A computational study of artery curvature and endograft oversize influence on seal zone behavior in endovascular aortic repair.

Thoracic endovascular aortic repair (TEVAR) is a minimally invasive procedure involving the placement of an endograft inside the dissection or an aneurysm to direct blood flow and prevent rupture. A significant challenge in endovascular surgery is the geometrical mismatch between the endograft and the artery, which can lead to endoleak formation, a condition where blood leaks between the endograft and the vessel wall. This study uses computational modeling to investigate the effects of artery curvature and endograft oversizing, the selection of an endograft with a larger diameter than the artery, on endoleak creation. Finite element analysis is employed to simulate the deployment of endografts in arteries with varying curvature and diameter. Numerical simulations are conducted to assess the seal zone and to quantify the potential endoleak volume as a function of curvature and oversizing. A theoretical framework is developed to explain the mechanisms of endoleak formation along with proof-of-concept experiments. Two main mechanisms of endoleak creation are identified: local buckling due to diameter mismatch and global buckling due to centerline curvature mismatch. Local buckling, characterized by excess graft material buckling and wrinkle formation, increases with higher levels of oversizing, leading to a larger potential endoleak volume. Global buckling, where the endograft bends or deforms to conform to the centerline curvature of the artery, is observed to require a certain degree of oversizing to bridge the curvature mismatch. This study highlights the importance of considering both curvature and diameter mismatch in the design and clinical use of endografts. Understanding the mechanisms of endoleak formation can provide valuable insights for optimizing endograft design and surgical planning, leading to improved clinical outcomes in endovascular aortic procedures.

A tiny, long-distance hunter.

Lacrymaria olor cytoskeleton and membrane "origami" enables rapid cell hyperextension.

Ridge localization driven by wrinkle packets.

While buckling is a time independent phenomenon for filaments or films bonded to soft elastic substrates, time evolution plays an important role when the substrate is a viscous fluid. Here we show that buckling instabilities in fluid-structure interactions can be reduced to the analysis of a growth function that amplifies the initial noise characterizing experimental or numerical error. The convolution between a specific growth function and noise leads to natural imperfections that emerge in the form of wave packets with a large scale modulation that can transform into localized structures depending on nonlinear effects. Specifically, we provide an experimental example where these wave packets are amplified into ridges for sufficiently low compression rates or are diluted into wrinkles for high compression rates.

Topographic de-adhesion in the viscoelastic limit.

The superiority of many natural surfaces at resisting soft, sticky biofoulants have inspired the integration of dynamic topography with mechanical instability to promote self-cleaning artificial surfaces. The physics behind this novel mechanism is currently limited to elastic biofoulants where surface energy, bending stiffness and topographical wavelength are key factors. However, the viscoelastic nature of many biofoulants causes a complex interplay between these factors with time-dependent characteristics such as material softening and loading rate. Here, we enrich the current elastic theory of topographic de-adhesion using analytical and finite-element models to elucidate the nonlinear, time-dependent interaction of three physical, dimensionless parameters: biofoulant's stiffness reduction, the product of relaxation time and loading rate, and the critical strain for short-term elastic de-adhesion. Theoretical predictions, in good agreement with numerical simulations, provide insight into tuning these control parameters to optimize surface renewal via topographic de-adhesion in the viscoelastic regime.

Lateral indentation of a thin elastic film.

Indentation is a standard, widely used technique in mechanical assays and theoretical analysis. It unveils the fundamental modes of deformation and predicts the response of the material under more complex loads. Here we present an experimental setup for testing thin-film materials by studying the lateral indentation of a narrow opening cut into a film, triggering a cascade of buckling events. The force response F is dominated by bending and stretching effects for small displacements and slowly varies with indenter displacement F ∼ d2/5, to finally reach a wrinkled state that results in a robust nonlinear asymptotic relation, F ∼ d4. Experiments with films of various thicknesses and material properties, and numerical simulations confirm our analysis and help to define an order parameter that accounts for the different response regimes observed in experiments and simulations.

Active wrinkles to drive self-cleaning: A strategy for anti-thrombotic surfaces for vascular grafts.

