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Objective:Surgical site infections (SSIs) are a major source of morbidity after cardiac surgery, involving prolonged hospitalisation. Among the numerous techniques of skin closure and dressings available, the optimal method remains undetermined. The DERMABOND-PRINEO (PRINEO) (PRINEO, Ethicon, J&J) is the only skin closure system which combines a topical skin adhesive with a mesh. Other surgical disciplines have highlighted remarkable results with PRINEO. The aim of this study was to evaluate the effects of PRINEO, used as the final layer in sternotomy closure, in the incidence of postoperative SSIs.Method:This was a retrospective single-centre cohort study including adult patients who underwent cardiac surgery between January 2015 and December 2018. Patients who had undergone heart transplantation or ventricular assist surgery were excluded. Included patients were divided into two groups depending on the type of post-operative wound care technique used. Group 1 consisted of patients who had their sternotomy closed with a standard dressing and group 2 consisted of patients who were treated with PRINEO. The primary endpoint of our study was the occurrence of SSIs and secondary outcomes were the length of hospitalisation and mortality.Results:A total of 1603 patients were reviewed with the occurrence of 44 SSIs. Both groups were homogeneous in terms of risk factors. The incidence of SSIs was significantly lower in group 2 (PRINEO) than in group 1 (standard dressing) (n=29, 3.8% vs n=15, 1.8%, respectively; p=0.042). However, there was no significant difference in the duration of hospitalisation and mortality.Conclusion:In our practice, PRINEO has proven to be a safe wound closure system after sternotomy, with a reduced SSI rate compared to conventional wound care techniques.

ABSTRACTLeptospirosis is a life-threatening and emerging zoonotic disease with a worldwide annual occurrence of more than 1 million cases. Leptospirosis is caused by spirochetes belonging to the genus Leptospira. The mechanisms of disease manifestation in the host remain elusive, and the roles of leptospiral exoproteins in these processes have yet to be determined. Our aim in this study was to assess the composition and quantity of exoproteins of pathogenic Leptospira interrogansand to construe how these proteins contribute to disease pathogenesis. Label-free quantitative mass spectrometry of proteins obtained from Leptospiraspirochetes cultured in vitrounder conditions mimicking infection identified 325 exoproteins. The majority of these proteins are conserved in the nonpathogenic species Leptospira biflexa, and proteins involved in metabolism and energy-generating functions were overrepresented and displayed the highest relative abundance in culture supernatants. Conversely, proteins of unknown function, which represent the majority of pathogen-specific proteins (presumably involved in virulence mechanisms), were underrepresented. Characterization of various L. interrogansexoprotein mutants in the animal infection model revealed host mortality rates similar to those of hosts infected with wild-type L. interrogans. Collectively, these results indicate that pathogenic Leptospiraexoproteins primarily function in heterotrophic processes (the processes by which organisms utilize organic substances as nutrient sources) to maintain the saprophytic lifestyle rather than the virulence of the bacteria. The underrepresentation of proteins homologous to known virulence factors, such as toxins and effectors in the exoproteome, also suggests that disease manifesting from Leptospirainfection is likely caused by a combination of the primary and potentially moonlight functioning of exoproteins.

Les directives officielles de la Confédération suisse (directives R-11) pour la protection des personnes auprès des centrales nucléaires sont reproduites dans le texte en annexe relatif aux objectifs de la protection contre les rayonnements ionisants pour les personnes travaillant dans les centrales nucléaires et pour les personnes du public.

ABSTRACTLeptospira interrogansis a global zoonotic pathogen and is the causative agent of leptospirosis, an endemic disease of humans and animals worldwide. There is limited understanding of leptospiral pathogenesis; therefore, further elucidation of the mechanisms involved would aid in vaccine development and the prevention of infection. HtpG (high-temperature protein G) is the bacterial homolog to the highly conserved molecular chaperone Hsp90 and is important in the stress responses of many bacteria. The specific role of HtpG, especially in bacterial pathogenesis, remains largely unknown. Through the use of an L. interroganshtpGtransposon insertion mutant, this study demonstrates that L. interrogansHtpG is essential for virulence in the hamster model of acute leptospirosis. Complementation of the htpGmutant completely restored virulence. Surprisingly, the htpGmutant did not appear to show sensitivity to heat or oxidative stress, phenotypes common in htpGmutants in other bacterial species. Furthermore, the mutant did not show increased sensitivity to serum complement, reduced survival within macrophages, or altered protein or lipopolysaccharide expression. The underlying cause for attenuation thus remains unknown, but HtpG is a novel leptospiral virulence factor and one of only a very small number identified to date.

