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An experiment on 57 rats was performed in order to elaborate an alternative model of cardiac lesion. The antero-apical area of the heart (i.e. a part of right, septum and left ventricles) was cauterized with a «Cautery high temperature fine tip» (Bovie Medical Corporation-USA) to create an injury of controllable, precise and reproducible dimensions (8x8 mm2 surface, 1 mm depth). To evaluate functional and morphological characteristics of the lesion, electrocardiography, pulse oximetry, echocardiography and optic microscopy were performed at different times (from day 0 to 230) after the operation. After technical adjustment a 100% survival of the last 12 operated animals was obtained. A sub epicardial “infarction” was documented (ST-modifications on the ECG in 2 leads, significant decrease of the ejection fraction (37.4% at day 10+/-2 and 27.3% at day 30+/-5), necrotic alterations and fibrosis of the lesion area in the myocardium). The survival and the evolution of the injury suggest that the proposed model could be used for studies concerning cardiac tissue repair.

Background. Significant functional decrease and sclerosis of the pancreas graft in late delays cannot only be related to chronic rejection. Any transplantation leads to graft denervation, which may be an important cause of dysfunction. Studies concerning graft reinnervation were controversial. Purpose of the Study The purpose of this study was to investigate the feasibility and pertinence of a surgically directed reinnervation (SDR) of denervated/neuro- reflex isolated (NRI) or autotransplanted (aTx) pancreas. Basic Procedures Anatomy of the nerves penetrating into the pancreas was studied in humans, dogs, cats, and rats. Surgery and physiological investigations were performed in dogs, cats, and rats. Nervous conductivity between NRI, NRI+SDR pancreas, and brain was tested. Load tests with glucose, insulin, and adrenalin were performed; amylase and lipase were determined in fasted and not fasted animals to evaluate the influence of NRI and SDR on pancreatic function. Histology was provided. Observation delays were 6 months. Main Findings Anatomic feasibility of SDR in humans and animals was proved. Models of pancreatic tail NRI and surgical reconstitution of the interrupted nervous pathways (SDR) were elaborated in animals. The restoration of the pancreas-brain reflex axis after SDR was electro physiologically proved. As blood glucose curves after load test, exocrine amylase and lipase determination have shown that pancreas NRI or aTx leads to an exaggerated reaction to usual stimulations that may cause the observed graft functional exhaustion in late delays. SDR shortened the period of the graft neuro-reflex isolation, contributed to a quick normalization of its function, and prevented its late degradation. Conclusion. SDR was shown to be a simple surgical technique, easily performed after the graft surgical revascularization. Its functional and morphological efficiency was tested and proved. Thus, SDR may be recommended in human pancreas transplantation as pertinent. © 2014 by Elsevier Inc. All rights reserved., SCOPUS: cp.j, info:eu-repo/semantics/published

Existing experimental models of cardiac lesion do not allow precise reproducible dimensions of injury with complete safeness of surrounding tissues and cannot answer the tremendous question for heart cell therapy: are the implanted cells unable to influence the heart healing process or do the conditions in the injured heart prevent their complete development and integration?60 rats were used for elaborating an alternative technique of cardiac lesion.The anterior apical area of the heart was cauterized with a «Cautery high temperature fine tip» to create an injury of controllable, precise and reproducible dimensions (8×8 mm² surface, 1 mm depth).To evaluate functional and morphological characteristics of the lesion, electrocardiography, pulse oximetry, echocardiography and optic microscopy were performed at different times (from day 0 to 230) after the operation.After technical adjustment a 100% survival of the last 15 operated animals was obtained. A sub epicardium “infarction” was documented: ECG mirror ST-modifications in 2 leads, stable ejection fraction significant decrease, necrotic alterations and fibrosis of the lesion area, with surrounding myocardium preserved.The survival and the injury evolution suggest that the proposed technique could be used for studies concerning cardiac tissue repair.