The inner surfaces of arteries and veins are naturally anti-thrombogenic, whereas synthetic materials placed in blood contact commonly experience thrombotic deposition that can lead to device failure or clinical complications. Presented here is a bioinspired strategy for self-cleaning anti-thrombotic surfaces using actuating surface topography. As a first test, wrinkled polydimethylsiloxane planar surfaces are constructed that can repeatedly transition between smooth and wrinkled states. When placed in contact with blood, these surfaces display markedly less platelet deposition than control samples. Second, for the specific application of prosthetic vascular grafts, the potential of using pulse pressure, i.e. the continual variation of blood pressure between systole and diastole, to drive topographic actuation was investigated. Soft cylindrical tubes with a luminal surface that transitioned between smooth and wrinkled states were constructed. Upon exposure to blood under continual pressure pulsation, these cylindrical tubes also showed reduced platelet deposition versus control samples under the same fluctuating pressure conditions. In both planar and cylindrical cases, significant reductions in thrombotic deposition were observed, even when the wrinkles had wavelengths of several tens of µm, far larger than individual platelets. We speculate that the observed thrombo-resistance behavior is attributable to a biofilm delamination process in which the bending energy within the biofilm overcomes interfacial adhesion. This novel strategy to reduce thrombotic deposition may be applicable to several types of medical devices placed into the circulatory system, particularly vascular grafts.

Prototypical model for tensional wrinkling in thin sheets.

The buckling and wrinkling of thin films has recently seen a surge of interest among physicists, biologists, mathematicians, and engineers. This activity has been triggered by the growing interest in developing technologies at ever-decreasing scales and the resulting necessity to control the mechanics of tiny structures, as well as by the realization that morphogenetic processes, such as the tissue-shaping instabilities occurring in animal epithelia or plant leaves, often emerge from mechanical instabilities of cell sheets. Although the most basic buckling instability of uniaxially compressed plates was understood by Euler more than two centuries ago, recent experiments on nanometrically thin (ultrathin) films have shown significant deviations from predictions of standard buckling theory. Motivated by this puzzle, we introduce here a theoretical model that allows for a systematic analysis of wrinkling in sheets far from their instability threshold. We focus on the simplest extension of Euler buckling that exhibits wrinkles of finite length--a sheet under axisymmetric tensile loads. The first study of this geometry, which is attributed to Lamé, allows us to construct a phase diagram that demonstrates the dramatic variation of wrinkling patterns from near-threshold to far-from-threshold conditions. Theoretical arguments and comparison to experiments show that the thinner the sheet is, the smaller is the compressive load above which the far-from-threshold regime emerges. This observation emphasizes the relevance of our analysis for nanomechanics applications.

Contamination and chemical fractionation of heavy metals in street dust from the metropolitan area of Monterrey, Mexico.

The prevalence of heavy metal pollution and mobility of both Pb and Cd was investigated in street dust samples from the Metropolitan Area of Monterrey (MAM) in northern Mexico. Street dust samples from 30 selected sites were analysed for their content of Zn, Cd, Pb, Cr and Ni after digestion according to U.S. EPA Method 3051. Multivariate analysis including correlation coefficient analysis, Principal Component Analysis and Cluster Analysis was used to analyse the data and identify possible sources of these heavy metals. Compared with background values, elevated concentrations of Pb (300 mg kg(-1)), Cd (7.6 mg kg(-1)) and Cr (78 mg kg(-1)) were observed in street dust of MAM. Based on multivariate statistical approaches, the studied elements were classified in three main sources: (1) Cr, Ni and Zn mainly derived from industrial activities; (2) Cd originating from traffic-related activities; and (3) Pb associated with vehicular emissions. A sequential extraction procedure using the Tessier method was applied to evaluate the mobility of Pb and Cd in street dust. The majority of Pb was associated with the residual fraction followed by the carbonate fraction. The majority of Cd was associated with the residual fraction. These results indicated that the mobility was higher in Pb (26%) compared with Cd (11%), posing a potential risk to the environment.

Community-acquired respiratory coinfection in critically ill patients with pandemic 2009 influenza A(H1N1) virus.

