[Invasive treatment of phlegmasia cerulea dolens].
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Acute Disease↗
Biomedical subjects
B Marty
Publications and source records attributed to B Marty.
MEP (Mars Environment Package): toward a package for studying environmental conditions at the surface of Mars from future lander/rover missions.
In view to prepare Mars human exploration, it is necessary to promote and lead, at the international level, a highly interdisciplinary program, involving specialists of geochemistry, geophysics, atmospheric science, space weather, and biology. The goal of this program will be to elaborate concepts of individual instruments, then of integrated instrumental packages, able to collect exhaustive data sets of environmental parameters from future landers and rovers of Mars, and to favour the conditions of their implementation. Such a program is one of the most urgent need for preparing human exploration, in order to develop mitigation strategies aimed at ensuring the safety of human explorers, and minimizing risk for surface operations. A few main areas of investigation may be listed: particle and radiation environment, chemical composition of atmosphere, meteorology, chemical composition of dust, surface and subsurface material, water in the subsurface, physical properties of the soil, search for an hypothesized microbial activity, characterization of radio-electric properties of the Martian ionosphere. Scientists at the origin of the present paper, already involved at a high degree of responsibility in several Mars missions, and actively preparing in situ instrumentation for future landed platforms (Netlander--now cancelled, MSL-09), express their readiness to participate in both ESA/AURORA and NASA programs of Mars human exploration. They think that the formation of a Mars Environment working group at ESA, in the course of the AURORA definition phase, could act positively in favour of the program, by increasing its scientific cross-section and making it still more focused on human exploration.
Atmosphere↗
Sutureless videoendoscopic thoracic aorta to iliac artery bypass: the easiest approach to occlusive aorto-iliac diseases.
OBJECTIVE: We designed an animal study to determine the feasibility of videoendoscopic thoracic aorta to iliac artery bypass using a sutureless anastomotic device for proximal anastomosis construction. METHODS: In 12 pigs the descending thoracic aorta was exposed using the thoracoscopic technique. A 4 mm PTFE thin wall graft was used as conduit. The proximal anastomosis was constructed using a mechanical device for sutureless anastomosis inserted through the camera port incision. The prosthesis was passed through the diaphragm in the retroperitoneal space and the distal anastomosis was done with running suture. RESULTS: The operation was successfully completed in 11 animals. One animal died due to hemorrage during anastomosis construction. Mean graft flow was 144 ml/min (range 88-167 mmHg). The angiogram showed no graft kinking or stenosis. Total operative time was 58 min (range 47-68 min). CONCLUSIONS: This approach allows quick and excellent exposure of the entire descending thoracic aorta. The use of the sutureless device to perform the proximal anastomosis dramatically reduces the technical demands of this procedure and could avoid an aortic clamp.
Anastomosis, Surgical↗
Routine use of intravascular ultrasound for endovascular aneurysm repair: angiography is not necessary.
INTRODUCTION: to assess the outcome of endovascular aortic aneurysm repair (EVAR) using intravascular ultrasound (IVUS) without angiography. MATERIALS/METHODS: eighty consecutive patients (median age 69 years (range 25-90): male 72 (90%), female 8 (10%)) underwent endovascular aneurysm repair (AAA 68 (85%), TAA 12 (15%)) using either angiography in 31/80 patients (39%) or IVUS in 49/80 patients (61%) in accordance to the surgeons preference. RESULTS: hospital mortality was 2/80 (3%), 1/68 for AAA (2%), 1/12 for TAA (8%), 2/31 for angiography (7%), and 0/49 for IVUS (0.0%: NS). Median quantity of contrast medium was 190 ml (range: 20-350) for angiography versus 0 ml for IVUS (p<0.01). Median X-ray exposure time 24 min (range 9-65 min) versus 8 min (range 0-60 min) for IVUS (p<0.05). No coverage of renal or suprarenal artery orifices occurred in either group. Conversion to open surgery was necessary in 4/80 patients (5%), 1/31 for angiography (3%) and 3/49 patients for IVUS (6%: NS). Early endoleaks were observed in 13/80 patients (16%): 8/31 patients for angiography (26%) versus 5/49 for IVUS (10%: p<0.05): 5/13 endoleaks resolved spontaneously (39%) whereas 8/13 (61%) required additional procedures. CONCLUSIONS: IVUS is a reliable tool for EVAR. In most cases, perprocedural angiography is not necessary.
