Unexpected high toughness of Samia cynthia ricini silk gut.

Silk gut fibers were produced from the silkworm Samia cynthia ricini silk glands by the usual procedure of immersion in a mildly acidic solution and subsequent stretching. The morphology of the silk guts was assessed by scanning electron microscopy, and their microstructure was assessed by infrared spectroscopy and X-ray diffraction. It was found that both naturally spun and Samia silk guts share a common semicrystalline microstructure. The mechanical characterization of the silk guts revealed that these fibers show an elastomeric behavior when tested in water, and exhibit a genuine ground state to which the fiber may revert independently of its previous loading history. In spite of its large cross-sectional area compared with naturally spun silk fibers, Samia silk guts show values of work to fracture up to 160 MJ m-3, much larger than those of most of their natural counterparts, and establish a new record value for this parameter in silk guts.

Strategies for the Biofunctionalization of Straining Flow Spinning Regenerated Bombyx mori Fibers.

High-performance regenerated silkworm (Bombyx mori) silk fibers can be produced efficiently through the straining flow spinning (SFS) technique. In addition to an enhanced biocompatibility that results from the removal of contaminants during the processing of the material, regenerated silk fibers may be functionalized conveniently by using a range of different strategies. In this work, the possibility of implementing various functionalization techniques is explored, including the production of fluorescent fibers that may be tracked when implanted, the combination of the fibers with enzymes to yield fibers with catalytic properties, and the functionalization of the fibers with cell-adhesion motifs to modulate the adherence of different cell lineages to the material. When considered globally, all these techniques are a strong indication not only of the high versatility offered by the functionalization of regenerated fibers in terms of the different chemistries that can be employed, but also on the wide range of applications that can be covered with these functionalized fibers.

Choledochoduodenostomy with LAMS (Hot-Axios type) for malignant obstructive jaundice - An increasingly used technique.

An 82-year-old woman who presented with obstructive jaundice and constitutional syndrome was diagnosed with pancreatic adenocarcinoma. Palliative management was decided with endoscopic ultrasound drainage as it was impossible to perform ERCP due to anatomical alterations, a consequence of the neoplastic lesion.

Mechanical and structural adaptations to migration in the flight feathers of a Palaearctic passerine.

Current avian migration patterns in temperate regions have been developed during the glacial retreat and subsequent colonization of the ice-free areas during the Holocene. This process resulted in a geographic gradient of greater seasonality as latitude increased that favoured migration-related morphological and physiological (co)adaptations. Most evidence of avian morphological adaptations to migration comes from the analysis of variation in the length and shape of the wings, but the existence of intra-feather structural adjustments has been greatly overlooked despite their potential to be under natural selection. To shed some light on this question, we used data from European robins Erithacus rubecula overwintering in Campo de Gibraltar (Southern Iberia), where sedentary robins coexist during winter with conspecifics showing a broad range of breeding origins and, hence, migration distances. We explicitly explored how wing length and shape, as well as several functional (bending stiffness), developmental (feather growth rate) and structural (size and complexity of feather components) characteristics of flight feathers, varied in relation to migration distance, which was estimated from the hydrogen stable isotope ratios of the summer-produced tail feathers. Our results revealed that migration distance not only favoured longer and more concave wings, but also promoted primaries with a thicker dorsoventral rachis and shorter barb lengths, which, in turn, conferred more bending stiffness to these feathers. We suggest that these intra-feather structural adjustments could be an additional, largely unnoticed, adaptation within the avian migratory syndrome that might have the potential to evolve relatively quickly to facilitate the occupation of seasonal environments.

Incisional endoscopic therapy as a therapeutic alternative in esophageal anastomotic strictures refractory to conventional treatment.

Esophageal anastomotic strictures are a non-negligible cause of benign strictures and secondary dysphagia. It should be noted that these are often complex strictures, with a large ischemic-fibrotic component. Thus, they are difficult to treat due to their recurrence, despite endoscopic dilation. Endoscopic incisional therapy appears as a therapeutic alternative in this type of patient, which allows the elimination of the stenotic ring, with a good efficacy and safety profile. We present the case of a patient with postoperative esophageal strictures refractory to treatment with dilation and endoscopic prosthesis, who was finally satisfactorily treated with incisional therapy.