BACKGROUND: Little is known about the impact of community-acquired respiratory coinfection in patients with pandemic 2009 influenza A(H1N1) virus infection. METHODS: This was a prospective, observational, multicenter study conducted in 148 Spanish ICUs. RESULTS: Severe respiratory syndrome was present in 645 ICU patients. Coinfection occurred in 113 (17.5%) of patients. Streptococcus pneumoniae (in 62 patients [54.8%]) was identified as the most prevalent bacteria. Patients with coinfection at ICU admission were older (47.5±15.7 vs 43.8±14.2 years, P<.05) and presented a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score (16.1±7.3 vs 13.3±7.1, P<.05) and Sequential Organ Failure Assessment (SOFA) score (7.0±3.8 vs 5.2±3.5, P<.05). No differences in comorbidities were observed. Patients who had coinfection required vasopressors (63.7% vs 39.3%, P<.05) and invasive mechanical ventilation (69% vs 58.5%, P<.05) more frequently. ICU length of stay was 3 days longer in patients who had coinfection than in patients who did not (11 [interquartile range, 5-23] vs 8 [interquartile range 4-17], P=.01). Coinfection was associated with increased ICU mortality (26.2% vs 15.5%; OR, 1.94; 95% CI, 1.21-3.09), but Cox regression analysis adjusted by potential confounders did not confirm a significant association between coinfection and ICU mortality. CONCLUSIONS: During the 2009 pandemics, the role played by bacterial coinfection in bringing patients to the ICU was not clear, S pneumoniae being the most common pathogen. This work provides clear evidence that bacterial coinfection is a contributor to increased consumption of health resources by critical patients infected with the virus and is the virus that causes critical illness in the vast majority of cases.

Foldable structures and the natural design of pollen grains.

Upon release from the anther, pollen grains of angiosperm flowers are exposed to a dry environment and dehydrate. To survive this process, pollen grains possess a variety of physiological and structural adaptations. Perhaps the most striking of these adaptations is the ability of the pollen wall to fold onto itself to prevent further desiccation. Roger P. Wodehouse coined the term harmomegathy for this folding process in recognition of the critical role it plays in the survival of the pollen grain. There is still, however, no quantitative theory that explains how the structure of the pollen wall contributes to harmomegathy. Here we demonstrate that simple geometrical and mechanical principles explain how wall structure guides pollen grains toward distinct folding pathways. We found that the presence of axially elongated apertures of high compliance is critical for achieving a predictable and reversible folding pattern. Moreover, the intricate sculpturing of the wall assists pollen closure by preventing mirror buckling of the surface. These results constitute quantitative structure-function relationships for pollen harmomegathy and provide a framework to elucidate the functional significance of the very diverse pollen morphologies observed in angiosperms.

Limb intracompartmental sepsis in burn patients associated with occult infection.

BACKGROUND: Intracompartmental sepsis (IS) is a rare complication in burn patients. IS presents in patients with inadequate perfusion of intracompartmental tissues with subsequent ischaemic necrosis and infection. Contributing factors include high-volume resuscitation, delayed escharotomies and previous bacteraemias. We describe the profile of a series of patients who developed IS in our Intensive Care Burn Unit (ICBU). METHODS: We carried out a retrospective chart review of patients admitted to an ICBU over a 5-year period. RESULTS: Seven patients of 659 admissions (1.0%) developed IS involving the extremities. Diagnosis was based on the identification of purulent drainage and local swelling associated with signs of sepsis of unknown origin. Total body surface area (TBSA) burned averaged 67.4% and full-thickness body surface area (FTBSA) burned averaged 48.4%. All patients were sedated and mechanically ventilated. The first 24-h fluid requirements averaged 6.0 ml kg(-1) per %TBSA burn (range 3.5-7.0 ml kg(-1)per %TBSA). Escharotomies were performed in five patients within the first 24h of admission. Median time of diagnosis of IS was 23 days from admission (range 11-45 days). Four patients developed bacteraemia caused by the same microorganism infecting the soft tissue. In five cases, the infecting microorganism had previously colonised the overlying burned skin. Three patients required amputation of the affected limb. CONCLUSION: IS is a devastating infectious complication which appears late after large burns. Predisposing factors include high-volume resuscitation, delayed escharotomies, colonisation of the overlying skin and previous bacteraemias. Earlier diagnosis and management are needed to attain a better outcome.