Adult↗
Transient promoter formation: a new feedback mechanism for regulation of IS911 transposition.
IS911 transposition involves a free circular transposon intermediate where the terminal inverted repeat sequences are connected. Transposase synthesis is usually driven by a weak promoter, p(IRL), in the left end (IRL). Circle junction formation creates a strong promoter, p(junc), with a -35 sequence located in the right end and the -10 sequence in the left. p(junc) assembly would permit an increase in synthesis of transposase from the transposon circle, which would be expected to stimulate integration. Insertion results in p(junc) disassembly and a return to the low p(IRL)- driven transposase levels. We demonstrate that p(junc) plays an important role in regulating IS911 transposition. Inactivation of p(junc) strongly decreased IS911 transposition when transposase was produced in its natural configuration. This novel feedback mechanism permits transient and controlled activation of integration only in the presence of the correct (circular) intermediate. We have also investigated other members of the IS3 and other IS families. Several, but not all, IS3 family members possess p(junc) equivalents, underlining that the regulatory mechanisms adopted to fine-tune transposition may be different.
Bacterial Proteins↗
Solvent extraction, ion chromatography, and mass spectrometry of molybdenum isotopes.
A procedure was developed that allows precise determination of molybdenum isotope abundances in natural samples. Purification of molybdenum was first achieved by solvent extraction using di(2-ethylhexyl) phosphate. Further separation of molybdenum from isobar nuclides was obtained by ion chromatography using AG1-X8 strongly basic anion exchanger. Finally, molybdenum isotopic composition was measured using a multiple collector inductively coupled plasma hexapole mass spectrometer. The abundances of molybdenum isotopes 92, 94, 95, 96, 97, 98, and 100 are 14.8428(510), 9.2498(157), 15.9303(133), 16.6787(37), 9.5534(83), 24.1346(394), and 9.6104(312) respectively, resulting in an atomic mass of 95.9304(45). After internal normalization for mass fractionation, no variation of the molybdenum isotopic composition is observed among terrestrial samples within a relative precision on the order of 0.00001-0.0001. This demonstrates the reliability of the method, which can be applied to searching for possible isotopic anomalies and mass fractionation.
Journal Article↗
Geochemistry. New prospects for old gas.
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News↗
Active cooling during open repair of thoraco-abdominal aortic aneurysms improves outcome.
