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The effects of increasing proportions of soybean soapstock (SSS) in laying hen diets on egg quality parameters and on the fatty acid (FA) composition of the yolk were studied. One hundred sixty Babcock B-300 × laying hens, 20 wk of age, were allotted to 5 dietary treatments comprising a control diet (D5) with soybean oil at 100% or SSS in proportions of 25% (Dl), 50% (D2), 75% (D3), and 100% (D4) replacing the oil source in commercial-type diets throughout the 15-wk laying period. Egg quality parameters were recorded weekly. Four pooled yolks for each treatment were collected at 0, 9, and 15 wk, and their FA profiles were determined. Egg weight, shell thickness, shape index, and Haugh unit were not influenced by dietary treatment. The concentrations of saturated FA (SFA) in yolks were generally kept at a constant level, regardless of the percentage of SSS in the hen diets. Total monounsaturated FA (MUFA) content did not vary over the course of the experiment, except for C14:1. After 15 wk of feeding, the total polyunsaturated FA (PUFA) n-3 increased in yolks of all diets. Among the long-chain PUFA, the percentage of C20:4 (arachidonic acid) was less affected. Inclusion of 100% SSS allowed production of eggs with similar PUFA/SFA and n-6/n-3 ratios when compared with eggs from hens fed D5. As SSS represents one-third of the oil cost, its inclusion in layer diets could represent an important economic benefit. [ABSTRACT FROM AUTHOR]

Five whole bronchoalveolar lavages were performed in 2 patients with pulmonary alveolar proteinosis with continuous monitoring of mixed venous and arterial oxygen saturation. Hemodynamic parameters and gas-exchange status were measured during the different phases of the lavage. In the phase of filled lung, a significant increase of arterial partial pressure (PaO2) and arterial saturation of oxygen were observed, secondary to a decrease in the intrapulmonary shunt. The mean pulmonary arterial pressure, pulmonary vascular resistances and cardiac index were higher during the filling of the lung as compared to the controls. During the empty lung phase, although PaO2 decreased (without reaching statistical significance), due to an increase in the intrapulmonary shunt, the increase in cardiac output during this phase left the oxygen delivery (DO2) unchanged. [ABSTRACT FROM AUTHOR]

Fe–Au skarn deposits related to intrusive centers, mostly of granodioritic composition, are widespread in southern Mexico's Guerrero state. These intrusive rocks are largely associated with the NW–SE-oriented Laramide magmatic belt that extends across most of western Mexico. The geochemical composition and ages of representative rocks from the Mezcala mining district in central Guerrero are studied to evaluate the petrogenetic aspects of the ore-related magmas. Some major and trace elements display nearly linear silica variation trends, which suggest a possible comagmatic origin. However, other elements have scattered distributions, possibly due to irregular mantle-to-crust magma mixing ratios, heterogeneities in the composition of the assimilated crustal material, or modifications during the emplacement or postemplacement processes. Major element chemistry indicates calc-alkalic metaluminous compositions, whereas trace element data suggest a volcanic arc tectonic setting, confirming that these rocks evolved from magmas generated above a subduction zone. Compared with the Laramide granites from the northern part of the belt in northwestern Mexico, which intruded a crust underlain by Proterozoic North American rocks, the studied samples are similar but relatively low in Nb and high in Sr, the middle rare earth elements (REE), P, and Zr. They also display minor Ti enrichments and a moderate depletion in the heavy REE. These characteristics may indicate a source of basaltic composition. New 40Ar/39Ar dating of granodiorites and dacite porphyries shows a north-to-south age progression from 66.2±0.8 Ma in the northern part of the belt to 62.2±0.7 Ma in the south. Moreover, the argon dates identify a younger postorogenic igneous event 35–30 Ma ago. This event is poorly documented and may have occurred after the extinction of the Laramide arc and prior to the mid-Tertiary Sierra Madre Occidental ignimbrite flare-up. On the basis of limited geochemical data, these rocks appear to be depleted in P2O5 and Sr and enriched in U relative to the studied Laramide granites. A Fe skarn deposit located in Buena Vista de Cue´llar, in the north central part of Guerrero, suggests that this magmatic pulse took place after the ore development of the Mezcala district. [Copyright &y& Elsevier]