Intestinal tuberculosis and Crohn's disease: the importance and difficulty of a differential diagnosis.

Tuberculosis (TB) is the most prevalent infection worldwide and affects one third of the population, predominantly in developing countries. Intestinal TB (ITB) is the sixth most frequent extra-pulmonary TB infection. Crohn's disease (CD) is a chronic inflammatory bowel disease that arises from the interaction of immunological, environmental and genetic factors. Due to changes in the epidemiology of both diseases, distinguishing CD from ITB is a challenge, particularly in immunocompromised patients and those from areas where TB is endemic. Furthermore, both TB and CD have a predilection for the ileocecal area. In addition, they share very similar clinical, radiological and endoscopic findings. An incorrect diagnosis and treatment may increase morbidity and mortality. Thus, a great degree of caution is required as well as a familiarity with certain characteristics of the diseases, which will aid the differentiation between the two diseases.

Axonal Guidance Using Biofunctionalized Straining Flow Spinning Regenerated Silk Fibroin Fibers as Scaffold.

After an injury, the limited regenerative capacity of the central nervous system makes the reconnection and functional recovery of the affected nervous tissue almost impossible. To address this problem, biomaterials appear as a promising option for the design of scaffolds that promote and guide this regenerative process. Based on previous seminal works on the ability of regenerated silk fibroin fibers spun through the straining flow spinning (SFS) technique, this study is intended to show that the usage of functionalized SFS fibers allows an enhancement of the guidance ability of the material when compared with the control (nonfunctionalized) fibers. It is shown that the axons of the neurons not only tend to follow the path marked by the fibers, in contrast to the isotropic growth observed on conventional culture plates, but also that this guidance can be further modulated through the biofunctionalization of the material with adhesion peptides. Establishing the guidance ability of these fibers opens the possibility of their use as implants for spinal cord injuries, so that they may represent the core of a therapy that would allow the reconnection of the injured ends of the spinal cord.

The Spider Silk Standardization Initiative (S3I): A powerful tool to harness biological variability and to systematize the characterization of major ampullate silk fibers spun by spiders from suburban Sydney, Australia.

The true stress-true strain curves of 11 Australian spider species from the Entelegynae lineage were tensile tested and classified based on the values of the alignment parameter, α*, in the framework of the Spider Silk Standardization Initiative (S3I). The application of the S3I methodology allowed the determination of the alignment parameter in all cases, and were found to range between α* = 0.03 and α* = 0.65. These data, in combination with previous results on other species included in the Initiative, were exploited to illustrate the potential of this approach by testing two simple hypotheses on the distribution of the alignment parameter throughout the lineage: (1) whether a uniform distribution may be compatible with the values obtained from the studied species, and (2) whether any trend may be established between the distribution of the α* parameter and phylogeny. In this regard, the lowest values of the α* parameter are found in some representatives of the Araneidae group, and larger values seem to be found as the evolutionary distance from this group increases. However, a significant number of outliers to this apparent general trend in terms of the values of the α* parameter are described.

Enhancement of in vivo supraspinatus tendon-to-bone healing with an alginate-chitin scaffold and rhBMP-2.

