Embolization for multicompartmental bleeding in patients in hemodynamically unstable condition: prognostic factors and outcome.

PURPOSE: To determine prognostic factors and evaluate outcomes of transcatheter arterial embolization in severely injured patients in hemodynamically unstable condition with multicompartmental bleeding.¦MATERIALS AND METHODS: Between June 2000 and May 2008, 36 consecutive patients treated with transcatheter arterial embolization for major retroperitoneal bleeding associated with at least one additional source of bleeding were retrospectively reviewed. Mean Injury Severity Score (ISS) was 49.4 ± 15.8. Univariate and multivariate analyses were performed to identify parameters associated with failure of embolization, need for additional surgery to control bleeding, and fatal outcome at 30 d.¦RESULTS: Embolization was technically successful in 35 of 36 patients (97.2%) and resulted in immediate and sustained (> 24 h) hemodynamic improvement in 29 (80.5%). Additional hemostatic surgery was necessary after embolization in six patients (16.6%). Fifteen patients (41.6%) died within 30 d. Failure to restore hemodynamic stability was correlated with the rate of administration of packed red blood cells (P = .014), rate of administration of fresh frozen plasma (FFP; P = .031), and systolic blood pressure (SBP) immediately before embolization (P = .002). The need for additional surgery was correlated with FFP administration rate before embolization (P = .0002) and hemodynamic success (P = .003). Death was correlated with Glasgow Coma Scale score at admission (P = .001), ISS (P = .014), New Injury Severity Score (P = .016), number of injured sites (P = .012), SBP before embolization (P = .042), need for vasopressive drugs before embolization (P = .037), and hemodynamic success (P = .0004).¦CONCLUSIONS: In patients in hemodynamically unstable condition, transcatheter arterial embolization effectively controls bleeding and improves hemodynamic stability. Immediate survival is related to hemodynamic condition before embolization, and 30-d mortality is mainly related to associated brain trauma.

The shunt from the cyclooxygenase to lipoxygenase pathway in human osteoarthritic subchondral osteoblasts is linked with a variable expression of the 5-lipoxygenase-activating protein

Affiliation: Unité de recherche en Arthrose, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame

Functional γ-aminobutyrate shunt in Listeria monocytogenes: role in acid tolerance and succinate biosynthesis

Listeria monocytogenes, the causative agent of human listeriosis, is known for its ability to withstand severe environmental stresses. The glutamate decarboxylase (GAD) system is one of the principal systems utilized by the bacterium to cope with acid stress, a reaction that produces γ-aminobutyrate (GABA) from glutamate. Recently, we have shown that GABA can accumulate intracellularly under acidic conditions, even under conditions where no extracellular glutamate-GABA exchange is detectable. The GABA shunt, a pathway that metabolizes GABA to succinate, has been described for several other bacterial genera, and the present study sought to determine whether L. monocytogenes has this metabolic capacity, which, if present, could provide a possible route for succinate biosynthesis in L. monocytogenes. Using crude protein extracts from L. monocytogenes EGD-e, we show that this strain exhibits activity for the two main enzyme reactions in the GABA shunt, GABA aminotransferase (GABA-AT) and succinic semialdehyde dehydrogenase (SSDH). Two genes were identified as candidates for encoding these enzyme activities, argD (GABA-AT) and lmo0913 (SSDH). Crude protein extracts prepared from a mutant lacking a functional argD gene significantly reduced GABA-AT activity, while an lmo0913 mutant lost all detectable SSDH activity. The deletion of lmo0913 increased the acid tolerance of EGD-e and showed an increased accumulation of intracellular GABA, suggesting that this pathway plays a significant role in the survival of this pathogen under acidic conditions. This is the first report of such a pathway in the genus Listeria, which highlights an important link between metabolism and acid tolerance and also presents a possible compensatory pathway to partially overcome the incomplete tricarboxylic acid cycle of Listeria.

Design and simulation of a RF MEMS shunt switch for Ka and V bands and the impact of varying its geometrical parameters

RF MEMS plays an important role in microwave switching. The high performance of RF MEMS shunt such as high bandwidth, low insertion loss, and high isolation have made these switches well suitable for high performing microwave and millimeter wave circuits. This paper presents a RF MEMS shunt capacitive switch for Ka and V band application. This paper investigates the effect of various geometrical parameters on RF characteristics of the switch. The simulation results are presented and discussed.

RF techniques for lowering the actuation voltage of RF MEMS shunt capacitor switch for C-K band

Increasing the capacitance ratio in RF MEMS shunt capacitive switch will increase its RF performance but also raise its actuation voltage. To improve the RF performance of the switch without increasing its capacitance ratio, this paper explores two methods: reducing the LC resonance from the mm-wave into the X-band by using an inductive bridge, and using two short high impedance transmission lines at both ends of the CPW line. Accordingly, this paper presents the design and simulation of an electro-static low actuation voltage and a very high isolation multipurpose switch with a very large bandwidth. The simulation results are presented and discussed.

Design and simulation of a high isolation RF MEMS shunt capacitive switch for C-K band

This paper presents a wide band RF MEMS capacitive switch. The LC resonant frequency is reduced from mm wave to X band frequencies at down-state by using a meander type membrane, with the frequency band is being increased by adding two short high impedance lines at both ends of coplanar waveguide (CPW). Moreover, this acts as T-match circuit in up-state position and improves the matching. Simulation results demonstrate that the capacitance ratio reduces from 50 to 21.4, S21 and S11 are less than −10dB for the entire frequency band at down-state and up-state. Also, a comprehensive and complete electric model of the switch is proposed and simulation results agree well with the characteristics of the physical structure of the MEMS switch. Vpull-in and Vpull-out of this switch are 8.1V and 0.3V, respectively.

In vitro simulator with numerical stress analysis for evaluation of stent-assisted coiling embolization in cerebral aneurysm treatments

There are several complications associated with Stent-assisted Coil Embolization (SACE) in cerebral aneurysm treatments, due to damaging operations by surgeons and undesirable mechanical properties of stents. Therefore, it is necessary to develop an in vitro simulator that provides both training and research for evaluating the mechanical properties of stents.