OBJECTIVE: Evaluate impact of active cooling with partial cardiopulmonary bypass (CPB) and low systemic heparinization during open repair of thoracoabdoninal aortic aneurysms. METHODS: Prospective analysis of 100 consecutive patients undergoing surgical repair of thoracoabdominal aortic aneurysms. Partial CPB and normothermic (36 degrees C) or hypothermic (29 degrees C) perfusion was selected in accordance to the surgeons preference. In the hypothermic group, aortic cross clamp was applied when the target temperature of the venous blood was achieved and rewarming was started after declamping. RESULTS: 52/100 patients (62.2+/-10.9 years) received normothermic and 48/100 patients hypothermic perfusion (63.8+/-10.6 years: NS). Emergent procedures accounted for 18/52 (35%) with normothermia vs. 21/48 (44%: NS) with hypothermia. The number of aortic segments (eight = maximum including arch and bifurcation) replaced was 3.9+/-1.5 with normothermia vs. 4.1+/-1.5 with hypothermia (NS); Crawford type II aneurysms accounted for 21/52 patients (40%) for normothermia vs. 20/48 (42%:NS) for hypothermia. Total clamp time was 38+/-21 min with normothermia vs. 47+/-28 min with hypothermia (P=0.05). Pump time was 55+/-28 min with normothermia vs. 84+/-34 min with hypothermia (P=0.001). Mortality at 30 days was 8/52 patients (15%) with normothermia vs. 2/48 (4%) with hypothermia (P=0.06; odds ratio = 4.1). Parapareses/plegias occurred in 4/52 patients (8%) with normothermia vs. 4/48 (8%) with hypothermia (NS). Revisions for bleeding were required in 4/52 patients (8%) with normothermia vs. 2/48 patients (4%) with hypothermia (P=0.38). Revisions for distal vascular problems were necessary in 5/52 patients (10%) with normothermia vs. 2/48 (4%) with hypothermia (P=0.25). Freedom from death, paraplegia, and surgical revision was 89.9% with normothermia vs. 94.8% with hypothermia (P=0.04; odds ratio 2.0). CONCLUSIONS: Active cooling during repair of thoracoabdominal aortic aneurysms allows for longer cross-clamp times, more complex repairs and improves outcome.
Aged↗
Preliminary clinical experience with the Heartflo anastomosis device.
UNLABELLED: A clinical, prospective trial to evaluate a multi-suture anastomotic device (Heartflo) is currently underway. This new surgical tool can be used during CABG to perform end-to-side or side-to-side coronary arteries anastomoses with interrupted suture technique. This reports our interim preliminary clinical experience. METHODS: From February to November 2000, we attempted 15 anastomoses with the multi-suture anastomotic device (Heartflo) in 11 patients with coronary artery disease. RESULTS: 7 males, 4 females, mean age 64 +/- 3 yrs received 15 anastomoses with the device. The target vessels were: 8 RCA, 3 LAD, 4 OM. Mean coronary diameter was 2 +/- 0.3 mm. Grafts used were 14 saphenous veins and 1 IMA. 13/15 anastomoses were completed with the device. 5/13 required 0 - 1 additional stitches versus 8/13 requiring more due to inappropriate tissue capture on the native coronary side. Average time was 17.7 +/- 2 min. In 2/15 cases, the procedure was converted to a traditional handsaw anastomosis. Postoperative CK movement without Q-wave in the EKG was observed in 1/11 patients. CONCLUSIONS: This device is a reliable instrument that provides reproducible coronary anastomoses with interrupted suture technique, although it also requires additional measures to improve tissue capture and process of handling sutures before extensive clinical application.
Aged↗
Alternatives to unfractionated heparin for anticoagulation in cardiopulmonary bypass.
Despite the progress made in the development of cardiopulmonary bypass (CPB) equipment, systemic anticoagulation with unfractionated heparin and post-bypass neutralization with protamine are still used in most perfusion procedures. However, there are a number of situations where unfractionated heparin, protamine or both cannot be used for various reasons. Intolerance of protamine can be addressed with extracorporeal heparin removal devices, perfusion with (no) low systemic heparinization and, to some degree, by perfusion with alternative anticoagulants. Various alternative anticoagulation regimens have been used in cases of intolerance to unfractionated heparin, including extreme hemodilution, low molecular weight heparins, danaparoid, ancrod, r-hirudin, abciximab, tirofiban, argatroban and others. In the presence of heparin-induced thrombocytopenia (HIT) and thrombosis, the use of r-hirudin appears to be an acceptable solution which has been well studied. The main issue with r-hirudin is the difficulty in monitoring its activity during CPB, despite the fact that ecarin coagulation time assessment is now available. A more recent approach is based on selective blockage of platelet aggregation by means of monoclonal antibodies directed to GPIIb/IIIa receptors (abciximab) or the use of a GPIIb/IIIa inhibitor (tirofiban). An 80% blockage of the GPIIb/IIIa receptors and suppression of platelet aggregation to less than 20% allows the giving of unfractionated heparin and running CPB in a standard fashion despite HIT and thrombosis. Likewise, at the end of the procedure, unfractionated heparin is neutralized with protamine as usual and donor platelets are transfused if necessary. GPIIb/IIIa inhibitors are frequently used in interventional cardiology and, therefore, are available in most hospitals.