INTRODUCTION: Rotator cuff disorders present a high retear rate despite advances in surgical treatment. Tissue engineering could therefore be interesting in order to try to enhance a more biological repair. RhBMP-2 is one of the most osteogenic growth factors and it also induces the formation of collagen type I. However, it has a short half-life and in order to get a more stable release over time it could be integrated in a more slowly degradable carrier, such as an alginate-chitin scaffold. The aim of this study was to investigate the role of the alginate-chitin scaffold alone and in combination with different concentrations of rhBMP-2 when applied on chronic rotator cuff lesions in a rat model. MATERIALS AND METHODS: We performed an experimental study with 80 Sprague-Dawley rats, 8 months old, with a chronic rupture of the supraspinatus tendon that was repaired with a modified Mason Allen suture. A scaffold was applied over the suture and 4 groups were obtained; suture (S) only suture, double control (DC) alginate and chitin scaffold, single sample (SS) scaffold of alginate with rhBMP-2 (20 µg rhBMP-2) and chitin, double sample (DS) a scaffold containing alginate with rhBMP-2 and chitin with rhBMP-2 (40 µg rhBMP-2). Macroscopic, histological and biomechanical studies were performed at 4 months after reparation. RESULTS: The modified Åström and Rausing's histological scale (the higher the score the worse outcome, 0 points=native tendon) was applied: S got 52 points compared to DC 30 (p = 0,034), SS 22 (p = 0,009) and DS 16 (p = 0,010). Biomechanically the maximum load was highest in DC (63,05 N), followed by DS (61,60 N), SS (52,35 N) and S (51,08), p = 0,025 DS vs S. As to the elastic constant a higher value was obtained in DC (16,65), DS (12,55) and SS (12,20) compared to S (9,33), p = 0,009 DC vs S and 0,034 DS vs S. CONCLUSIONS: The alginate-chitin scaffold seems to promote a more biological response after the reparation of a chronic rotator cuff lesion. Its effect is further enhanced by the addition of rhBMP-2 since the osteotendinous junction is more native-like and has better biomechanical properties.

Orthogonal electrical cardioversion in atrial fibrillation refractory to biphasic shocks: a case series.

BACKGROUND: Biphasic waveform shock has been established as the standard method for cardioversion of atrial fibrillation (AF). Depending on various factors, standard electrical cardioversion for AF may be unsuccessful in some cases, even with biphasic shocks. CASE SUMMARY: We report the safety and efficacy of orthogonal electrical cardioversion (OECV) as an alternative in patients with paroxysmal AF refractory to standard biphasic electrical cardioversion after up to three subsequent shocks of increasing energy and/or two or three initial shocks with maximum energy of 200-Joules. Shocks were delivered with two external defibrillators via two sets of adhesive electrode pads to apply two perpendicular electrical vectors in a simultaneous-sequential mode in antero-lateral and antero-posterior configuration. Five patients, mean age 54.4 ± 11, three with hypertensive heart disease and a body mass index 27.2 ± 2 kg/m2. All individual mean impedance before OECV was 79 ± 5 Ω with a mean peak current applied of 22 ± 4.5 A. Restoration of sinus rhythm with OECV was achieved acutely and sustained in all five patients. No patients developed haemodynamic instability or thromboembolic events. DISCUSSION: Double simultaneous shocks in an orthogonal configuration could theoretically decrease the defibrillation threshold through the ability of sequential pulses applying a more efficient and uniform current density. OECV using lower/medium energy may be another useful rescue strategy in AF refractory to standard biphasic shocks.

Efficacy and Safety of a Novel Submucosal Injection Solution for Resection of Gastrointestinal Lesions.

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are minimally invasive and efficient techniques for the removal of gastrointestinal (GI) mucosal polyps. In both techniques, submucosal injection solutions are necessary for complete effectiveness and safety during the intervention to be obtained. The main objective of this study was to evaluate the efficacy and safety of a new sterile submucosal injection solution for EMR/ESD used within a clinical protocol in patients with intestinal polyps. We carried out a prospective study between 2016 and 2017 with patients who attended the Endoscopy Consultation-Digestive Department of Primary Hospital. Patients were selected for EMR/ESD after the application of clinical protocols. Thirty-six patients were selected (≥ 66 years with comorbidities and risk factors). Lesions were located mainly in the colon. Our solution presented an intestinal lift ≥ 60 min in EMR/ESD and a high expansion of tissue, optimum viscosity, and subsequent complete resorption. The genes S100A9 and TP53 presented an expression increase in the distal regions. TP53 and PCNA were the only genes whose expression was increased in polyp specimens vs. the surrounding tissue at the mRNA level. In EMR/ESD, our solution presented a prolonged effect at the intestinal level during all times of the intervention. Thus, our solution seems be an effective and safe alternative in cases of flat lesions in both techniques.

Tear and decohesion of bovine pericardial tissue.