A model for predicting mortality among critically ill burn victims.

OBJECTIVE: To develop a model for predicting mortality among burn victims. METHODS: All casualties admitted to our intensive care burn unit (ICBU) with a diagnosis of thermal or inhalation injury were studied. Age, total and full-thickness body surface area (BSA) burned, presence of inhalation injury, gender, mechanism of injury, delay to ICBU admission and mechanical ventilation during the first 72 h were recorded. The 851 participants were randomly divided into derivation (671) and validation (180) sets. From univariate and multivariate logistic regression analyses a mortality predictive equation was derived. RESULTS: Mortality was 17.6%. In univariate analysis, all variables were significantly associated with mortality except mechanism of injury and delay to ICBU admission. In multivariate analysis, age, total and full-thickness BSA burned, female gender and early mechanical ventilation were independently associated with mortality. CONCLUSIONS: We propose a mortality predictive equation for burned victims. In this model, MV and not inhalation injury is a mortality risk factor.

Organ dysfunction as estimated by the sequential organ failure assessment score is related to outcome in critically ill burn patients.

The objectives of the study were to assess organ dysfunction in burn patients by using the Sequential Organ Failure Assessment (SOFA) score, to determine the relationship between early (day 1) and late (day 4) organ dysfunction, as well as the change in organ dysfunction from admission to day 4, and mortality. The design was a prospective observational cohort study. Patients were admitted to our intensive care burn unit with severe thermal burns (> or =20% total body surface area [BSA] burned) or inhalation injury with a delay from injury to admission less than 12 h and a length of stay less than 3 days (n = 439; age, 46.0 +/- 20.3 yrs; total BSA burned, 31.6% +/- 20.2% [mean +/- SD]; inhalation injury, 44.4%; crude mortality, 18.5%). Sequential Organ Failure Assessment scores were measured on admission (SOFA 0) and on subsequent days (SOFA 1, SOFA 2, SOFA 3, and SOFA 4). The difference between SOFA 0 and SOFA 4 (DeltaSOFA 0-4) was calculated. Multivariate logistic regression analyses, including other variables associated with mortality in the models, were performed to calculate adjusted odds ratios (ORs) of organ dysfunction measurements for mortality. After adjusting for age, BSA burned, diagnosis of inhalation injury, and sex, SOFA 1 (OR, 1.89; 95% confidence interval [CI], 1.55-2.32), SOFA 4 (OR, 1.33; 95% CI, 1.19-1.47), and DeltaSOFA 0-4 (OR, 1.40; 95% CI, 1.28-1.55) were independently associated with mortality. The SOFA score is useful to assess organ dysfunction in burn patients. Burn-induced organ dysfunction (early and late), as well as the change in organ dysfunction, is independently associated with mortality.

Stress and fold localization in thin elastic membranes.

Thin elastic membranes supported on a much softer elastic solid or a fluid deviate from their flat geometries upon compression. We demonstrate that periodic wrinkling is only one possible solution for such strained membranes. Folds, which involve highly localized curvature, appear whenever the membrane is compressed beyond a third of its initial wrinkle wavelength. Eventually the surface transforms into a symmetry-broken state with flat regions of membrane coexisting with locally folded points, reminiscent of a crumpled, unsupported membrane. We provide general scaling laws for the wrinkled and folded states and proved the transition with numerical and experimental supported membranes. Our work provides insight into the interfacial stability of such diverse systems as biological membranes such as lung surfactant and nanoparticle thin films.

Tearing as a test for mechanical characterization of thin adhesive films.

Thin adhesive films have become increasingly important in applications involving packaging, coating or for advertising. Once a film is adhered to a substrate, flaps can be detached by tearing and peeling, but they narrow and collapse in pointy shapes. Similar geometries are observed when peeling ultrathin films grown or deposited on a solid substrate, or skinning the natural protective cover of a ripe fruit. Here, we show that the detached flaps have perfect triangular shapes with a well-defined vertex angle; this is a signature of the conversion of bending energy into surface energy of fracture and adhesion. In particular, this triangular shape of the tear encodes the mechanical parameters related to these three forms of energy and could form the basis of a quantitative assay for the mechanical characterization of thin adhesive films, nanofilms deposited on substrates or fruit skin.