Abciximab↗
Ileal digestibilities of neutral detergent fiber, crude protein, and amino acids associated with neutral detergent fiber in wheat shorts for growing pigs.
An experiment was carried out to determine the ileal digestibility values of NDF, CP, and AA associated with NDF in different samples of wheat shorts consisting of different proportions of wheat bran, shorts, and flour, hereafter referred to as wheat fractions. Six barrows (average initial BW 37.2 kg, and fitted with a simple T-cannula at the distal ileum) were fed one of six experimental diets, formulated to contain 17% CP (as-fed basis), according to a 6 x 6 Latin square design. Diets A, B, C, D, and E contained 17.53% soybean meal (SBM), which contributed 50% CP to these diets. The diets contained shorts, bran, or flour alone or in combination, contributing the remaining 50% CP to these diets. The proportions of shorts, bran, and flour in the wheat fractions were 70% shorts and 30% bran in diet A, 85% shorts and 15% bran in diet B, 100% shorts in diet C, 85% shorts and 15% flour in diet D, and 70% shorts and 30% flour in diet E. Diet F contained 35.05% soybean meal, which provided the sole source of dietary CP. Chromic oxide was used as a digestibility marker. During the first experimental period, the daily dietary allowance was provided at a rate of 5% (wt/wt) of the average BW. Thereafter, the allowance was increased by 100 g at each successive period. Each experimental period comprised 12 d. Following a 7-d adaptation period, feces were collected for 48 h and ileal digesta for a total of 24 h. The contribution of CP and AA associated with NDF gradually decreased from wheat fraction A to E, reflecting a decrease in NDF content from 42.3 to 29.5%. Of the indispensable AA in wheat fraction A, the contributions ranged from 12.9 to 15.9%. In wheat fraction E, these values ranged from 9.0 to 11.3%. The ileal digestibility values of NDF ranged from 11.8% in diet E to 17.1% in diet C (P > 0.05). There were usually no differences (P > 0.05) in the ileal digestibilities of AA associated with NDF between the wheat fractions. However, with the exception of lysine and tyrosine, there were negative correlations (P < 0.05) between the apparent ileal AA digestibilities and the content (%) of CP associated with NDF in the wheat fractions. Furthermore, there was no effect (P > 0.05) of the diets containing wheat fractions on the recovery of bacterial protein and mucin in ileal digesta.
Amino Acids↗
Endovascular treatment of aortic rupture by blunt chest trauma.
BACKGROUND: The usual treatment of blunt aortic injury (BAI) is prompt surgery. Frequently severe injuries to the brain or lungs exclude further surgical treatment. The purpose of this study is to assess the feasibility of placing endovascular stent-grafts. METHODS: From 1992 through 1999, in our primary and referral trauma center, 26 acute BAI, 21 males and 5 females, mean age 40.2+/-16.3 yrs were diagnosed. The last 4 patients underwent prospectively endovascular repair with Talent endograft. Endoprosthesis parameters were measured on three-dimensional spiral CT reconstruction. While waiting for devices, blood pressure was aggressively lowered and aortic lesions were monitored by transesophageal echography. RESULTS: Stent-graft deployment was successful in all 4 patients. There were no complications of endoleak, stent migration, paraplegia or death. Angiographic exclusion was complete in all 4 patients. CT scans at a mean follow-up of 11+/-5 months showed complete healing of the aortic wall in all patients. CONCLUSIONS: For stable acute BAI, endovascular stent-graft repair is feasible and safe, and is an effective therapeutic alternative to open surgery. Because of the normal proximal and distal wall in aortic injuries, endoluminal treatment might be the therapy of choice in the near future.
