Central talar fractures--therapeutic considerations

Talar fractures are rare and often have to be treated in the emergency department by young surgeons. Thus, important literature series, often multicentric, are generally of little interest regarding practical technical considerations. The aim of this paper is to lead the surgeon who has to treat such fractures to reflect on the goals of the treatment and the means to success. There is probably no better example than talar fractures for the application of the four AO basic principles: Anatomical reduction, stable internal fixation, preservation of the blood supply, and early active pain-free motion. After presenting the different approaches to the talus, the blood supply is described precisely, in reference to the surgical exposures. Then the many tools (tricks) to achieve the treatment goals, avoiding dangers and pitfalls, are meticulously described. Some of the goals, pitfalls, and tools are obvious, whereas some are not, but they could be just as important, if not more so.     

Difference between electrical remodelling after pulmonary veins and right atrium appendage pacing.

OBJECTIVE: Pulmonary veins (PVs) are important sources of paroxysmal atrial fibrillation (AF). Rapid atrial pacing changes atrial electrophysiology, and facilitates the induction and maintenance of AF. The purpose of our study was to evaluate the changes in atrial effective refractory period (AERP) proprieties and in ionic currents in PVs myocytes from dogs subjected to rapid atrial pacing in PVs and right atrial appendage (RAA) and to relate these changes to the ability to induce AF. METHODS: Twelve mongrel dogs in normal sinus rhythm were paced from the superior left PVs or RAA at 500 bpm for 4 h. Electrophysiological studies were conducted to determine the changes in AERP, dispersion, and rhythm. Ionic currents were evaluated using patch clamp technique in single PVs myocytes in sham-operated dogs, and the results were compared with those from PVs and RAA pacing groups. RESULTS: The presence of rapid atrial pacing was associated with a marked shortening in AERP in both PVs and RAA pacing group with a marked increase in AERP dispersion in PVs pacing. Both L-type calcium current (I(Ca,L)) and the transient outward current (I(to)) were reduced in both groups with an increased significance in PVs pacing group. The density of I(Ca,L) was decreased significantly from (-6.03 +/- 0.63) pA/pF in the control group to (-3.21 +/- 0.34) pA/pF in the PVs pacing group and (-4.75 +/- 0.41) pA/pF in the RAA pacing group (n = 6, P < 0.05), whereas the density of I(to) was decreased significantly from (8.45 +/- 0.71) pA/pF in the control group to (5.21 +/- 0.763) pA/pF in the PVs pacing group and (6.84 +/- 0.69) pA/pF in the RAA pacing group (n = 6, P < 0.05). CONCLUSION: Our findings provide likely ionic mechanisms of shortened repolarization in induced atrial tachycardia with a decrease in I(Ca,L) and I(to) densities, which is the likely mechanism for a decrease in action potential duration rate adaptation in the canine rapid pacing model more pronounced in the PVs pacing group underlying the crucial role of PVs in initiating AF.     

Wenxin Keli suppresses atrial substrate remodelling after epicardial ganglionic plexi ablation

BACKGROUND:

The chronic effects of ganglionic plexi (GP) ablation on atrial fibrillation (AF) inducibility have not been elucidated.

OBJECTIVE:

To investigate the effect of Wenxin Keli (WK) on the inducibility of AF and atrial substrate remodelling after epicardial GP ablation.

METHODS:

Twenty dogs were randomly divided into a sham-operated group, a GP ablation group and a WK-treated group. All animals underwent a left thoracotomy at the fourth intercostal space. AF inducibility was assessed by burst rapid pacing at the right atrium. Both the GP ablation group and the WK-treated group received four major GP ablations. In the WK-treated group, dogs were treated with oral WK once per day, and all animals were allowed to recover for eight weeks, after which AF inducibility and AF duration were measured again.

RESULTS:

After eight weeks of WK treatment, AF inducibility was lower than in the GP ablation group, and was similar to that of the sham-operated group. Compared with the sham-operated group, the levels of atrial natriuretic peptide (ANP), tumour necrosis factor-alpha (TNF-α) and interleukin (IL)-6 in right atrial tissues were increased in GP ablation group (143.6±33.7 pg/mg versus 206.2±41.4 pg/mg, P=0.02; 75.3±12.1 pg/mg versus 141.3±64 pg/mg, P=0.03; and 175.1±42.5 pg/mg versus 351.7±101 pg/mg, P<0.01, respectively). There were no significant differences in levels of ANP, TNF-α and IL-6 in atrial tissues between the sham-operated group and WK treated group. Expression of connexin 43 in atrial tissues was increased after eight weeks of GP ablation, while WK administration inhibited connexin 43 remodelling.

