Conformal piezoelectric energy harvesting and storage from motions of the heart, lung, and diaphragm.

Here, we report advanced materials and devices that enable high-efficiency mechanical-to-electrical energy conversion from the natural contractile and relaxation motions of the heart, lung, and diaphragm, demonstrated in several different animal models, each of which has organs with sizes that approach human scales. A cointegrated collection of such energy-harvesting elements with rectifiers and microbatteries provides an entire flexible system, capable of viable integration with the beating heart via medical sutures and operation with efficiencies of ∼2%. Additional experiments, computational models, and results in multilayer configurations capture the key behaviors, illuminate essential design aspects, and offer sufficient power outputs for operation of pacemakers, with or without battery assist.

Leukocytosis and hypercalcemia: a rare combination of paraneoplastic features in squamous cell penile cancer.

Penile cancer is very rare in North America and Europe, as compared with the rest of the world. Squamous cell carcinoma (SCC) accounts for more than 95% of the cancer type. Paraneoplastic syndrome (PNS), a clinical syndrome of nonmetastatic systemic effects that occurs in patients with malignant disease, is often associated with SCC. However, the association of penile SCC with leukocytosis and hypercalcemia is very rare. We report a case of penile SCC involving a change in the patient's mental status along with hypercalcemia and leukocytosis; all three conditions resolved after the tumor was excised. We also discuss the possible factors contributing to hypercalcemia, leukocytosis and change in mental status in SCC. These three conditions and other features of PNS can significantly influence a patient's overall prognosis and, if recognized early, can play an important role in the care plan.

Transillumination of the fingers for vascular anomalies: a novel method for evaluating hereditary hemorrhagic telangiectasia.

PURPOSE: We describe a novel approach for detecting vascular abnormalities deep in the digits by means of a handheld illuminator. METHODS: Ten patients with hereditary hemorrhagic telangiectasia were compared with 10 controls for telangiectases in the fingers using a handheld otoscope. RESULTS: This noninvasive transillumination method revealed telangiectases in 9 of 10 patients with hereditary hemorrhagic telangiectasia and none in controls. CONCLUSIONS: Transillumination of fingers with an otoscope identifies telangiectases in patients with hereditary hemorrhagic telangiectasia. Further studies are needed to determine the prevalence of telangiectases in the finger and whether this finding is present in other vascular diseases.

Thoracostomy tubes: A comprehensive review of complications and related topics.

Tube thoracostomy (TT) placement belongs among the most commonly performed procedures. Despite many benefits of TT drainage, potential for significant morbidity and mortality exists. Abdominal or thoracic injury, fistula formation and vascular trauma are among the most serious, but more common complications such as recurrent pneumothorax, insertion site infection and nonfunctioning or malpositioned TT also represent a significant source of morbidity and treatment cost. Awareness of potential complications and familiarity with associated preventive, diagnostic and treatment strategies are fundamental to satisfactory patient outcomes. This review focuses on chest tube complications and related topics, with emphasis on prevention and problem-oriented approaches to diagnosis and treatment. The authors hope that this manuscript will serve as a valuable foundation for those who wish to become adept at the management of chest tubes.

Potential role of oral anticoagulants in the treatment of patients with coronary artery disease: focus on dabigatran.

The pharmacologic management of patients with high-risk coronary artery disease consists of aspirin and a P2Y12 receptor inhibitor. Chronic oral anticoagulation with warfarin is the major treatment strategy to attenuate thromboembolism or stroke in patients with deep vein thrombosis, pulmonary embolism, heart failure and atrial fibrillation. A substantial percentage of the latter group of patients have coronary artery disease and may require stenting with long-term dual antiplatelet therapy in addition to therapy with warfarin to reduce arterial ischemic events in addition to stroke. These new oral anticoagulants have been developed for long-term therapy to overcome the limitations of warfarin. Dabigatran is a direct thrombin inhibitor and its role in patients with acute coronary syndrome is being explored.

Review of abdominal damage control and open abdomens: focus on gastrointestinal complications.