Adult↗
Solar wind record on the moon: deciphering presolar from planetary nitrogen.
Ion microprobe analyses show that solar wind nitrogen associated with solar wind hydrogen implanted in the first tens of nanometers of lunar regolith grains is depleted in 15N by at least 24% relative to terrestrial atmosphere, whereas a nonsolar component associated with deuterium-rich hydrogen, detected in silicon-bearing coatings at the surface of some ilmenite grains, is enriched in 15N. Systematic enrichment of 15N in terrestrial planets and bulk meteorites relative to the protosolar gas cannot be explained by isotopic fractionation in nebular or planetary environments but requires the contribution of 15N-rich compounds to the total nitrogen in planetary materials. Most of these compounds are possibly of an interstellar origin and never equilibrated with the 15N-depleted protosolar nebula.
Argon↗
Benefits of endoscopic vein harvesting.
The purpose of this study was to evaluate and compare the benefits of endoscopic saphenous vein harvesting (EVH) with the traditional incision technique (TIT) for coronary artery bypass grafting (CABG) in respect to the technical procedure and clinical outcome. In a prospective nonrandomized, case-matched study the greater saphenous vein was harvested for CABG in 22 patients using the endoscopic technique and in 18 patients with the traditional method. Comparisons were made for the operating time, length of incision and vein harvested, graft quality, postoperative complications, and pain assessment. Patient demographics were well matched. EVH required smaller incisions than did the TIT (10.5 +/- 6.6 vs. 31.2 +/- 7.8 cm, respectively; p < 0.0001). Harvest time and vein quality were comparable in the two groups. Total vein operating time was shorter following the endoscopic technique (60 +/- 24 vs. 100 +/- 35 minutes, respectively; p < 0.0001). EVH had fewer complications (NS), and postoperative pain was significantly less (p = 0.0034). The major advantages of endoscopic vein harvesting are a significant reduction of postoperative pain and strikingly better cosmetic results. Wound complications seem to be less frequent.
Aged↗
[Endothelial lesions caused by intra-aortic counterpulsation balloons].
Intra-aortic balloon pump (IABP) is the most frequently used mechanical circulatory support. Repeated trauma on the aortic wall has been reported as a cause of balloon perforation by endothelial denudation of atheromatous plaque. This study analyses the effect of IABP on the endothelium of the calf aorta. In 12 calves (mean weight: 72 +/- 6 kg) an IABP was inserted by femoral route and left during 6 hours on internal mode with a frequency of 80 cycles/min. The animals were sacrificed after the procedure (n = 4), at postoperative day (POD) 7 (n = 4), and at POD 14 (n = 4). In the aorta facing the balloon, nine transmural samples were taken proximally (n = 3), at mid height (n = 3) and distally (n = 3), for histological analysis of the percentage of aortic surface covered with endothelium. The percentage of aortic surface covered with endothelium at POD 0, 7 and 14 was proximally: 72.5 +/- 27.5%, 83.7 +/- 16.9% and 93.3 +/- 8.9% respectively; at mid-height: 50.8 +/- 30.7%, 65 +/- 25% and 95 +/- 5%; and distally: 31.4 +/- 20.1%, 48.3 +/- 34.4% and 85 +/- 10%. A large portion of the aortic endothelium is abraded after 6 hours of IAB pumping. This effect is more important at the distal level of the aorta. After two weeks, most of the endothelium has regenerated.
Animals↗
Heavy nitrogen in carbonatites of the kola peninsula: A possible signature of the deep mantle
Nitrogen and argon isotopes were measured in carbonatites and associated rocks from the Kola Peninsula in Russia. The Kola mantle source, which is thought to be located in the deep mantle, is enriched in heavy nitrogen (+3 per mil relative to air) as compared to Earth's surface (atmosphere and crust, +2 per mil) and the shallow mantle (-4 per mil). Recycling of oceanic crust (+6 per mil) or metal-silicate partitioning may account for the nitrogen isotopic composition of the deep mantle.