Dispersion of potentially toxic elements associated with efflorescent crusts and mine tailings materials from historical mine sites threaten the environment and human health. Limited research has been done on traceability from historical mining sites in arid and semi-arid regions. Pb isotope systematics was applied to decipher the importance of identifying the mixing of lead sources involved in forming efflorescent salts and the repercussions on traceability. This research assessed mine waste (sulfide-rich and oxide-rich tailings material and efflorescent salts) and street dust from surrounding settlements at a historical mining site in northwestern Mexico, focusing on Pb isotope composition. The isotope data of tailings materials defined a trending line (R 2  = 0.9); the sulfide-rich tailings materials and respective efflorescent salts yielded less radiogenic Pb composition, whereas the oxide-rich tailings and respective efflorescent salts yielded relatively more radiogenic compositions, similar to the geogenic component. The isotope composition of street dust suggests the dispersion of tailings materials into the surroundings. This investigation found that the variability of Pb isotope composition in tailings materials because of the geochemical heterogeneity, ranging from less radiogenic to more radiogenic, can add complexity during environmental assessments because the composition of oxidized materials and efflorescent salts can mask the geogenic component, potentially underestimating the influence on the environmental media., (© 2024. The Author(s).)

Ring avulsions continue to be a challenge in reconstructive surgery. We conducted a retrospective study and reviewed all Urbaniak-Kay type IV degloving injuries replanted at our institution between 2011 and 2018. A systematic review of the literature was also conducted to assess the survival rates, functional, and sensibility outcomes. The results of our systematic review outline a survival rate of 79.50% (101/127). With 1 artery being repaired, 79% of the fingers survived, a value that increased to 87.50% when 2 arteries were anastomosed (P = 0.484). Statistically significant differences (P < 0.001) were found when comparing the survival rates of the fingers with 2 or more veins repaired (87%) with those with only 1 vein anastomosed (51.90%). In terms of nerve reconstruction, there was a significant difference (P < 0.001) with the 2-point discrimination test in favor of the reconstructed group when nerve reparation was done (10.80 mm ± 2.95 mm) versus when digital nerves were not repaired (15.25 mm ± 0.50 mm). Fingers after secondary procedures did not obtain better mobility. The mean total active motion in nonreoperated fingers was 221 degrees (195-270 degrees), whereas the total active motion in the cases who received secondary surgeries was 152 degrees (110-195 degrees), with statistically significant differences (P = 0.02). Therefore, we recommend attempting replantation of degloved fingers. All efforts must be done to carry out 2 vein anastomoses, and our results strongly recommend attempting at least some kind of nerve reconstruction. Secondary surgeries should be reserved for selected cases only, because of the extensive scarring in this kind of injuries. Early mobilization protocols must be encouraged to achieve a good functional result.

Several methods can be used for identifying tissues for transfer in donor-site-depleted patients. A fillet flap can be temporarily stored in other parts of the body and transferred back to the site of tissue defect, including covering the amputated stump of the lower extremity. Human arm transplant is rare and has some unique concerns for the surgery and postsurgical treatment. Cosmetics of the narrow neck of transferred second toes can be improved with insertion of a flap. Lymphedema of the breast after cancer treatment can be diagnosed with several currently available imaging techniques and treated surgically with lymphaticovenous anastomosis., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Early excision of burn wounds is the standard approach for burns, but it is usually associated with the need of allogeneic blood transfusion. Our aim was to determine if intravenous administration of tranexamic acid (TXA) was able to reduce packed red blood cell (pRBC) transfusion requirements in burn patients., Methods: We conducted a retrospective cohort study of 2 consecutive series of severely burned patients (≥20% total body surface are) admitted for primary burn surgery. We searched for differences in pRBC transfusion occurrence and requirements during surgery and up to 24 hours after surgery., Results: A total of 107 patients were included in the study, and 48.6% (52 patients) received TXA during primary excision. The use of TXA exhibited an absolute risk reduction in the need for transfusion during surgery of 24.2% (95% CI: 7.1-41.4%). In total, patients receiving TXA required 1.6 units of pRBC in the perioperative period vs. 2.6 units in those not receiving TXA (P=0.017)., Conclusions: The intraoperative use of TXA in burn patients undergoing primary burn excision reduced the incidence of allogeneic transfusion and the total number of pRBC transfused.

