[Emergency free flap in reconstruction of the lower limb: About 23 cases over 11 years]. / Reconstruction des pertes de substance des membres inférieurs par lambeau libre en urgence : à propos de 23 cas sur 11 ans.

OBJECTIVES: To study the coverage period influence and various parameters concerning the microsurgical act on the patient clinical outcomes. METHODS: We report 23 cases of reconstruction of lower limb loss of substance by free flap operated from 2010 to 2021. Among them, 9 patients were operated on as an emergency versus 14 in the secondary or late phase of the trauma. RESULTS: The average age of injured patients operated on emergency was 42 years (17-68 years) and 34 years for the patients who undergo deferred surgery (17-57 years). The sex ratio (female/male) was 22% in patients operated on urgently and 7% in patients operated on later. Regarding the type of free flap, it was Serratus anterior muscle flap in 10 cases, Latissismus dorsi flap in 9 cases, ALT flap in 3 cases and Gracilis muscle flap in 1 case. There were 2 failures of vascularized free transfer (8.7%) with complete necrosis of the flap and 3 revision surgeries on venous thrombosis which finally made it possible to obtain 3 flap successes. We analyze the results (complications/osteitis) according to the time to coverage. CONCLUSIONS: In our study, we did not find any significant difference between the groups operated in emergency and at a distance concerning the rate of infection and failure of the flaps.

On reversals in 2D turbulent Rayleigh-Bénard convection: Insights from embedding theory and comparison with proper orthogonal decomposition analysis.

Turbulent Rayleigh-Bénard convection in a 2D square cell is characterized by the existence of a large-scale circulation which varies intermittently. We focus on a range of Rayleigh numbers where the large-scale circulation experiences rapid non-trivial reversals from one quasi-steady (or meta-stable) state to another. In previous work [B. Podvin and A. Sergent, J. Fluid Mech. 766, 172201 (2015); B. Podvin and A. Sergent, Phys. Rev. E 95, 013112 (2017)], we applied proper orthogonal decomposition (POD) to the joint temperature and velocity fields at a given Rayleigh number, and the dynamics of the flow were characterized in a multi-dimensional POD space. Here, we show that several of those findings, which required extensive data processing over a wide range of both spatial and temporal scales, can be reproduced, and possibly extended, by application of the embedding theory to a single time series of the global angular momentum, which is equivalent here to the most energetic POD mode. Specifically, the embedding theory confirms that the switches among meta-stable states are uncorrelated. It also shows that, despite the large number of degrees of freedom of the turbulent Rayleigh Bénard flow, a low dimensional description of its physics can be derived with low computational efforts, providing that a single global observable reflecting the symmetry of the system is identified. A strong connection between the local stability properties of the reconstructed attractor and the characteristics of the reversals can also be established.

Use of a formwork in the induced membrane technique: Relevance and technical note.

The induced membrane technique is used for bone reconstruction. It is based on the osteoinductive properties of a membrane induced by the insertion of a PMMA cement spacer. We will describe a simple, cost-effective method in which the body of a syringe is used to facilitate the cement introduction, allow insertion of a regular spacer, contain the cement volume in the extension of the diaphysis and protect the underlying tissues from the exothermic reaction during PMMA polymerisation.

Pseudo-first-order reaction of chemically and biologically formed green rusts with HgII and C15H15N3O2: effects of pH and stabilizing agents (phosphate, silicate, polyacrylic acid, and bacterial cells).

The kinetics of Hg(II) and methyl red (MR) reduction by hydroxycarbonate green rust (GR1) and by hydroxysulfate green rust (GR2) were studied in the presence of naturally occurring organic and inorganic ligands (phosphate, polyacrylic acid, bacterial cells, silicate). The reducing ability of biogenic hydroxycarbonate green rust (GR1bio), obtained after microbial reduction of lepidocrocite by Shewanella putrefaciens, was also investigated and compared to those of chemically synthesized GR1 and GR2 (GR1ab and GR2ab). Pseudo first-order rate constants (kobs) of Hg(II) reduction (at pH 7.0, 8.2, and 9.5) and MR reduction (at pH 7.0) were determined and were normalized to the structural Fe(II) content of GRs (kFeII) and to the estimated concentration of surface Fe(II) sites (kS). The kS values ranged from 0.3 L mmol(-1) min(-1) to 43 L mmol(-1) min(-1) for the Hg reduction, and from 0.007 L mmol(-1) min(-1) to 3.4 L mmol(-1) min(-1) for the MR reduction. No significant discrepancy between GRab and GRbio was observed in term of reactivity. However, the reduction kinetics of MR was generally slower than the Hg(II) reduction kinetics for all tested GRs. While a slight difference in Hg(II) reduction rate was noted whatever the pH values (7.0, 8.2, or 9.5), the reduction of MR was significantly affected in the presence of ligands. A decrease by a factor of 2-200, depending on the type of ligand used, was observed. These data give new insights into the reactivity of GRs in the presence of co-occurring organic and inorganic ligands, and have major implications in the characterization of contaminated systems as well as water treatment processes.

