Medical and surgical management of lower extremity war-related injuries. Experience of the French Military Health Service (FMHS).

Lower extremity war wounds are characterized by high-energy trauma occasioning loss of complex and pluritissular substances. The support pipeline put into place by the French defense health service (SSA) is designed to rapidly evacuate the injured person from the scene of injury to mainland France, following initial surgery in the framework of a sequential tactic known as "Damage Control Surgery". This strategy is aimed at stabilizing the traumatized individual and enabling his evacuation. Patients are subsequently treated in a restorative surgery unit in a Hôpital d'Instruction des Armées (HIA), a level 1 trauma center (HIA Percy, HIA Saint-Anne) Cooperation between the plastic and orthopedic surgery specialties is essential insofar as it allows for surgical optimization aimed at saving the limb while restoring function to the greatest possible extent. Notwithstanding painstaking application of this common strategy, septic pseudoarthrosis remains the principal and most feared complication, at times rendering impossible any therapeutic solution other than amputation. Whether prosthetic or non-prosthetic, the rehabilitation provided by doctor/physiotherapists is conducive to patients' social and professional reintegration. The nation's duty to assist its wounded veterans is carried out with determination by the French defense ministry. As concerns lower extremity war wounds, the authors detail the reconstruction doctrine based on the 6/7/8/9 rule, in accordance with which strategies for repair of soft tissue and reconstruction of the lost bone substance have been developed.

Main-chain liquid-crystal elastomers versus side-chain liquid-crystal elastomers: similarities and differences in their mechanical properties.

After a general introduction on the main aspects of the mechanical properties of main-chain liquid-crystal elastomers (MCLCEs) and side-chain liquid-crystal elastomers (SCLCEs), new results will be presented dealing with several MCLCEs with a cross-linker density C = 8%, 6% and 4% and with a SCLCE with C = 10%, all prepared by the two-step cross-linking process. A non-SCLCE with bulky side-groups similar in shape to the mesogens was also synthesized for comparison with the SCLCE. Most of the experiments were performed with a piezorheometer allowing the determination of the shear anisotropy of the samples by applying shear in a direction parallel or perpendicular to the director, and with a thermo-elastic device for the E measurements. The main results concern: (a) the influence of the supercritical nature of SCLCE and the subcritical nature of MCLCEs on the mechanical properties of these elastomers, as well as that of SmC domains present in MCLCEs; (b) the relationship between the degrees of elongation and of anisotropy deduced from the variations of and during the poly-domain to mono-domain transition of the 10% SCLCE and the 8% MCLCE; (c) the determination of the Poisson's ratio showing that it is isotropic for the non-SCLCE, with a crossover between 0.5 (classical value for rubbers) for small strains and 0.38 for high strains, and anisotropic for the 10% SCLCE and 8% MCLCE, with values <0.5. The particular behaviors of the Poisson's ratios can be explained by confinement effects occurring when stretching increases.

Mechanical properties of monodomain nematic side-chain liquid-crystalline elastomers with homeotropic and in-plane orientation of the director.

We present the first study of the shear mechanical properties of monodomain nematic side-chain liquid-crystal elastomers (SCLCEs) prepared by cross-linking with UV irradiation a nematic side-chain liquid-crystal polymer oriented with an electric or a magnetic field. Their elastic behavior was studied in the dry, swollen and stretched states, in order to check the various theoretical descriptions of these systems. The shear measurements taken on the dry samples show that the shear anisotropy is much smaller than that of the usual twice cross-linked samples oriented by a mechanical stretching of the network formed after the first cross-linking step, demonstrating that the elasticity of the networks strongly depends on the preparation procedure used. The shear experiments performed on the swollen state of these two different types of elastomers reveal that the elasticity of the network is Gaussian for the elastomers oriented with the electric or the magnetic field, and non-Gaussian for the elastomers oriented with the usual stretching procedure. The analysis of the stress-strain curves of both types of elastomers with the neoclassical model based on Gaussian rubber elasticity confirms the Gaussian and non-Gaussian nature of their elasticity. The shear experiments performed as a function of the elongation of the homeotropically oriented elastomer when the shear is applied in a direction parallel to the elongation, do not show the decrease of the associated shear modulus, which is theoretically expected when the strain approaches the threshold value marking the beginning of the elastic plateau. However, the observation of this effect could be prevented by possible small misalignments of the director, as suggested by a calculation presented in one of the theories describing this effect.

[Amputation in low-income countries: particularities in epidmiological features and management practices]. / Les amputations dans les pays à faibles revenus: particularités de l'épidémiologie, de l'appareillage et de la rééducation.