The aim of this study was to evaluate quantitatively the fracture-by tear and delamination-of bovine pericardium tissues which are usually employed for the manufacture of bioprosthetic valves. A large number of samples (77) were tested in root-to-apex and circumferential directions, according to a standardised tear test (ASTM D 1938). Before performing the tear test, some samples were subjected to 1000 cycles of fatigue to a maximum stress of 3MPa. Fracture toughness of tearing and delamination were computed by following a simple fracture model. The study showed significantly lower values of delamination toughness compared with tear delamination. Moreover, tear forces were different in each test direction, revealing a clear orthotropic behaviour. All these results, as well as the testing procedure, could be of value for future research in the physiological function of pericardium tissues and clinical applications.

Indentation hardness: A simple test that correlates with the dissipated-energy predictor for fatigue-life in bovine pericardium membranes for bioprosthetic heart valves.

The aim of this study was to evaluate the variation of hardness with fatigue in calf pericardium, a biomaterial commonly used in bioprosthetic heart valves, and its relationship with the energy dissipated during the first fatigue cycle that has been shown to be a predictor of fatigue-life (García Páez et al., 2006, 2007; Rojo et al., 2010). Fatigue tests were performed in vitro on 24 pericardium specimens cut in a root-to-apex direction. The specimens were subjected to a maximum stress of 1MPa in blocks of 10, 25, 50, 100, 250, 500, 1000 and 1500 cycles. By means of a modified Shore A hardness test procedure, the hardness of the specimen was measured before and after fatigue tests. Results showed a significant correlation of such hardness with fatigue performance and with the energy dissipated in the first cycle of fatigue, a predictor of pericardium durability. The study showed indentation hardness as a simple and reliable indicator of mechanical performance, one which could be easily implemented in improving tissue selection.

Endocarditis no infecciosa de la válvula mitral asociada con lupus eritematoso sistémico / Non-infectious endocarditis of mitral valve concomitant to systemic lupus erythematosus

Resumen La endocarditis de Libman-Sacks es una forma de endocarditis no infecciosa, caracterizada por vegetaciones estériles que afectan principalmente las válvulas aórtica y mitral. Se asocia con enfermedades como lupus eritematoso sistémico y la manifestación más común es asintomática. Se relaciona con duración de la enfermedad, actividad lúpica y existencia de anticuerpos antifosfolipídicos. El diagnóstico se establece por ecocardiografía transtorácica y el definitivo por estudio de patología que demuestra vegetaciones en la autopsia o en muestras quirúrgicas. Se informa el caso de una paciente de 62 años que acudió por astenia, adinamia, ataque al estado general y disnea de medianos esfuerzos; en la ecocardiografía se encontraron vegetaciones. Se sometió a tratamiento quirúrgico y el diagnóstico se confirmó por estudio de patología.

Abstract Libman-Sacks endocarditis is a nonbacterial thrombotic endocarditis, characterized by the deposition of sterile platelet thrombi on heart valves, aortic and mitral. It is associated with systemic lupus erythematosus and the clinical manifestation is typically asymptomatic. It is associated with disease duration, lupus activity and antiphospholipid antibodies. The diagnosis is by echocardiography and the definitive diagnosis can be made pathologically by the demonstration of vegetations on autopsy or surgical speci mens. This paper reports the case of a 62-year old patient with asthenia, adynamia and dyspnea of medium efforts; the echocardiography showed vegetations and patient was underwent to surgical treatment with resection of vegetations, diagnosis was confirmed by pathology.

Doble ruptura miocárdica como complicación mecánica de un infarto agudo / Double myocardial rupture as a mechanical complication of an acute infarction

Resumen Las complicaciones del infarto agudo de miocardio se clasifican en mecánicas, eléctricas, isquémicas, tromboembólicas e inflamatorias; entre las complicaciones mecánicas destaca la ruptura de la pared libre del ventrículo izquierdo, músculos papilares y del septum ventricular, con incidencia menor de 1%, que ha descendido con la introducción de la intervención coronaria percutánea como principal estrategia de reperfusión. Se comunica el caso de una paciente de 64 años de edad, que acudió a urgencias por un cuadro de dolor torácico agudo compatible con síndrome coronario agudo con elevación del segmento ST (SICACEST) y durante su evolución tuvo deterioro clínico, se identificó una doble ruptura miocárdica. Se plantea el abordaje del caso y se revisa la bibliografía, porque una doble ruptura miocárdica corresponde solo a 0.3% de los casos reportados.