Several methods can be used for identifying tissues for transfer in donor-site-depleted patients. A fillet flap can be temporarily stored in other parts of the body and transferred back to the site of tissue defect, including covering the amputated stump of the lower extremity. Human arm transplant is rare and has some unique concerns for the surgery and postsurgical treatment. Cosmetics of the narrow neck of transferred second toes can be improved with insertion of a flap. Lymphedema of the breast after cancer treatment can be diagnosed with several currently available imaging techniques and treated surgically with lymphaticovenous anastomosis., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Previous studies on solid organ transplantation have shown that cold ischemia contributes to the development of chronic allograft vasculopathy. The authors evaluated the effect of cold ischemia on the development of chronic rejection in vascularized composite allotransplantation., Methods: Thirty rat hindlimbs were transplanted and divided into two experimental groups: immediate transplantation and transplantation after 7 hours of cold ischemia. The animals received daily low-dose immunosuppression with cyclosporine A for 2 months. Intimal proliferation, arterial permeability rate, leukocyte infiltration, and tissue fibrosis were assessed. The CD3, CD4, CD8, CD20, and CD68 cells per microscopic field (200×) were counted, and C4d deposition was investigated. Cytokine RNA analysis was performed to measure tumor necrosis factor-α, interleukin-6, and interleukin-10 levels., Results: Significant differences were found in the intimal proliferation and arterial permeability rate between the two groups (p = 0.004). The arterial permeability rate worsened in the most distal and small vessels (p = 0.047). The numbers of CD3, CD8, CD20, and CD68 were also statistically higher in the cold ischemia group (p < 0.05, all levels). A trend toward significance was observed with C4d deposition (p = 0.059). No differences were found in the RNA of cytokines., Conclusions: An association between cold ischemia and chronic rejection was observed in experimental vascularized composite allotransplantation. Chronic rejection intensity and distal progression were significantly related with cold ischemia. The leukocyte infiltrates in vascularized composite allotransplantation components were a rejection marker; however, their exact implication in monitoring and their relation with cold ischemia are yet to be clarified.

The case of a patient with sequels of a right Syme amputation and a left replanted upper tibial amputation was treated with elective cross-transfer of the left foot and ankle to the right distal tibial stump, and the left below-knee (BK) stump was resurfaced with a latissimus dorsi free flap. The patient regained independent walking capacity with a left BK prosthesis at 8 months postoperatively., (Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Segmental bone defects of the tibia after high-energy trauma are limb-threatening conditions. Multiple treatment options have been proposed, including nonvascularized bone grafts, vascularized bone transfers, and callus distraction. A series of 41 patients with major segmental defects of the tibia treated with vascularized bone reconstruction is presented., Methods: Forty-one acute or nonacute segmental bone defects of the tibia, 4 cm or more in length, were included in the series. In acute defects (nine cases), a single-stage or two-stage reconstruction with vascularized bone transfer was performed. In nonacute segmental infected bone defects (32 cases), single-stage reconstruction with vascularized bone transfer (seven cases) or two-stage reconstruction with vascularized bone transfer (25 cases) was performed. Reconstruction was performed with fibular flaps in 38 cases (36 contralateral free and two ipsilateral pedicled flaps) and iliac flaps in three cases. Bone fixation was performed with screws and external fixation, with early conversion to locking plate internal fixation., Results: Two fibular flaps needed urgent revision for venous congestion. One fibular flap was lost. Infection after vascularized bone transfer occurred in two delayed reconstructions. Bone healing occurred in all cases. Stress fractures occurred in three fibular flaps. Time to bone union was 5 to 9 months, and time to full weight bearing was 9 to 14 months., Conclusions: The use of vascularized bone transfer in the treatment of major segmental tibial defects was successful in the present series. The management of bone fixation and infection in these cases is discussed.