The epidemiological features and management practices associated with amputation in low-income countries, generally synonymous with the tropics, are different from those observed in Western countries. Unlike developed countries, amputation most frequently involves traumatic injury in young active people. However, Westernization of the lifestyle is leading to an increasing number of cases involving diabetes and atherosclerotic disease. In the developing world, leprosy and Buruli ulcer are still significant etiologic factors for amputation. In war-torn countries, use of antipersonnel landmines is another major cause of amputation with characteristic features. Management of amputees in the developing world is hindered by the lack of facilities for rehabilitation and prosthetic fitting. Many international organizations are supporting national programs to develop such facilities. In addition to being affordable, prosthetics and orthotics must be adapted to the living conditions of a mostly rural amputee population, i.e., heat, humidity, and farm work. The rehabilitation process must be part of a global handicap policy aimed at changing attitudes about disability and reintegrating amputees both socially and professionally.

A rare case of paraplegia complicating a lumbar epidural infiltration.

OBJECTIVE: We report the case of a patient who developed paraplegia following a low lumbar epidural steroid injection. Alternative approaches to (or alternative means of) performing transforaminal injections should be considered, in order to avoid devastating neurological complications. CASE REPORT: A 54-year-old man (who had undergone surgery 14 years earlier to cure an L5-S1 slipped disc with right S1 radiculopathy) presented with low back pain (which had begun 6 weeks previously) and left S1 radiculopathy. During a second infiltration of prednisolone acetate, the patient reported feeling a heat sensation in his legs and concomitantly developed facial flushing. Immediately after the injection, the patient developed complete, flaccid T7 ASIA A motor and sensory paraplegia. Three days later, T2 magnetic resonance imaging (MRI) of the spine revealed a spontaneous hypersignal in the conus medullaris and from T6 to T9, suggesting medullary ischemia. Recovery has been slow; after 4 months of treatment in a physical and rehabilitation medicine department, urinary and sensory disorders are still present (T7 ASIA D paraplegia). The patient can walk 200 m unaided. Three months later, the MRI data had not changed. DISCUSSION: This is a rare case report of paraplegia following low lumbar epidural infiltration via an interlaminar route. The mechanism is not clear. Most of authors suggest that the pathophysiological basis of this type of complication is ischemia caused by accidental interruption of the medullary blood supply. Direct damage to a medullary artery, arterial spasm or corticosteroid-induced occlusion due to undetected intra-arterial injection could result in medullary infarction. This serious incident should prompt us to consider how to avoid further problems in the future. It also raises the issue of providing patients with information on the risks inherent in this type of procedure. CONCLUSION: Despite the rarity of this complication, patients should be made aware of its potential occurrence. In the case reported here, the functional prognosis is uncertain.

Gel-like elasticity in glass-forming side-chain liquid-crystal polymers.

We study the complex shear modulus G of two side-chain liquid-crystal polymers (SCLCPs), a methoxy-phenylbenzoate substituted polyacrylate (thereafter called PAOCH3 ), and a cyanobiphenyl substituted polyacrylate supplied by Merck (thereafter called LCP105) using a piezoelectric rheometer. Two methods of filling the cell are used: (a) a capillary method, which can be used only at high temperature because of the low value of the viscosity, and (b) the classical one, thereafter called compression method, which consists in placing the sample between the two slides of the cell and to bring them closer. By filling the cell at high temperature either with the compression or the capillary method, we show that the response of both compounds is liquidlike ( G' approximately f2 and G'' approximately f , where f is the frequency) for temperatures higher than a certain temperature T0 and gel-like (G' approximately const, G'' approximately f) below T0. This change in behavior from the conventional flow response to a gel-like response, when approaching the glass transition, is observed for nonsliding conditions and for very weak-imposed shear strains. It can be explained by a percolation-type mechanism of preglassy elastic clusters, which correspond to long-range and long-lived density fluctuations that are frozen at the time scale of the experiment. The sample response is therefore the sum of two contributions: one is due to the flow response of the polymer melt and the other to the elastic response of the network formed by the preglassy elastic clusters. By filling the cell below T0 with the compression method, both compounds exhibit a gel-type behavior by gently bringing closer the slides of the cell and an anomalous low-frequency behavior characterized by G'=const and G''=const by increasing the pressure used to bring closer the slides of the cell. A compression-assisted aggregation of the preglassy elastic clusters can explain both the increase in the low-frequency elastic plateau when the sample thickness is decreased and the anomalous low-frequency behavior. Further evidence for the existence of these elastic clusters is provided by the following results: (a) the nonlinear response of the samples as a function of the strain amplitude, which can be explained by the Payne effect, and (b) the aggregation effects, which can be mimicked by a polydimethylsiloxane melt filled with silica particles, the silica particles playing the role of the preglassy elastic clusters. All these observations show that PAOCH3 is not a macroscopically solidlike material with an unconventional type of elasticity, as claimed by Mendil [Phys. Rev. Lett. 96, 077801 (2006)]. The gel-type behavior observed here on two SCLCPs ( PAOCH3 and LCP105) and previously on some conventional flexible polymers (atactic polystyrene, poly-n-butylacrylate) seems to be a generic effect of the glass transition. The presence of the preglassy elastic clusters questions the widely accepted hypothesis of ergodicity in the supercooled state.