CONCLUSIONS:

Epicardial GP ablation can induce atrial substrate remodelling, including Cx43 upregulation and increased levels of ANP, TNF-α and IL-6. These changes may be suppressed by long-term oral WK administration.     

Preparation of Teucrium polium extract-loaded chitosan-sodium lauryl sulfate beads and chitosan-alginate films for wound dressing application

This study aimed to formulate sodium lauryl sulfate cross-linked chitosan beads and sodium alginate-chitosan films for designing a dressing that would shorten the healing time of skin wounds. Teucrium polium extract-loaded chitosan-sodium lauryl sulfate beads (CH-SLS) and chitosan-alginate (CH-ALG) films were prepared and characterized by using Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD) analysis, and scanning electron microscopy (SEM). The swelling properties of the CH-SLS beads were also analyzed in a water solution. The obtained Teucrium polium extract-loaded CH-SLS beads and CH-ALG films (TBF) were further incorporated into the commercial adhesive dressing. This TBF wound dressing was then investigated for evaluation of its wound healing potential in the mice using the excision wound model. Healing was assessed by the macroscopic appearance and the rate of wound contraction during 8 days. On day 4, the TBF-treated wounds exhibited 98% reduction in the wound area when they were compared with healing ointment, elastic adhesive dressing, and untreated wounds which were exhibited 63%, 43%, and 32%, respectively. Furthermore, the application of TBF dressing reduced skin wound rank scores and increased the percentage of wounds contraction. These results demonstrate that TBF dressing improves considerably the healing rate and the macroscopic wound appearance at a short delay and this application may have therapeutic benefits in wound healing.     

(ii) Open reduction and internal fixation of calcaneal “thalamic” fractures

Using concepts derived from the French literature, particularly the concept of the ‘thalamus’, the authors review the anatomy of the calcaneus and its biomechanics, particularly with regard to fracture patterns. They review the imaging of the fractures and describe a computer-based fracture classification based on modern imaging and describe their preferred techniques for internal fixation of the fractures based on biomechanical principles.     

A conserved molecular basis for photoperiod adaptation in two temperate legumes

Legumes were among the first plant species to be domesticated, and accompanied cereals in expansion of agriculture from the Fertile Crescent into diverse environments across the Mediterranean basin, Europe, Central Asia, and the Indian subcontinent. Although several recent studies have outlined the molecular basis for domestication and eco-geographic adaptation in the two main cereals from this region, wheat and barley, similar questions remain largely unexplored in their legume counterparts. Here we identify two major loci controlling differences in photoperiod response between wild and domesticated pea, and show that one of these, HIGH RESPONSE TO PHOTOPERIOD (HR), is an ortholog of EARLY FLOWERING 3 (ELF3), a gene involved in circadian clock function. We found that a significant proportion of flowering time variation in global pea germplasm is controlled by HR, with a single, widespread functional variant conferring altered circadian rhythms and the reduced photoperiod response associated with the spring habit. We also present evidence that ELF3 has a similar role in lentil, another major legume crop, with a distinct functional variant contributing to reduced photoperiod response in cultivars widely deployed in short-season environments. Our results identify the factor likely to have permitted the successful prehistoric expansion of legume cultivation to Northern Europe, and define a conserved genetic basis for major adaptive changes in flowering phenology and growth habit in an important crop group.     

Argan oil improves surrogate markers of CVD in humans

Limited - though increasing - evidence suggests that argan oil might be endowed with potential healthful properties, mostly in the areas of CVD and prostate cancer. We sought to comprehensively determine the effects of argan oil supplementation on the plasma lipid profile and antioxidant status of a group of healthy Algerian subjects, compared with matched controls. A total of twenty healthy subjects consumed 15 g/d of argan oil - with toasted bread - for breakfast, during 4 weeks (intervention group), whereas twenty matched controls followed their habitual diet, but did not consume argan oil. The study lasted 30 d. At the end of the study, argan oil-supplemented subjects exhibited higher plasma vitamin E concentrations, lower total and LDL-cholesterol, lower TAG and improved plasma and cellular antioxidant profile, when compared with controls. In conclusion, we showed that Algerian argan oil is able to positively modulate some surrogate markers of CVD, through mechanisms which warrant further investigation.