The sequence of repair of structures in macroreplantation surgery is important, since it has a direct influence on ischaemia time, blood loss and technical accuracy. Different sequences have been recommended in the literature. A uniform order of repair was used in a series of macroreplants, performing the arterial repair at the end of the procedure. A total of 341 parts were replanted in 249 patients. Of these, 28 cases (27 patients) were amputations proximal to the wrist. The sequence of repair was temporary catheter arterial shunt for 10-15 minutes, debridement, bone, musculotendons, veins and dorsal skin, nerves, arteries and volar skin. Fasciotomies were performed only if primary ischaemia time had been over 6 hours. A 100% survival rate was achieved. Primary ischaemia time was less than 6 hours in all cases but two. Fasciotomy was performed only in these two patients. Infection rate was 10% (three cases). Soft-tissue necrosis requiring free flap coverage occurred in four cases (14%). In these complicated cases (24%), salvage rate was 100%. Mean operative time was 240 minutes. Functional results according to Chen's criteria were grade I in six cases, grade II in nine, grade III in 13, and no patients with grade IV. Temporary catheter arterial perfusion reduces ischaemia time and permits an artery-last sequence. This may reduce blood loss, permits an accurate repair of non-vascular structures, and shortens operative time.

Background: Replantation surgery in lower extremity amputations continues to be controversial. Overall results have been considered poor and the procedure is usually discouraged. It is the opinion of the authors that infrapopliteal replantation may be indicated., Methods: A series of 12 patients with 13 amputations through the tibia or below were treated with replantation of the parts. The main indication was an intact sole and amenability of direct tibial nerve repair. Extensive bone loss or soft-tissue damage was not a contraindication. All replantations were orthotopic, and in one case a temporary ectopic replantation was performed. All transtibial replantations underwent subsequent bone lengthening (8 to 13 cm)., Results: The survival rate of the replanted segments was 100 percent. There was one death caused by pulmonary thromboembolism. The number of additional operations was 3.1 (range, one to five). Soft-tissue necrosis occurred in 83 percent of cases, requiring flap coverage. A free flap was used in 90 percent of these cases, with a 100 percent success rate. Chen functional grade was I or II (good or excellent) in all but one case. Treatment time averaged 11.3 months (range, 8 to 16 months). No delayed amputations or plantar ulcers occurred., Conclusions: Although the complication rate has been high, in dedicated teams and with proper selection of patients, replantation of infrapopliteal lower limb amputations can yield satisfactory results.

Background: Recalcitrant nonunions of the distal tibia without bone defect are severe problems whose treatment is difficult. Stable internal fixation and osteogenetic enhancement are required. The thin corticoperiosteal flap based on the descending genicular artery has been previously described to treat nonunions in the upper extremity without bone defect. The use of this flap to treat distal tibial nonunions is reported in the present article., Methods: Twenty-five patients with recalcitrant nonunion of the distal tibial metaphysis without segmental bone defect or evidence of infection were treated with revision of the internal fixation and a corticoperiosteal free flap from the medial condyle of the femur. The number of previous surgical procedures was two to five. The flaps were compound, including muscle or fat, for wound coverage in seven cases., Results: All compound flaps survived. Bony union was achieved in all cases, with bone formation at the nonunion site by the fourth month in all cases but one. In this case bone union took 7 months. Donor morbidity was negligible. Two tibiotalar arthrodeses were performed secondarily for posttraumatic osteoarthritis., Conclusions: Treatment of recalcitrant distal tibial nonunions without bone defect with removal of previous hardware, stable internal fixation, and free corticoperiosteal flap transfer is safe and effective in noninfected cases.