To evaluate indications and results of surgery for primary cardiac tumors in children.

This paper presents a method for merging Unified Modelling Language (UML) models, which takes place in a quality evaluation framework for Web Services (WSs). This framework, called iTac Tests and Certified Quality of Services (iTac-QoS), is an extended Universal Description Discovery and Integration (UDDI) server using model-based testing to assess quality. Depending on the results of the test execution, a mark is given to the WSs. Until now, our framework was limited to WSs without composition. This was justified by the fact that it is impossible for vendors to create a good model of a foreign product. Our method proposes to automatically merge the models (produced by each vendor) of the WSs involved in the composition. For each type of diagram present in the models (class, instance or statechart diagram), a method is proposed to produce a unique model. In addition to this, a solution is proposed to merge all Object Constraint Language (OCL) codes in the class modelling the WSs under study. Unfortunately, this process introduces inconsistencies in the resulting model that falsify the results of the test generation phase. We thus propose detecting such inconsistencies to distinguish inconsistent and unreachable test targets.

Congenital heart disease (CHD) is a risk factor for infective endocarditis (IE). We aimed to assess the impact of cardiac interventions on the frequency and microbial profile of IE in children with CHD.

Postsynaptic density-95/disks large/zonula occludens-1 (PDZ) domains are relatively small (80–120 residues) protein binding modules central in the organization of receptor clusters and in the association of cellular proteins. Their main function is to bind C-terminals of selected proteins that are recognized through specific amino acids in their carboxyl end. Binding is associated with a deformation of the PDZ native structure and is responsible for dynamical changes in regions not in direct contact with the target. We investigate how this deformation is related to the harmonic dynamics of the PDZ structure and show that one low-frequency collective normal mode, characterized by the concerted movements of different secondary structures, is involved in the binding process. Our results suggest that even minimal structural changes are responsible for communication between distant regions of the protein, in agreement with recent NMR experiments. Thus, PDZ domains are a very clear example of how collective normal modes are able to characterize the relation between function and dynamics of proteins, and to provide indications on the precursors of binding/unbinding events.

Several CXC-chemokines, of which interleukin (IL)-8 is the prototype, are potent neutrophil chemotactic and activating cytokines, inducing the secretion of granule proteins and the generation of reactive oxygen intermediates that may cause tissue damage and amplify inflammatory responses. Here, we investigated whether chemokines play a key role in the inflammatory process following cardiac surgery with cardiopulmonary bypass (CPB) in children. We performed an observational prospective clinical study of 40 pediatric patients before, during, and after open heart surgery with CPB. Plasma levels of chemokines, myeloperoxidase (MPO), and lactoferrin were measured by immunoassays. Cell surface receptors were detected by flow cytometry. Plasma levels of IL-8 were increased after CPB, correlating strongly with a reduction of expression of the CXC-chemokine receptors (CXCR) 1 and 2 on neutrophils indicating in vivoactivation of neutrophils by IL-8. Other CXC-chemokines with Glu-Leu-Arg motif showed no correlation with CXCR1 or CXCR2 expression. Two components of neutrophilic granules, MPO and lactoferrin, were strongly elevated postoperatively, and the levels of both were correlated with IL-8. Levels of monocyte chemoattractant protein (MCP)-1 were increased postoperatively, correlating with a reduction of CCR2 expression and an increase of CD11b expression on monocytes, suggesting monocyte activation by MCP-1. The early postoperative course was complicated in patients with an increase of these inflammatory parameters. Impaired cardiovascular function correlated with increased levels of IL-8 and activation of neutrophils and was most prominent in patients with a long time on CPB and in those with cyanotic heart lesions. In conclusion, MCP-1 is involved in the regulation of chemotaxis and function of monocytes during and early after the end of CPB. Activation of neutrophils and down-regulation of CXCR1 and CXCR2 were predominantly caused by IL-8. This activation implies release of components of neutrophilic granules and correlates with the need for inotropic support.

Vespa velutina nigrithorax (VVN), typically known as the Asian yellow-legged wasp, has been one of the most significant invasive species in western Europe since 2010. Currently, VVN has become the most prevalent cause of Hymenoptera anaphylaxis in the north and northwestern Spain. For this reason, it is crucial to diagnose anaphylaxis cases in the acute moment for carrying out the best available treatment as soon as possible.