Capillary wrinkling of floating thin polymer films.

A freely floating polymer film, tens of nanometers in thickness, wrinkles under the capillary force exerted by a drop of water placed on its surface. The wrinkling pattern is characterized by the number and length of the wrinkles. The dependence of the number of wrinkles on the elastic properties of the film and on the capillary force exerted by the drop confirms recent theoretical predictions on the selection of a pattern with a well-defined length scale in the wrinkling instability. We combined scaling relations that were developed for the length of the wrinkles with those for the number of wrinkles to construct a metrology for measuring the elasticity and thickness of ultrathin films that relies on no more than a dish of fluid and a low-magnification microscope. We validated this method on polymer films modified by plasticizer. The relaxation of the wrinkles affords a simple method to study the viscoelastic response of ultrathin films.

Enteral vancomycin controls methicillin-resistant Staphylococcus aureus endemicity in an intensive care burn unit: a 9-year prospective study.

OBJECTIVE: The aim of this study was to assess the efficacy and safety of enteral vancomycin in controlling MRSA endemicity in an intensive care burn unit. SUMMARY BACKGROUND DATA: MRSA is a serious clinical and epidemiologic problem. It is not uncommon that the traditional maneuvers, detection and isolation of carriers, fail to control endemicity due to MRSA. METHODS: All patients admitted to an Intensive Care Burn unit from January 1995 to February 2004 have been included in this prospective cohort study comprised 2 different periods. During period 1 (January 1995 to January 2000), barrier and isolation measures were enforced. During period 2 (February 2000 to February 2004), patients received enteral vancomycin 4 times daily in addition to selective digestive decontamination. RESULTS: A total of 777 patients were enrolled into the study: 402 in period 1, and 375 in period 2. There were no significant differences in the characteristics of patients between the 2 periods, except for the total body surface burned area, 30.3% in period 1 and 25.61% in period 2 (P = 0.009). There was a significant reduction in the incidence of patients who acquired MRSA from 115 in period 1 to 25 in period 2 (RR, 0.22; 95% confidence interval [CI], 0.15-0.34). Similar reductions were observed in the number of patients with wound (RR, 0.20; 95% CI, 0.12-0.32), blood (RR, 0.13; 95% CI, 0.04-0.35), and tracheal aspirate (RR, 0.07; 95% CI, 0.03-0.19), samples positive for MRSA. There was no emergence of either vancomycin-resistant enterococci or Staphylococcus aureus with intermediate sensitivity to glycopeptides in period 2. CONCLUSIONS: Enteral vancomycin is an effective and safe method to control MRSA in intensive care burn units without VRE.

Vigilancia de la infección nosocomial en pacientes críticos ingresados en servicios de medicina intensiva / Nosocomial infection surveillance in critically ill patients in the intensive care units

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Percepción de los alumnos sobre su primer año de universidad. Facultad de medicina Universidad de Chile / Students perceptions about their first year at the university. University of Chile. Faculty of Medicine

Se diseñó un estudio que permitiera describir la percepción de los estudiantes de las ocho escuelas de la Facultad de Medicina de la Universidad de Chile, al terminar su primer año académico, relacionada con adaptación a la vida universitaria; ambiente afectivo, calidad de la docencia, ambiente físico y cumplimiento de expectativas. Material y método: Se diseñó un instrumento, que fue validado por expertos, con 66 aseveraciones tipo Likert. Se dio puntaje a cada respuesta. Para el análisis, la escala total se dividió en cuatro categorías. Resultados: Respondieron 496 estudiantes. Sólo 23% logró “adaptación a la vida universitaria” Entre los factores que la afectan: cantidad de contenidos de las asignaturas; carga horaria y falta de orientaciones prácticas de cómo estudiar. El “ambiente afectivo” 80% lo considera “bueno”. 75% percibe “regular calidad de la docencia”; Alta proporción percibe “docentes que sólo se interesan en pasar la materia” y otros “desmotivados por la docencia”. Se encontró preferencia por clases expositivas y participativas; por los trabajos de grupo en aula, no fuera de ella; el aprendizaje a través de los trabajos de laboratorio y las guías de estudio. Las preguntas de las evaluaciones son percibidas como desconectadas de los contenidos de las clases. Se requiere revisar actitudes de docentes que hacen que el alumno sienta que “debe caerle bien”, que con frecuencia “son descalificados”, que son percibidos ” muy lejanos” y “menos humanos” que lo esperado (AU)

