Animal model to compare the effects of suture technique on cross-sectional compliance on end-to-side anastomoses.

OBJECTIVE: An animal model has been developed to compare the effects of suture technique on the luminal dimensions and compliance of end-to-side vascular anastomoses. METHODS: Carotid and internal mammalian arteries (IMAs) were exposed in three pigs (90 kg). IMAs were sectioned distally to perform end-to-side anastomoses on carotid arteries. One anastomosis was performed with 7/0 polypropylene running suture. The other was performed with the automated suture delivery device (Perclose/Abbott Labs Inc.) that makes a 7/0 polypropylene interrupted suture. Four piezoelectric crystals were sutured on toe, heel and both lateral sides of each anastomosis to measure anastomotic axes. Anastomotic cross-sectional area (CSAA) was calculated with: CSAA = pi x mM/4 where m and M are the minor and major axes of the elliptical anastomosis. Cross-sectional anastomotic compliance (CSAC) was calculated as CSAC=Delta CSAA/Delta P where Delta P is the mean pulse pressure and Delta CSAA is the mean CSAA during cardiac cycle. RESULTS: We collected a total of 1200000 pressure-length data per animal. For running suture we had a mean systolic CSAA of 26.94+/-0.4 mm(2) and a mean CSAA in diastole of 26.30+/-0.5 mm(2) (mean Delta CSAA was 0.64 mm(2)). CSAC for running suture was 4.5 x 10(-6)m(2)/kPa. For interrupted suture we had a mean CSAA in systole of 21.98+/-0.2 mm(2) and a mean CSAA in diastole of 17.38+/-0.3 mm(2) (mean Delta CSAA was 4.6+/-0.1 mm(2)). CSAC for interrupted suture was 11 x 10(-6) m(2)/kPa. CONCLUSIONS: This model, even with some limitations, can be a reliable source of information improving the outcome of vascular anastomoses. The study demonstrates that suture technique has a substantial effect on cross-sectional anastomotic compliance of end-to-side anastomoses. Interrupted suture may maximise the anastomotic lumen and provides a considerably higher CSAC than continuous suture, that reduces flow turbulence, shear stress and intimal hyperplasia. The Heartflo anastomosis device is a reliable instrument that facilitates performance of interrupted suture anastomoses.

Sweerts sur Georges Lévy, 750 cmc [course motocycliste Paris-Reims-Paris, side-car, 6 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54748

Boutet sur Rover, side-car 500 cmc [course motocycliste Paris-Reims-Paris, 6 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54749

[Concurrent de la course motocycliste Paris-Reims-Paris, conduisant un side-car Rover, 6 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54751

6.7.19, Paris-Reims-Paris, Catelle Georges (25) sur Lévy et Le Pen (26) sur Lévy à l'arrivée [en side-cars] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54768

Catellas/Georges Leroy, 750 cm3 [le side-car n° 25 au départ de la course Paris-Reims-Paris] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54754

Lecomte sur Rover, 500 cmc [course motocycliste Paris-Reims-Paris, side-car, 6 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54746

In vivo assessment of antiretroviral therapy-associated side effects

Antiretroviral therapy has been associated with side effects, either from the drug itself or in conjunction with the effects of human immunodeficiency virus infection. Here, we evaluated the side effects of the protease inhibitor (PI) indinavir in hamsters consuming a normal or high-fat diet. Indinavir treatment increased the hamster death rate and resulted in an increase in triglyceride, cholesterol and glucose serum levels and a reduction in anti-oxLDL auto-antibodies. The treatment led to histopathological alterations of the kidney and the heart. These results suggest that hamsters are an interesting model for the study of the side effects of antiretroviral drugs, such as PIs.

[Paul] Péan, sur Peugeot [course Paris-Reims-Paris, moto 6 HP avec side-car, 6 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54734

Pasola sur A.J. S. [le side-car n° 31 au départ de la course Paris-Reims-Paris] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54756

A Clinical Decision Support using a Terminology Server to improve Patient Safety.