Background. Injury to the ascending aorta is a rare lesion that may present in various forms. A thorough analysis of this lesion is lacking in the literature. This study was undertaken to delineate the prevalence and modes of presentation of injuries to the ascending aorta after blunt trauma and to suggest guidelines for management. Methods. A retrospective analysis of autopsies performed in our department of forensic medicine on blunt trauma victims from 1984 to 1993 and a literature review of autopsy series were undertaken to delineate the prevalence and relevant characteristics of this injury. A case report from our institution and a review of the literature were used to provide information regarding clinical presentations of this injury and treatment approaches. Results. Three modes of presentation were encountered. (1) Presentation at autopsy: The prevalence of injury to the ascending aorta after a traffic accident was 2% in our autopsy series. Among 13 patients with this injury 12 had other associated, potentially lethal lesions. A massive hemopericardium was present in two patients only. In autopsy series the incidence of injury to the ascending aorta in patients with an injury to the aorta ranged from 0% to 23%. (2) Clinical presentation: Twenty-one patients were treated surgically and reported in the literature. Fourteen presented with a pseudoaneurysm and seven with a chronic sinus of Valsalva fistula. One patient with a pseudoaneurysm presented with signs of cardiac tamponade and required immediate decompression; the others were hemodynamically stable. Seven patients had a cardiac lesion (valve tear in six and cardiac contusion in one), and three had an arch vessel lesion. Aorta repair was performed under cardiopulmonary bypass in every patient. (3) Incidental presentation: Seven patients with a traumatic tear of the aortic valve presented an incidental lesion of the ascending aorta. It was a subadventitial hematoma in three patients and an intimal and medial tear in four patients. Aortic tears were reinforced by direct suture. Conclusions. Injury to the ascending aorta after blunt trauma is rare but lethal mostly from associated injuries. Survivors may appear in stable condition and present mostly with pseudoaneurysms of the ascending aorta or sinus of Valsalva fistula. Associated lesions to the heart and arch vessels should be looked for. Repair of the ascending aorta injury is performed under cardiopulmonary bypass.

Relaxation processes in nonlinear optical (NLO) polymers with glass transition temperatures in the range of 125 °C < Tg < 176 °C have been studied. The relaxational mechanisms of these side- and main-chain polymers have been investigated above and below the glass transition by second-harmonic decay, dielectric relaxation, and differential scanning calorimetry measurements, and the results obtained have been compared with a variety of nonlinear optical polymer systems cited in the literature. The nonexponential relaxation in both the time and frequency domain was modeled by the Kohlrausch−Williams−Watts function whereas the nonlinear relaxational behavior of these polymers was modeled in terms of the Tool−Narayanaswamy description of the glassy state using the Adam−Gibbs expression for the relaxation time. This procedure allows for the nonlinear extension of the liquid equilibrium state behavior into and below the glass transition region with an accurate prediction of the relaxation times over more than 15 orders of magnitude in time. Time−temperature scaling of the relaxation times with respect to Tg/T as the relevant scaling parameter is observed below the glass transition. The effect of annealing was investigated using differential scanning calorimetry with the result that a single set of parameters is sufficient to describe a wide range of thermal histories with as well as without annealing. Optimum annealing temperatures/annealing times for best orientational stability in NLO polymers were calculated according to the same relaxation scheme.

Relaxation processes in nonlinear optical modified polyimide polymers with side-chain azo chromophores having glass transition temperatures in the range of 140 < Tg < 170 °C have been studied. The relaxational mechanisms of the side-chain chromophores in these polymers have been investigated above and below the glass transition by second-harmonic decay, dielectric relaxation, and differential scanning calorimetry measurements. The nonexponential relaxation in both the time and frequency domains was modeled by the Kohlrausch−Williams−Watts (KWW) function. The nonlinear relaxational behavior of these polymers can be modeled in terms of the Tool−Narayanaswamy description of glassy state behavior. It allows for the nonlinear extension of the liquid equilibrium state behavior into and below the glass transition region with an accurate prediction of the relaxation times over more than 15 orders of magnitude in time. Time−temperature scaling of the relaxation times with (Tg − T)/T as the relevant scaling parameter is observed below the glass transition.

Background Blunt trauma causing injury to the vessels of the aortic arch is uncommon but may be attended by serious consequences. Most surgeons will experience only an occasional case and will need to rely on published literature for guidance.
Methods A Medline search over 1986-1995 was carried out using the following keywords: brachiocephalic trunk, common carotid artery and subclavian artery; injury was used as a subheading.
Results and Conclusion After the aortic isthmus, the innominate is the most commonly injured artery in the chest. Whatever the site of an arterial lesion, however, angiography is the diagnostic test of choice. Some vascular lesions are relatively benign and may be managed without operation; this form of management may also be appropriate if there is severe associated neurological injury. Otherwise, operation using an approach and technique suited to the site of the injury is advocated.