Bacterial contamination of the hospital environment during wound dressing change.

INTRODUCTION: The hospital environment plays a role in the cross-transmission of multidrug-resistant bacteria. The aim of this study was to evaluate the bacterial contamination of the hospital environment during chronic wound dressing change. PATIENTS AND METHODS: This study was performed from July 2010 to May 2011. Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacteriaceae were counted in environmental samples (air and surfaces) that were obtained in the rooms of patients with wounds colonized (cases, n=9) or not (controls, n=15) during or not during wound dressing change. Bacterial contamination was compared to that found in the rooms of patients without colonized wounds. RESULTS: The environment was frequently contaminated during wound dressing change (38% of the sampled series were positive). In comparison, the contamination was less frequent in the environment of patients with colonized wounds when the wounds were not being dressed (14.3%) and in controls (3.8%). S. aureus was the most frequent species identified in positive samples. DISCUSSION: These results suggest that previously recommended measures such as hand hygiene after contact with the environment and wearing a mask are justified. Moreover, other measures should be suggested, in particular cleaning the room before and after dressing change of colonized wounds. LEVEL OF EVIDENCE: Level III: case control study.

Impact of spin-orbit coupling on quantum Hall nematic phases.

Anisotropic charge transport is observed in a two-dimensional (2D) hole system in a perpendicular magnetic field at filling factors nu=7/2, nu=11/2, and nu=13/2 at low temperature. In stark contrast, the transport at nu=9/2 is isotropic for all temperatures. Isotropic hole transport at nu=7/2 is restored for sufficiently low 2D densities or an asymmetric confining potential. The density and symmetry dependences of the observed anisotropies suggest that strong spin-orbit coupling in the hole system contributes to the unusual transport behavior.

Transport and percolation in a low-density high-mobility two-dimensional hole system.

We present a study of the temperature and density dependence of the resistivity of an extremely high quality two-dimensional hole system grown on the (100) surface of GaAs. For high densities in the metallic regime (p > or approximately4x10;{9} cm;{-2}), the nonmonotonic temperature dependence ( approximately 50-300 mK) of the resistivity is consistent with temperature dependent screening of residual impurities. At a fixed temperature of T=50 mK, the conductivity versus density data indicate an inhomogeneity driven percolation-type transition to an insulating state at a critical density of 3.8x10;{9} cm;{-2}.

Amorphouslike density of gap states in single-crystal pentacene.

We show that optical and electrical measurements on pentacene single crystals can be used to extract the density of states in the highest occupied molecular orbital-lowest unoccupied molecular orbital band gap. It is found that these highly purified crystals possess band tails broader than those typically observed in inorganic amorphous solids. Results on field-effect transistors fabricated from similar crystals imply that the gap state density is much larger within 5-10 nm of the gate dielectric. Thus, organic thin-film transistors for such applications as flexible displays might be significantly improved by reducing these defects.

Bias-dependent generation and quenching of defects in pentacene.

We describe a defect generation phenomenon that is new to organic semiconductors. A defect in pentacene single crystals can be created by bias-stress and persists at room temperature for an hour in the dark but only seconds with 420 nm illumination. The defect gives rise to a hole trap at Ev+0.38 eV and causes metastable transport effects at room temperature. Creation and decay rates of the hole trap have a 0.67 eV activation energy with a small (10(8) s(-1)) prefactor, suggesting that atomic motion plays a key role in the generation and quenching process.

Quantum cascade surface-emitting photonic crystal laser.

We combine photonic and electronic band structure engineering to create a surface-emitting quantum cascade microcavity laser. A high-index contrast two-dimensional photonic crystal is used to form a micro-resonator that simultaneously provides feedback for laser action and diffracts light vertically from the surface of the semiconductor surface. A top metallic contact allows electrical current injection and provides vertical optical confinement through a bound surface plasmon wave. The miniaturization and tailorable emission properties of this design are potentially important for sensing applications, while electrical pumping can allow new studies of photonic crystal and surface plasmon structures in nonlinear and near-field optics.

High-power mode-locked hybrid pulse source using two-section laser diodes.

We describe a mode-locked hybrid pulse source with a two-section laser diode to obtain short mode-locked pulses (23 ps) with an average power of 7.8 mW, a high peak power of 137 mW, and a repetition rate of 2.51 GHz. The hybrid laser incorporates a two-section laser and an optical fiber cavity with an integrated Bragg reflector. The Bragg reflector controls the operating wavelength to subnanometer precision and also confines the bandwidth of the pulses so as to keep the time-bandwidth product below 1.

Preoperative, intraoperative, and immediate postoperative skeletal scintigraphy to locate and facilitate excision of an osteoid osteoma of the coronoid process.

We report the case of a 39-year-old woman with a 3-year history of inflammatory right elbow pain caused by an osteoid osteoma. Two hours before the operation, the patient received an intravenous injection of 350 MBq of Tc 99m dimethylaminodiphosphonate. The resection of the nidus, guided by the intraoperative scintigraphy, was easily performed and confirmed by postresection counting and an x-ray film. Three hours after the operation, new scintigraphic views without further injection of the bone-seeking radioisotope confirmed the complete removal of the nidus. When immediate postoperative scintigraphy shows the disappearance of the focal reinforcement of activity, it gives additional evidence of complete tumor resection.

