of infection [OR 4.0, IC 95% (1.1–15.6), p = 0.04] were significantly associated with TIVAP-related infection. Patients with TIVAP-related infection had lower ICU and 6-month mortality as compared to their counterparts (9 vs. 40%, respectively, p < 0.01; and 50 vs. 66%, respectively, p = 0.04). TIVAP-related infection was significantly associated with ICU survival [OR 0.2, IC 95% (0.05–0.5), p < 0.01]. Conclusions TIVAP-related infection was confirmed in nearly one out of two cases of life-threatening sepsis in patients in whom it has been removed. TIVAP-related infection was associated with a good prognosis, as compared to patients with other causes of infection

Comparison of hydroxychloroquine, lopinavir/ritonavir, and standard of care in critically ill patients with SARS-CoV-2 pneumonia: an opportunistic retrospective analysis

International audienceBackground: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak is spreading worldwide. To date, no specific treatment has convincingly demonstrated its efficacy. Hydroxychloroquine and lopinavir/ritonavir have potential interest, but virological and clinical data are scarce, especially in critically ill patients.Methods: The present report took the opportunity of compassionate use and successive drug shortages to compare the effects of two therapeutic options, lopinavir/ritonavir and hydroxychloroquine, as compared to standard of care only. The primary outcomes were treatment escalation (intubation, extra-corporeal membrane oxygenation support, or renal replacement therapy) after day 1 until day 28. Secondary outcomes included ventilator-free days at day 28, mortality at day 14 and day 28, treatment safety issues and changes in respiratory tracts, and plasma viral load (as estimated by cycle threshold value) between admission and day 7.Results: Eighty patients were treated during a 4-week period and included in the analysis: 22 (28%) received standard of care only, 20 (25%) patients received lopinavir/ritonavir associated to standard of care, and 38 (47%) patients received hydroxychloroquine and standard of care. Baseline characteristics were well balanced between the 3 groups. Treatment escalation occurred in 9 (41%), 10 (50%), and 15 (39%) patients who received standard of care only, standard of care and lopinavir/ritonavir, and standard of care and hydroxychloroquine, respectively (p = 0.567). There was no significant difference between groups regarding the number of ventilator-free days at day 28 and mortality at day 14 and day 28. Finally, there was no significant change between groups in viral respiratory or plasma load between admission and day 7.Conclusion: In critically ill patients admitted for SARS-CoV-2-related pneumonia, no difference was found between hydroxychloroquine or lopinavir/ritonavir as compared to standard of care only on the proportion of patients who needed treatment escalation at day 28. Further randomized controlled trials are required to demonstrate whether these drugs may be useful in this context.The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak is spreading worldwide. To date, no specific treatment has convincingly demonstrated its efficacy. Hydroxychloroquine and lopinavir/ritonavir have potential interest, but virological and clinical data are scarce, especially in critically ill patients