Abstract The complications of acute myocardial infarction are classified in mechanical, electrical, ischemic, embolic and inflammatory. The main mechanical complications are free wall rupture, papillary muscle and ventricular septal rupture. Its incidence is less than 1% and has decreased with the introduction of percutaneous coronary intervention as the main reperfusion strategy. This article presents a clinical case of a 64-year-old female that arrived to emergency room with thoracic pain, due to an acute coronary syndrome: ST-elevation myocardial infarction (STEMI); with a clinical deterioration presenting a double myocardial rupture. Clinical approach and bibliographic review are reported, the incidence estimation of this disorder is only 0.3% of the reported clinical cases.

Tuberculosis intestinal: importancia y dificultad del diagnóstico diferencial con enfermedad de Crohn / Intestinal tuberculosis and Crohn's disease: the importance and difficulty of a differential diagnosis

La tuberculosis (TBC) es la infección más prevalente del mundo y afecta a un tercio de la población mundial, predominantemente a países subdesarrollados, representando la TBC intestinal la sexta causa en frecuencia de afectación tuberculosa extrapulmonar. La enfermedad de Crohn (EC) es una enfermedad inflamatoria crónica intestinal que surge de la interacción de factores inmunológicos, ambientales y genéticos. El diagnóstico diferencial entre TBC intestinal y EC puede resultar un reto, sobre todo en pacientes inmunodeprimidos y en aquellos procedentes de áreas endémicas de TBC, debido a los cambios en la epidemiología de ambas patologías. Además, tanto la TBC intestinal como la EC tienen predilección por la región ileocecal y suelen presentar hallazgos clínicos, radiológicos y endoscópicos muy similares. El diagnóstico y tratamiento incorrectos podrían conllevar una elevada morbimortalidad, por lo que es necesario un alto índice de sospecha así como conocer algunas características que nos ayuden a diferenciar ambas enfermedades

Tuberculosis (TB) is the most prevalent infection worldwide and affects one third of the population, predominantly in developing countries. Intestinal TB (ITB) is the sixth most frequent extra-pulmonary TB infection. Crohn's disease (CD) is a chronic inflammatory bowel disease that arises from the interaction of immunological, environmental and genetic factors. Due to changes in the epidemiology of both diseases, distinguishing CD from ITB is a challenge, particularly in immunocompromised patients and those from areas where TB is endemic. Furthermore, both TB and CD have a predilection for the ileocecal area. In addition, they share very similar clinical, radiological and endoscopic findings. An incorrect diagnosis and treatment may increase morbidity and mortality. Thus, a great degree of caution is required as well as a familiarity with certain characteristics of the diseases, which will aid the differentiation between the two diseases

Terapia incisional endoscópica como alternativa terapéutica en estenosis esofágica anastomótica refractaria a tratamiento convencional / Incisional endoscopic therapy as a therapeutic alternative in esophageal anastomotic strictures refractory to conventional treatment

Las estenosis esofágicas anastomóticas son una causa no desdeñable de estenosis benigna y disfagia secundaria. Cabe destacar que son estenosis a menudo complejas, con un gran componente isquémico-fibrótico y, por tanto, difíciles de tratar por su recurrencia a pesar de dilatación endoscópica. En este tipo de pacientes, aparece como alternativa terapéutica la terapia incisional endoscópica, que permite eliminar el anillo estenótico, con un buen perfil de eficacia y seguridad. Presentamos el caso de un paciente con estenosis esofágica postquirúrgica refractaria a tratamiento con dilatación y prótesis endoscópica, tratado finalmente de forma satisfactoria con terapia incisional

Esophageal anastomotic strictures are a non-negligible cause of benign strictures and secondary dysphagia. It should be noted that these are often complex strictures, with a large ischemic-fibrotic component. Thus, they are difficult to treat due to their recurrence, despite endoscopic dilation. Endoscopic incisional therapy appears as a therapeutic alternative in this type of patient, which allows the elimination of the stenotic ring, with a good efficacy and safety profile. We present the case of a patient with postoperative esophageal strictures refractory to treatment with dilation and endoscopic prosthesis, who was finally satisfactorily treated with incisional therapy