The gracilis muscle has been used extensively in reconstructive surgery, based on the proximal dominant pedicle. In the literature, little attention has been paid to the secondary distal pedicles. The distribution of the secondary pedicles of the gracilis muscle was investigated in 20 cadaver thighs. The mean number of secondary pedicles was 2.2 (range, two to three). When two pedicles were present-the most common situation-they were located at a mean distance of 12.4 and 17.5 cm from the knee joint line. The most proximal secondary pedicle was injected with barium sulfate in five specimens, and constant and abundant connections with the main pedicle were noted. A series of seven clinical cases of segmental gracilis free muscle flaps based on a secondary pedicle is reported. The flaps were successfully transferred to reconstruct traumatic defects of limited size, with one case of partial necrosis caused by a technical error. The morbidity of this flap is minimal, the scar is well hidden, the muscle need not be sacrificed, elevation is fast and straightforward under tourniquet control, and the pedicle is sizable. This flap should be considered a viable option when a small, straightforward free flap is needed.

Refractory hypotension is the main cause of death of patients with septic shock. It has been shown that an excessive release of NO is responsible for the sepsis-induced hypotension and vascular hyporeactivity. Nitric oxide is produced under normal conditions by a constitutive enzyme present, among other cell types, in the endothelial cell, and is necessary for maintenance of normal organ perfusion. Under inflammatory or septic conditions, a new enzyme is expressed in phagocytic cells and vascular smooth muscle cells, giving rise to an uncontrolled NO production that is associated with cytotoxic effects and vasodilatation. Randomized clinical trials have shown that the administration of inhibitors of NO synthesis to patients with septic shock is associated with a greater incidence of shock resolution, without significant adverse effects. The recent discovery of the different biological functions of NO, both under normal and inflammatory conditions, has allowed the development of new concepts about the pathophysiology of septic shock, and has provided the bases to design novel therapeutic strategies for the treatment of septic shock, based on the inhibition of NO synthesis.

Background: Septic shock is characterized by systemic vasodilation and an impaired reactivity to vasoconstrictor agents. It has been suggested that an excessive release of nitric oxide has a role in this hemodynamic derangement., Objective: To investigate whether inhibition of nitric oxide synthesis by the administration of N omega-nitro-L-arginine (LNNA), improves the vasoconstrictor effects of catecholamines in sepsis., Material and Methods: Mechanically ventilated and pentobarbital-anesthetized sheep received either no treatment (n = 6) or LNNA (100 mg/kg IV bolus, n = 4). Other sheep (septic group) received live Escherichia coli (E coli) (1,5* 10(9) micro-organisms/kg over 30 min) followed 1 hour later by either no treatment (n = 5) or LNNA (100 mg/kg IV bolus, n = 7). After those interventions, all sheep were given noradrenaline in a continuous IV infusion at three different doses (0.5, 1.5, and 4.5 micrograms, kg-1, min-1). Cardiovascular parameters were recorded at maximal blood pressure response achieved with each dose., Results: The administration of live E coli to the septic group resulted in systemic hypotension, high cardiac output, and hyperlactatemia. The LNNA caused a significant systemic and pulmonary vasoconstriction in both septic and nonseptic sheep. In nonseptic sheep, noradrenaline induced a significant increase in systemic vascular resistance (from 2,973 +/- 637 to 4,561 +/- 1,287 dyn/s/cm-5/m-2), whereas the increase caused in those that received LNNA was nonsignificant (5,562 +/- 3,489 to 6,693 +/- 2,871 dyn, s, cm-5, m-2). Septic sheep showed a nonsignificant vasoconstriction during the infusion of noradrenaline (from 1,438 +/- 1,132 to 2,244 +/- 1,391 dyn/s/cm-5/m-2). However, treatment with LNNA markedly improved the vasoconstrictor effect of noradrenaline (from 2,804 +/- 2,317 to 4,894 +/- 3,435 dyn/s/cm-5/m-2). The dose-response curve of systemic vascular resistance in these LNNA-pretreated septic sheep became very similar to the corresponding curve obtained in nonseptic animals., Conclusions: Inhibition of nitric oxide synthesis by the administration of LNNA significantly improves the vasoconstrictor effect of noradrenaline in septic sheep, allowing an increase in systemic vasomotor tone similar to that observed in nonseptic sheep. It is concluded that increased synthesis of nitric oxide contributes to the depressed vascular reactivity to vasoconstrictor agents characteristic of sepsis.