[Need of risk reevaluation in morphine dependence in pain patients]. / Nécessité de réévaluation du risque de dépendance avec les analgésiques morphiniques chez le malade douloureux.

It is commonly recognized than opioids analgesics have an major place in the treatment of pain. In spite of guidelines, opioids drugs remain underutilized in chronic cancer pain and acute severe pain. Among the possible factors, involved in the insufficient use of opioids drugs, is the fear (opiophoby) of physicians, nurses, patients and family to induce or to maintain an addiction. This review examines the potential of iatrogenic addiction. We will examined the place of morphine-like drugs in the treatment of severe acute pain and chronic cancer pain, the definition of dependency in pain patients, the assessment of the dependency potential in patients treated for pain. Available studies indicate that iatrogenic addiction is quite scarce and that the risk for a major tolerance is very small. Further studies will be necessary, since opioids analgesics may also be useful in some non-cancer chronic pain.

Intraoperative bone scintigraphy in orthopaedic surgery.

A sterilisable radiation probe of small dimensions was designed to locate the lesions at orthopaedic surgical sites according to the procedure of intraoperative bone scintigraphy. The probe has a collimated opening 2 mm in diameter. It is connected to a portable radioactivity counter which converts the disintegration rates detected at surgical sites into an acoustic signal that increases steeply with increasing disintegration rate. The acoustic signal enables the surgeons and isotope specialists to readily monitor radioactivity in the region of interest without attention being distracted from the surgical site. Dimethylaminodiphosphonate (designated SF44) was the osteotropic radiopharmaceutical chosen for carrying out intraoperative bone scintigraphy, since the available data show that this chemical increases the pathological: normal bone uptake ratio of the lesion by 25% compared to the usual diphosphonates. Forty-seven orthopaedic interventions were carried out according to the intraoperative bone scintigraphy procedure. They showed that this procedure facilitated the rapid location of the lesion, the objective termination of the operation, less frequently the reduction in dimension of the excised areas, and rarely the simplification of the surgical technique. Practice of intraoperative bone scintigraphy requires proper training and caution.

Cortical perfusion assessment with 123I-isopropyl amphetamine (123I-IAMP) in normal pressure hydrocepha lus (NPH).

NPH can be reversible after cerebrospinal fluid (CSF) diversion. In the past no reliable criteria could be defined to predict the successful outcome of CSF shunting. Several authors demonstrated an increased cerebral blood flow after lumbar puncture in patients with NPH, indicating an underlying impairment of cerebral circulation autoregulation. 123I-AMP brain tomoscintigraphy was applied to 23 individuals with NPH before and after CSF drainage. Of these 23 patients, 10 underwent surgical shunting. The frontal and parietal hypoactive cortical pattern was present in NPH but not pathognomonic. Under stimulation of CSF pressure lowering, seven patients with improved outcome after shunting demonstrated an increase of cerebral perfusion in these areas, whereas a decrease of activity was found in three patients whose clinical status was unchanged after CSF diversion. This tomoscintigraphic test may be an interesting additional criterion for surgical admission.

Amines for brain tomoscintigraphy.

Amines like N-isopropyl-p-123I-iodoamphetamine (IMP) and hydroxy 123I-iodobenzyl propyl diamine (HIPDM) associated with brain tomoscintigraphy have proved their worth for detecting ischaemic abnormalities. Even though the chemistry of their metabolism and their biodistribution are not fully understood, their application in the study of parenchymal impairment in stroke and reversible ischaemia yields additional information compared to the other methods of imaging like CT or MRI. The concept of a steady state in brain with a wash in/wash out model has been considered especially with IMP, to explain the evolution of the activity pattern with time when comparing early and delayed images. (This review leads to foresee the prognosis of of ischaemic diseases when redistribution is taken into account.)

Early and delayed SPECT using N-isopropyl p-iodoamphetamine iodine 123 in cerebral ischemia. A prognostic index for clinical recovery.

Sixteen patients with stroke, five patients with permanent regressive ischemic neurologic deficit, and three patients with transient ischemic attacks were studied by single photon emission computed tomography performed within the first hour (early scan) and four hours (delayed scan) after injection of N-isopropyl-p-iodoamphetamine-iodine-123 (IMP). These patients were classified into three groups according to their clinical improvement three months later, and results of single photon emission computed tomography were compared with computed tomographic scan results and correlated to the clinical outcome. Regional brain hypoactivity of IMP differed in some cases between early and delayed IMP scans, showing in those cases a "redistribution" activity. The amplitude of this redistribution was significantly correlated with the clinical outcome of patients with stroke, whereas the value of hypoactivity on early IMP scan did not show such a correlation. The higher the redistribution amplitude was, the better was the clinical outcome. Comparative regional brain hypoactivity of IMP on early and delayed scans could represent a prognostic index of clinical recovery inasmuch as it gives information concerning viability of ischemic brain tissue.