A study was designed with the aim of describing the perception of students from the eight schools in the Faculty of Medicine of the University of Chile, at the end of their first academic year, with respect to the following: adjustment to university life, emotional environment, quality of teaching, physical environment and fulfillment of expectations. Material and method: An instrument comprising 66 Likert-type statements was designed and validated by experts. A score was given for each response. For the analysis, the total scale was divided into four categories. Results: 496 students responded. Only 23% felt they had achieved “adjustment to university life”. Among the factors affecting this were the amount of subject material, the time commitment and the lack of practical guidance regarding study techniques. 80% considered the "emotional environment" to be “good” and 75% regarded the “quality of teaching” as average. A high proportion felt teachers were only interested in teaching the content, while others were regarded as lacking motivation to teach. Students prefer lectures and participatory activities, classroom-based group work and learning through laboratory work and study guides. The evaluation questions were perceived as “unrelated to the taught content”. It is necessary to review the attitudes of certain teachers who make students feel they have to behave in a particular way so as to be accepted. They often feel disqualified. Teachers are perceived as being “very distant” and “less human than expected” (AU)

[Staphylococcus aureus nosocomial infections in critically ill patients admitted in intensive care units]. / Infecciones nosocomiales por Staphylococcus aureus en pacientes críticos en unidades de cuidados intensivos.

BACKGROUND AND OBJECTIVE: To investigate the frequency of nosocomial infections caused by Staphylococcus aureus in critically ill patients admitted to Spanish intensive care units (ICUs) and to describe the characteristics and outcome of patients in whom this pathogen was isolated. PATIENTS AND METHOD: Prospective, observational, and multicenter study. All patients admitted during one or 2 months to the participating ICUs in the National Nosocomial Infection Surveillance Study (ENVIN) between 1997 and 2003 were included. Patients were classified as infected by S. aureus, infected by other microorganisms, and without nosocomial infection. RESULTS: A total of 34,914 patients were controlled of whom 3,450 (9.9%) had acquired a nosocomial infection during his/her ICU stay (16.0 infections per 100 patients). In 682 (19.8%) patients, a total of 775 infectious episodes in which one of the microorganisms isolated was S. aureus were documented (cumulative incidence 2.2 episodes of S. aureus infection per 100 patients). There was a predominance of S. aureus infection in patients with pneumonia associated with mechanical ventilation (21.4%) and in patients with catheter-related bacteremia (13%). Independent variables associated with S. aureus infection were male sex (odds ratio [OR] = 1.25; 95% confidence interval [CI], 1.03-1.52) and underlying trauma pathology (OR = 1.72, 95%; 95%CI, 1.26-2.35), whereas an older age has been a protective factor (OR = 0.90; 95%CI, 0.84-0.96). Mortality in patients with S. aureus infection was significantly higher than in infections caused by other microorganisms, and in both cases higher than in patients without infection (34.5%, 30.3%, and 10.7%, respectively). In 208 (30.5%) patients, infections due to methicillin-resistant S. aureus were diagnosed, which in turn had increased significantly over the years (p = 0.001). Mortality in patients with methicillin-resistant S. aureus infection was 35.1% compared with 34.2% in patients with methicillin sensitive S. aureus infections (p = NS). CONCLUSIONS: S. aureus was isolated in 19.8% of patients with ICU-acquired infection, particularly in relation to pneumonia in mechanically ventilated patients. Mortality in patients with S. aureus infection was higher than that in patients with infections due to other microorganisms and patients without infection. In contrast, differences in the outcome of patients with infections caused by methicillin-sensitive or methicillin-resistant S. aureus were not found.