Clinical Decision Support Systems (CDSS) are software applications that support clinicians in making healthcare decisions providing relevant information for individual patients about their specific conditions. The lack of integration between CDSS and Electronic Health Record (EHR) has been identified as a significant barrier to CDSS development and adoption. Andalusia Healthcare Public System (AHPS) provides an interoperable health information infrastructure based on a Service Oriented Architecture (SOA) that eases CDSS implementation. This paper details the deployment of a CDSS jointly with the deployment of a Terminology Server (TS) within the AHPS infrastructure. It also explains a case study about the application of decision support to thromboembolism patients and its potential impact on improving patient safety. We will apply the inSPECt tool proposal to evaluate the appropriateness of alerts in this scenario.

Effets secondaires meconnus des glucocorticoi'des: prevention et traitement spécifiques requis [Some less well known side effects of glucocorticoids: specific prevention and treatment?]

Steroid treatment is required in many clinical settings and if prolonged can be associated with serious side effects. Certain less well-known side effects may require specific prevention, diagnosis and treatment. The risk of developing hyperglycemia, psychiatric disorders and opportunistic infections associated with immunosuppression is often forgotten. We present herein some evidence on the prevalence, preventive measures and treatment of some of these side effects. Large controlled trials are lacking and do not allow to provide strong recommendations. Nevertheless, we try to provide some suggestions based on a review of the literature.

Suppression of tumor angiogenesis through the inhibition of integrin function and signaling in endothelial cells: which side to target?

Tumor angiogenesis is an essential step in tumor progression and metastasis formation. Suppression of tumor angiogenesis results in the inhibition of tumor growth. Recent evidence indicates that vascular integrins, in particular alpha V beta 3, are important regulators of angiogenesis, including tumor angiogenesis. Integrin alpha V beta 3 antagonists, such as blocking antibodies or peptides, suppress tumor angiogenesis and tumor progression in many preclinical tumor models. The potential therapeutic efficacy of extracellular integrin antagonists in human cancer is currently being tested in clinical trials. Selective disruption of the tumor vasculature by high doses of tumor necrosis factor (TNF) and interferon gamma (IFN-gamma), and the antiangiogenic activity of nonsteroidal anti-inflammatory drugs are associated with the suppression of integrin alpha V beta 3 function and signaling in endothelial cells. Furthermore, expression of isolated integrin cytoplasmic domains disrupts integrin-dependent adhesion, resulting in endothelial cell detachment and apoptosis. These results confirm the critical role of vascular integrins in promoting endothelial cell survival and angiogenesis and suggest that intracellular targeting of integrin function and signaling may be an alternative strategy to extracellular integrin antagonists for the therapeutic inhibition of tumor angiogenesis.

ClubADSL: When your neighbors are your friends

ADSL is becoming the standard form of residential and small-business broadband Internet access due to, primarily, its low deployment cost. These ADSL residential lines are often deployed with 802.11 Access Points (AP) that providewireless connectivity. Given the density of ADSL deployment, it is often possible for a residential wireless client to be in range of several other APs, belonging to neighbors, with ADSL connectivity. While the ADSL technology has showed evident limits in terms of capacity (with speeds ranging 1-10 Mbps), the short-range wireless communication can guarantee a muchhigher capacity (up to 20 Mbps). Furthermore, the ADSL links in the neighborhood are generally under-utilized, since ADSL subscribers do not connect 100% of the time. Therefore, it is possible for a wireless client to simultaneously connect to several APs in range and effectively aggregate their available ADSL bandwidth.In this paper, we introduce ClubADSL, a wireless client that can simultaneously connect to several APs in range on different frequencies and aggregate both their downlink and uplink capacity. ClubADSL is a software that runs locally on the client-side, and it requires neither modification to the existing Internet infrastructure, nor any hardware/protocol upgradesto the 802.11 local area network. We show the feasibility of ClubADSL in seamlessly transmitting TCP traffic, and validate its implementation both in controlled scenarios and with current applications over real ADSL lines. In particular we show that a ClubADSL client can greatly benefit from the aggregated download bandwidth in the case of server-client applications such as video streaming, but can also take advantage of the increased upload bandwidth greatly reducing download times with incentive-based P2P applications such as BitTorrent.