Shear mechanical anisotropy of side chain liquid-crystal elastomers: influence of sample preparation.

We study the mechanical anisotropy of a series of uniaxial side chain nematic elastomers prepared with the same chemical composition but with different preparation protocols. For all the compounds, the experiments performed as a function of temperature show no discontinuity in both G' (//) and G' ( perpendicular) (the labels // and perpendicular stand for the director parallel, respectively perpendicular to the shear displacement) around the nematic-isotropic (N-I) phase transition temperature determined by DSC. They also all show a small decrease in G' (//) starting at temperatures well above this temperature (from approximately 4( degrees ) C to approximately 20( degrees ) C depending on the compound studied) and leading to a small hydrodynamic value of the G' ( perpendicular)/G' (//) ratio. The measurements taken as a function of frequency show that the second plateau in G' (//) and the associated dip in G (//)" expected from dynamic semi-soft elasticity are not observed. These results can be described by the de Gennes model, which predicts small elastic anisotropy in the hydrodynamic and linear regimes. They correspond to the behavior expected for compounds beyond the mechanical critical point, which is consistent with the NMR and specific heat measurements taken on similar compounds. We also show that a reduction in the cross-linking density does not change the non-soft character of the mechanical response. From the measurements taken as a function of frequency at several temperatures we deduce that the time-temperature superposition method does not apply. From these measurements, we also determine the temperature dependence of the longest relaxation time tau(E) of the network for the situations where the director is either parallel or perpendicular to the shear velocity. Finally, we discuss the influence on the measurements of the mechanical constraint associated with the fact that the samples cannot change their shape around the pseudo phase transition, because of their strong adherence on the sample-bearing glass slides.

Behavior of the layer compression elastic modulus near, above, and below a smectic C-hexatic I critical point in binary mixtures.

We present the first study of the layer compression modulus B carried out near, above and below the Smectic C-Hexatic I critical point in racemic mixtures of methylbutyl phenyl octylbiphenyl-carboxylate (8SI) and the octyloxy biphenyl analog (8OSI), at frequencies ranging from 0.2 Hz to 2 x 10(3) Hz. The behavior of B as a function of temperature shows a progressive evolution from a first order transition in 8SI to a continuous supercritical behavior in 8OSI. The latter is characterized by an increase in B, which appears above the transition, and which is followed by a leveling off when the temperature is decreased towards the transition. It is proposed that this behavior stems from the relaxation of the hexatic domains which are frozen in the frequency range studied. For the supercritical and near-critical compounds, B exhibits a small dip near the transition temperature, which is visible in the low frequency range only, indicating that the dynamics associated with the critical point is very slow. We also report measurements in the Crystal-J phase of the pure compounds, and show that 8SI behaves mechanically as a hexatic phase and 8OSI as a soft crystal phase.

Behavior of the layer compression modulus as a function of frequency near the nematic-smectic-A and re-entrant nematic-smectic-A phase transitions.

A progressive cross-over of the layer compression modulus B from a simple power law behavior to a saturation behavior when the frequency is increased from 1 Hz to 2 x 10(3) Hz is observed for the first time near the nematic-smectic-A and the re-entrant nematic-smectic-A phase transitions of a mixture of 4-cyano-4'-( n-hexyloxy)biphenyl and 4-cyano-4'-( n-octyloxy)biphenyl (6OCB-8OCB). This result shows that the saturation of B determined by second sound near the nematic-smectic-A phase transition of a similar mixture is dynamic in nature, and cannot be associated with the static saturation effect predicted by the dislocation loop model, as proposed previously.

Ultrasonic Cole-Cole diagram for solutions and application to alpha-chymotrypsin.

Deconvolution of ultrasonic data into single relaxations is rarely feasible when only the absorption or the velocity of the waves is measured. Here we use both series of data to construct a Cole-Cole diagram for a solution. When applied to alpha-chymotrypsin, this method shows two relaxations that are well separated on the time scale, a result that will help simplify analyses of the ultrasonic data for this enzyme.

Ultrasonic studies of proton-transfer reactions at the catalytic site of alpha-chymotrypsin.

Ultrasonic relaxation measurements for alpha-chymotrypsin in phosphate, sulfite and arsenate buffers exhibit a high peak of absorption at neutral pH. The analysis is based on: comparison of the relaxation measurements for the enzyme and for the zymogen and inhibited enzyme; X-ray and neutron diffraction data, and high-resolution NMR data. The ultrasonic relaxation is shown to result mainly from a proton-transfer reaction that involves the histidine at the catalytic site (His-57). The question is raised of whether the enhanced ultrasonic effect observed in the enzyme is indicative of a property that plays a part in the catalytic activity.