Journal Article↗
[Treatment of endovascular aneurysms: the indications widen].
Recently, the material available for endovascular aneurysm repair (covered stents and application systems), real time medical imaging and operator experience have significantly improved. Hence, more and more complex vascular lesions, well beyond the original indications, can now be treated by endovascular surgery. Since 1996 our group has implanted 55 endovascular systems in the clinical setting: 45/55 (80%) for classical indications and 11/55 (20%) for extended indications. In the latter group four different endoprosthetic systems were used according to either their performance and availability or the type of lesion to be treated. For the 11 patients undergoing endovascular procedures with extended indications, 6/11 had thoracic aortic lesions (55%) and 5/11 (45%) had aorto-iliac lesions requiring either progressive embolisation of the internal iliac arteries or suprarenal anchorage. For these extended indications hospital mortality was 0/11 (0%). One patient died after hospital discharge. 1/11 patients (9%) had to be converted to open surgery during the interval between iliac embolisation and endovascular repair. There has been no conversion to open surgery during or after the endovascular procedures. Two major endoleaks were detected (2/11: 18%). One has been corrected by an additional covered stent and endovascular repair is planned for the other one. Spontaneously regressive functional hypoperfusion has been observed in 4/5 patients with progressive internal iliac embolisation. There was no irreversible renal insufficiency. Early results of endovascular aneurysm repair for extended indications are promising. Although the long-term outcome is unknown, it can already be said that traditional open surgery can be avoided for a considerable amount of time in an increasing number of patients.
Aneurysm↗
Amino acid digestibilities in different samples of wheat shorts for growing pigs.
An experiment was carried out to investigate the variability in apparent ileal amino acid (AA) digestibilities in simulated samples of wheat shorts consisting of different proportions of wheat bran (WB), wheat shorts (WS), and wheat flour (WF), hereafter referred to as wheat fractions. The proportions of WS, WB, and WF and the NDF content (DM basis) of the wheat fractions were as follows: A, 70% WS, 30% WB, and 42.3% NDF; B, 85% WS, 15% WB, and 41.8% NDF; C, 100% WS and 41.3% NDF; D, 85% WS, 15% WF, and 35.2% NDF; and E, 70% WS, 30% WF, and 29.5% NDF. Six barrows, average initial BW of 37.2 kg, fitted with a simple T-cannula at the distal ileum, were fed one of six experimental diets according to a 6 x 6 Latin square design. Six diets were formulated to contain 17% CP (as-fed basis). Diets A, B, C, D, and E contained 17.53% soybean meal (SBM), which contributed 50% of the CP in these diets. The wheat fractions contributed the remaining 50% of the CP in these diets. Diet F contained 35.05% SBM, which was the sole source of dietary CP. Chromic oxide was used as the digestibility marker. During the first experimental period, the daily dietary allowance was provided at a rate of 5% (wt/wt) of the average BW. Thereafter, the daily dietary allowance was increased by 100 g at each successive period. Each experimental period comprised 12 d. Following a 7-d adaptation period, feces were collected for 48 h and ileal digesta for a total of 24 h. The apparent ileal digestibilities of AA in the wheat fractions were calculated using the difference method. The digestibilities were usually lowest in the wheat fractions containing WB and highest in those containing no WB. The average of the digestibilities of the indispensable AA was 63.5% for wheat fraction A, which contained 30% WB, and 71.9% for wheat fraction C, which did not contain WB. There were no differences (P > .05) in lysine digestibilities among the wheat fractions, which ranged from 54.7 to 64.1%. Of the indispensable AA, with the exception of arginine, lysine, and methionine, the apparent ileal digestibility values of AA were negatively correlated (P < .05) with the NDF content in the wheat fractions.
Amino Acids↗