The treatment of glucose metabolism disorders in critically ill or in diabetic patients remains sometimes arduous because the serum glucose concentration does not reflect in real time the tissues metabolic situation. We hypothesized that the difference Dt between core (Tc) and subcutaneous (Ts) temperatures of the body can reflect the tissues energy balance (which glucose metabolism ensures for 70%) and hence be used to monitor glucose metabolism. A device – ADD-CIT - was elaborated and patented. It includes a thin rectal catheter with two temperature captors at a distance of 4.5 cm, a temperature analyser, a computer which commands an insulin pump according to an algorithm linked with the recorded evolution of Dt values. The results of its first tests are presented here. The device technical liability was tested in thermostat according to standard methods. The feasibility of temperature registration was verified in animal experiments on rats. From 1998 till 2012, the device was tested in13 healthy volunteers and 58 diabetic patients type 1 with a more than 24 hours lasting blood glucose level above 11.1 mM/l (200 mg/dl) in spite of usual insulin therapy, 19 from them undergoing only Dt investigation with traditional treatment continuation. Ethic Committee agreements were obtained. Range of glycaemia normalization delays after the observation beginning, per cent of failure (glycaemia remaining above the hyperglycaemia threshold), hypoglycaemia and “yo-yo” episodes were analysed. Acceptable stability and reproducibility of the Dt measures were shown in thermostat, in animals and in healthy human volunteers. Compared with the traditional treatment, new feedback monitored insulin treatment has demonstrated: some acceleration of the glycaemia decrease during the first 3-4 hours, less treatment failures, yo-yo events, and deep hypoglycaemia episodes. In most cases, a 3-4 hour session significantly improved the patient condition. These first results suggest the validity of the new feedback for insulin therapy control.

BACKGROUND The aim of the study was to evaluate the influence of blood insulin measurements on acute coronary syndrome (ACS) pathways. METHODS All patients admitted to the emergency department within 12 months for acute, retrosternal, constrictive chest pain lasting for more than 30 minutes; cardiogenic pulmonary edema; electrocardiogram ST changes; and echographic alterations were included. The study parameters were clinical (age, sex, blood pressure, presence of pulmonary rales and gallop), including classic laboratory tests associated with troponin T, blood insulin levels, and hemoglobin A1C, and echographic values. These were taken on admission and throughout hospital stay. All patients underwent a coronary angiography for ACS diagnosis confirmation as well as treatment intention. RESULTS Sixty patients were included in the study. Abnormal blood insulin levels were present on admission in 47% of the population. Blood insulin level was significantly correlated to thrombolysis in myocardial infarction coronary perfusion score (Spearman Rank, 0.55, P < 0.0001). Abnormal insulinemia was normalized with reperfusion. Insulin was administered essentially to the 16 patients with hypoinsulinemia. Patients with hypoinsulinemia seem to have the most severe coronary lesions and highest Killip score. CONCLUSIONS In ACS, insulin levels are altered in half of the patients. After the investigators noted its tight correlation with the thrombolysis in myocardial infarction coronary flow score, its determination could be important in ACS for triggering emergency coronary angiography for percutaneous coronary intervention. This could modify the critical pathways of ACS patients in the emergency department.

Sciatic nerve blocks through lateral approaches in the popliteal fossa have been proposed. We describe a new medial approach to the sciatic nerve at this level.After an anatomical study on six cadavers, we performed sciatic nerve blocks on 20 patients. A 100-mm insulated needle and a nerve stimulator were used; 20 mL of lidocaine 1.5% with epinephrine were injected.Patients lied in the supine position, the thigh flexed, abducted and rotated externally (30 degrees in all directions). The leg was flexed at 130 degrees . In this position, above the adductor tubercle, a depression known as Jobert's fossa is palpated. Through this groove, a medial approach to the sciatic nerve at the level of the popliteal fossa is possible. The mean distance between the adductor tubercle and the puncture site is 6.18 cm (range 4-8 cm) and the mean distance between the skin and the sciatic nerve is 6.62 cm (range 4-9 cm). Mean time to perform the block was 100 sec (range 55-165 sec). Complete motor blockade was obtained after a mean time of 30 min (range 5-60 min) inside the common peroneal nerve area and 43 min (range 15-75 min) inside the tibial nerve area. Motor block was complete in 17 patients and sensory block in 18 patients. No vessel puncture was observed.We describe a new medial approach to the sciatic nerve in the popliteal fossa. More studies will be required to demonstrate the technique is effective and safe.