Massive trauma and abdominal catastrophes carry high morbidity and mortality. In addition to the primary pathologic process, a secondary systemic injury, characterized by inflammatory mediator release, contributes to subsequent cellular, end-organ, and systemic dysfunction. These processes, in conjunction with large-volume resuscitations and tissue hypoperfusion, lead to acidosis, coagulopathy, and hypothermia. This "lethal triad" synergistically contributes to further physiologic derangements and, if uncorrected, may result in patient death. One manifestation of the associated clinical syndrome is the development of intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS). The development of ACS is insidious. If not recognized and treated promptly, ACS leads to multi-system organ failure (MSOF) and mortality. Improved understanding of IAH and ACS led to the development of damage control (DC)/open abdomen (OA) as surgical decompressive strategy. The DC/OA approach consists of three basic management steps. During the initial step the abdomen is opened, hemorrhage/abdominal contamination are controlled, and temporary abdominal closure is performed (Stage I). The patient then enters Stage II - physiologic restoration with core rewarming, correction of coagulopathy and completion of acute resuscitation. After physiologic normalization, definitive management of injuries and eventual abdominal closure (Stage III) are achieved. The authors will provide an overview of the DC/OA approach, as well as the clinical diagnosis of ACS, followed by a discussion of DC/OA-associated complications, with focus on digestive system-specific complaints.

Relationship of microparticles to progenitor cells as a measure of vascular health in a diabetic population.

OBJECTIVE: Quantitative measures are needed to identify diabetic patients at higher risk for CV events. Cell-derived microparticles (MPs) are submicron membrane vesicles released from activated cells that are indicative of cell damage. Progenitor cells (PCs) including proangiogenic cells (PACs), often termed endothelial progenitor cells (EPCs), are mediators of reparative capacity. We examined whether the relationship of MPs to PCs/PACs could be used as an improved and clinically feasible index of vascular pathology. METHODS AND RESULTS: Plasma samples were collected from patients with early-stage (ES, Diagnosis < 1 year) and long-term (LT, Diagnosis > 5 years,) Type 2 diabetes and compared with age related healthy subjects (H). PC and MP subtypes were measured by a combination of flow cytometry and ELISA-based methods. The ratio of procoagulant MPs/CD34(+) PCs proved a valuable index to distinguish between subject groups (P = 0.01). This index of compromised vascular function was highest in the LT group despite intensive statin therapy and was more informative than a range of soluble protein biomarkers. CONCLUSIONS: This is the first report of a relationship between MPs and PCs in Type 2 diabetes. This ratio may provide a quantitative and clinically feasible measurement of vascular dysfunction and cardiovascular risk in patients with diabetes. © 2010 International Clinical Cytometry Society.

Premature peripheral arterial disease - difficult diagnosis in very early presentation.

Peripheral arterial disease (PAD) is defined as an ankle-brachial index of less than 0.9. It is mostly prevalent in patients older than 50 years of age; its occurrence in younger patients is rare. Nevertheless, the diagnosis must be considered in any patient with exertional lower extremity symptoms. Patients with early-onset disease, also called premature PAD, have a particularly difficult course with early involvement of other major arterial beds such as the carotid and coronary arteries. Their diagnosis and treatment have to be comprehensive to prevent early morbidity and mortality. Reports of very early occurrence and management are rare, especially of onset before 25 years of age. Management of this early presentation of PAD is unclear because most of the available information concerns treatment of patients 40 years of age or older. The cases of two patients who developed symptomatic PAD before 25 years of age are described, and the various causes and management options available for the treatment of early onset PAD patients are discussed.

Complications related to endoscopic retrograde cholangiopancreatography: a comprehensive clinical review.

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most commonly performed endoscopic procedures. It provides the treating physician with both diagnostic and therapeutic options. The recent shift towards interventional uses of ERCP is largely due to the emergence of advanced imaging techniques, including magnetic resonance cholangiopancreatography and ultrasonography. With over 500,000 ERCP procedures performed yearly in the United States alone, it is important that all medical and surgical practitioners be well versed in indications, contraindications, potential complications, benefits, and alternatives to ERCP. The authors present an in-depth review of ERCP-related complications (pancreatitis, bleeding, perforation, etc) as well as special topics related to ERCP (periprocedural antibiotic use, performance of intraoperative ERCP, performance of ERCP during pregnancy, etc).