La protection radiologique est basée sur l'hypothèse linéaire attribuant aussi aux faibles doses la capacité potentielle d'induire un détriment sanitaire. La Commission internationale de protection radiologique (CIPR) a publié en 1990 ses dernières estimations du risque radiologique et les recommandations correspondantes. Pour en déduire son coefficient de risque, la CIPR se base surtout sur les observations épidémiologiques des survivants d'Hiroshima et de Nagasaki. En outre, la CIPR a dû prendre en considération le fait que les faibles débits de dose sont, par unité de dose, moins préjudiciables que les hauts débits de dose tels que ceux d'Hiroshima et de Nagasaki. Cette différenciation conduisit à l'introduction du facteur correctif FEDDD (facteur d'efficacité de la dose et du débit de dose) très controversé. La recherche en radiobiologie pendant les 5 dernières années a mis en évidence quelques aspects nouveaux qui modifient légèrement la situation mais qui, globalement, n'invalident pas la base scientifique des recommandations "CIPR 60". Les auteurs estiment donc que la limite principale de dose pour les travailleurs (20 mSv/an) repose sur des bases robustes, et va rester en vigueur pendant de nombreuses années. D'autre part, les auteurs expriment quelques doutes sur une étape du raisonnement conduisant à la limite de dose pour le public qu'ils estiment inutilement basse.

Cette publication dtcrit un dosimttre neutronique qui est actuellement porté par le personnel du centre nucléaire de Würenlingen (Suisse) et qui permet de mesurer aussi bien les doses de routine que d'éventuelles doses accidentelles. Il contient 2 détecteurs compoés chacun d'un disque de métal fissile adjacent à un disque de plastique ('Lexan'). Le métal est d'une part Th 232 pour Ie détecteur à neutrons rapides, et d'autre part un alliage Al-U 235 pour celui des neutrons thermiques. Certains fragments de fission phttrent dans les disques de plastique et y laissent des traces qui sont révélées dans une solution de KOH puis comptées au microscope. Les doses neutroniques sont directement proportionnelles aux densités de traces.A neutron dosimeter is described which is at present being worn by personnel of the Nuclear Research Center, Würenlingen (Switzerland). This dosimeter allows the measurement of routine as well as accidental doses. It contains two detectors, each of which is composed of a fission metal disc in contact with a plastic foil ('Lexan'). For the fast neutron detector the metal used is Th-232 and for the thermal neutron detector it is an alloy of Al-U-235.Neutrons induce fission in the metals. Some of the fragments penetrate into the plastic foils, thereby producing tracks which can be developed in a KOH solution and then visualized under the optical microscope. Neutron doses are directly proportional to track densities.

This paper discusses the conversion from neutron fluence into either absorbed dose or dose equivalent. It shows that the quality factor can have four different meanings which should be separated properly from each other. Similarly, in a more general sense, it is proposed to distinguish between, (1) conservative quantities which are used for preventive purposes (radiation protection) and which refer to late somatic and genetic effects of chronic exposures at low dose-rate (conditions within ICRP limits), (2) realistic quantities which are used to estimate the actual damage (radiation accidents, radiotherapy, civil defense, animal experiments) and which refer to early somatic effects of an acute exposure at high dose-rate (conditions mostly beyond ICRP limits). This distinction is urgently needed, particularly in the case of dose-equivalent, because the unit “rem” is not unequivocally defined: There are in fact two different “rem”, one of them being the old but realistic “Roentgen Equivalent Man”, while the newer one includes comparatively more conservatism. Among the many interactions neutrons can undergo in tissue, the capture H(n, gamma)D is of great importance to man, due to the large dimensions of his body. Therefore, a substantial part of any neutron dose is absorbed by man in the form of a gamma dose. With this in mind, it is felt that the internationally recommended quality factors for neutrons are generally too high. Finally, the question is raised, why the protection against neutrons is more conservative than the protection against gamma quanta.

In a 13-year-old boy a correction of an atrioventricular septal defect (AVSD) was performed at the age of one year and a mitral valve reconstruction at the age of two years. The patient developed, after two median sternotomies, a massive sternal deformity. At the age of 12 years another mitral valve reconstruction had to be performed. At this time titanium plates were used for sternal closure and correction of the deformity. Six months later, and after a CT-follow-up, the plates could be removed with a very satisfying result. Sternal plate osteosynthesis represents an excellent alternative for the correction of difficult sternal closures and deformities in adults as well as in children.