Objective: To investigate the role of nitric oxide in the regulation of vascular tone in patients with the sepsis syndrome., Design: Prospective, intervention study., Setting: Tertiary care hospital., Patients: Fifteen patients admitted to our medical intensive care unit with the diagnosis of sepsis syndrome by defined criteria., Interventions: Eight patients received N omega-nitro-L-arginine (20 mg/kg, iv bolus) followed by L-arginine (200 mg/kg, iv bolus). Seven patients received L-arginine alone (200 mg/kg)., Measurements and Main Results: In the first group, hemodynamic and oxygen transport variables were recorded at baseline, during 45 mins after the injection of N omega-nitro-L-arginine, and during 45 mins after the administration of L-arginine. In the second group, hemodynamic parameters were recorded at baseline and during 15 mins after the administration of L-arginine. Data are mean +/- SEM. The administration of N omega-nitro-L-arginine was followed by hypertension (mean blood pressure increased from 89 +/- 8 to a maximum of 140 +/- 12 mm Hg) accompanied by a decrease in cardiac index (from 3.51 +/- 0.39 to a minimum of 2.65 +/- 0.21 L/min/m2) and an increase in right atrial and pulmonary artery occlusion pressure. Systemic vascular resistance index increased from 1871.1 +/- 302.3 to 3825.6 +/- 244.4 dyne.sec/cm5.m2, and pulmonary vascular resistance increased from 533.2 +/- 125.8 to 816.0 +/- 117.3 dyne.sec/cm5.m2. These changes induced by N omega-nitro-L-arginine were reversed by the administration of L-arginine. The administration of L-arginine to another group of patients caused transient hypotension (from 103 +/- 6 to 81 +/- 10 mm Hg) and an increase in cardiac index (from 3.57 +/- 0.15 to 4.74 +/- 0.54 L/min/m2). Both systemic and pulmonary vascular resistance indices decreased (from 1987.6 +/- 163.9 to 1251.4 +/- 231.5 dyne.sec/cm5.m2, and from 486.1 +/- 65.2 to 380.5 +/- 70.3 dyne.sec/cm5.m2). Parallel to the increase in oxygen transport due to the increase in cardiac output, oxygen consumption index increased significantly 1 min after L-arginine (from 127.0 +/- 19.0 to 182.5 +/- 37.3 mL/min/m2). All mentioned changes were statistically significant (p < .05)., Conclusions: A continuous basal release of nitric oxide plays a role in the regulation of systemic and pulmonary vascular tone in patients with sepsis syndrome. L-arginine has systemic and pulmonary vasodilatory actions.

Objective: To investigate whether increasing oxygen delivery (DO2) by increasing hematocrit results in increases in oxygen uptake (VO2) in septic patients with an abnormal DO2/VO2 relationship., Design: Prospective, randomized, interventional crossover study., Setting: Tertiary care hospital., Patients: A consecutive sample of 16 patients admitted to the intensive care unit, who were diagnosed as having severe sepsis by defined criteria and who had a hemoglobin concentration of < 10 g/dL., Interventions: Patients received, in random order, an infusion of dobutamine (10 micrograms/kg/min) and a blood transfusion (800 mL of packed red blood cells in 90 mins). Hemodynamic and oxygen transport variables were determined before and after each treatment, allowing at least 20 mins during the infusion of dobutamine to achieve the steady state., Measurements and Main Results: Changes in DO2 and VO2 induced by each intervention were measured. Dobutamine significantly increased DO2 (48.5 +/- 6.9%; p = .0001) and VO2 (21.7 +/- 3.3%; p = .0001). Blood transfusion increased DO2 (21.4 +/- 4.3%; p = .005) but VO2 did not change significantly (2.2 +/- 4.1%). Correlation coefficients for the percent changes of DO2 and VO2 (r2 = .67, p = .001 for dobutamine; and r2 = 21, p = .07 for blood transfusion) were significantly different for each treatment (p = .0001)., Conclusions: In patients with an abnormal DO2-dependent VO2, as shown by increases in VO2 brought about by an infusion of dobutamine, blood transfusion does not significantly increase VO2, despite significant changes in DO2. The VO2, in some critically ill patients, depends more on blood flow than on global DO2.