Современные методы и материалы моделирования тканей мозга и гематоэнцефалического барьера in vitro

Neurovascular unit (NVU) is an ensemble of brain cells (cerebral endothelial cells, astrocytes, pericytes, neurons, and microglia), which regulates processes of transport through the blood-brain barrier (BBB) and controls local microcirculation and intercellular metabolic coupling. Dysfunction of NVU contributes to numerous types of central nervous system pathology. NVU pathophysiology has been extensively studied in various animal models of brain disorders, and there is growing evidence that modern approaches utilizing in vitro models are very promising for the assessment of intercellular communications within the NVU. Development of NVU‑on-chip or BBB‑on-chip as well as 3D NVU and brain tissue models suggests novel clues to understanding cell-to-cell interactions critical for brain functional activity, being therefore very important for translational studies, drug discovery, and development of novel analytical platforms. One of the mechanisms controlled by NVU activity is neurogenesis in highly specialized areas of brain (neurogenic niches, NNs), which are well-equipped for the maintenance of stem/progenitor cell pool and proliferation, differentiation, and migration of newly formed neuronal and glial cells. Specific properties of brain microvascular endothelial cells, particularly, high content of mitochondria, are important for establishment of vascular support in NVU and NNs. Metabolic activity of cells within NNs and NVU contributes to maintaining intercellular communications critical for the multicellular module integrity. We will discuss modern approaches to development of optimal microenvironment for in vitro BBB, NVU and NN models with the special focus on neuroengineering and bioprinting potentialsНейроваскулярная единица (НВЕ) – это совокупность клеток головного мозга (церебральные эндотелиальные клетки, астроциты, перициты, нейроны, микроглия), которые регулируют процессы транспорта через гематоэнцефалический барьер (ГЭБ), контролируют местную микроциркуляцию, межклеточную метаболическую связь. Дисфункция НВЕ способствует возникновению многих типов патологии центральной нервной системы. Патофизиология НВЕ широко изучена на различных моделях заболеваний мозга на животных. В настоящее время появляется все больше свидетельств того, что современные подходы с использованием моделей in vitro наиболее перспективны для оценки межклеточных коммуникаций внутри НВЕ. Разработка сосудисто-нервных единиц на чипе или ГЭБ на чипе, а также 3D НВЕ и модели ткани мозга обеспечивают новые подходы к пониманию межклеточных взаимодействий, критических для функциональной активности мозга, поэтому они очень важны для трансляционных исследований, открытия лекарств и создания новых аналитических платформ. Одним из механизмов, который контролируется активностью НВЕ, является нейрогенез в узкоспециализированных областях мозга (нейрогенные ниши, НН), которые служат источником для поддержания пула стволовых/ прогениторных клеток, пролиферации, дифференциации и миграции новообразованных нейронов и глиальных клеток. Специфические свойства эндотелиальных клеток микрососудов головного мозга, в частности высокое содержание митохондрий, важны для создания сосудистой поддержки при НВЕ и НН. Метаболическая активность клеток внутри НН и НВЕ способствует поддержанию межклеточных коммуникаций, критически важных для целостности многоклеточного модуля. В работе обсуждаются современные подходы к разработке оптимальной микросреды для in vitro моделей ГЭБ, НВЕ и НН. Особое внимание уделено перспективам нейроинженерии и биопечат

coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit

Background/objectives: Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines. Methods: All consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data. Results: Complete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P = 0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P < 0.00001), early enteral feeding (33.2%, χ2 11.51, P = 0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P < 0.00001), with wide variability based on the admitting speciality. Conclusions: The results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality. Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990)

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990). Graphical abstract: [Figure not available: see fulltext.]

Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis

IMPORTANCE Considering the lack of equipoise regarding the timing of cholecystectomy in patients with moderately severe and severe acute biliary pancreatitis (ABP), it is critical to assess this issue.OBJECTIVE To assess the outcomes of early cholecystectomy (EC) in patients with moderately severe and severe ABP.DESIGN, SETTINGS, AND PARTICIPANTS This cohort study retrospectively analyzed real-life data from the MANCTRA-1 (Compliance With Evidence-Based Clinical Guidelines in the Management of Acute Biliary Pancreatitis) data set, assessing 5304 consecutive patients hospitalized between January 1, 2019, and December 31, 2020, for ABP from 42 countries. A total of 3696 patients who were hospitalized for ABP and underwent cholecystectomy were included in the analysis; of these, 1202 underwent EC, defined as a cholecystectomy performed within 14 days of admission. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality and morbidity. Data analysis was performed from January to February 2023.MAIN OUTCOMES Mortality and morbidity after EC.RESULTS Of the 3696 patients (mean [SD] age, 58.5 [17.8] years; 1907 [51.5%] female) included in the analysis, 1202 (32.5%) underwent EC and 2494 (67.5%) underwent delayed cholecystectomy (DC). Overall, EC presented an increased risk of postoperative mortality (1.4% vs 0.1%, P <.001) and morbidity (7.7% vs 3.7%, P < .001) compared with DC. On the multivariable analysis, moderately severe and severe ABP were associated with increased mortality (odds ratio [OR], 361.46; 95% CI, 2.28-57 212.31; P = .02) and morbidity (OR, 2.64; 95% CI, 1.35-5.19; P = .005). In patients with moderately severe and severe ABP (n = 108), EC was associated with an increased risk of mortality (16 [15.6%] vs 0 [0%], P < .001), morbidity (30 [30.3%] vs 57 [5.5%], P < .001), bile leakage (2 [2.4%] vs 4 [0.4%], P = .02), and infections (12 [14.6%] vs 4 [0.4%], P < .001) compared with patients with mild ABP who underwent EC. In patients with moderately severe and severe ABP (n = 108), EC was associated with higher mortality (16 [15.6%] vs 2 [1.2%], P < .001), morbidity (30 [30.3%] vs 17 [10.3%], P < .001), and infections (12 [14.6%] vs 2 [1.3%], P < .001) compared with patients with moderately severe and severe ABP who underwent DC. On the multivariable analysis, the patient's age (OR, 1.12; 95% CI, 1.02-1.36; P = .03) and American Society of Anesthesiologists score (OR, 5.91; 95% CI, 1.06-32.78; P = .04) were associated with mortality; severe complications of ABP were associated with increased mortality (OR, 50.04; 95% CI, 2.37-1058.01; P = .01) and morbidity (OR, 33.64; 95% CI, 3.19-354.73; P = .003).CONCLUSIONS AND RELEVANCE This cohort study's findings suggest that EC should be considered carefully in patients with moderately severe and severe ABP, as it was associated with increased postoperative mortality and morbidity. However, older and more fragile patients manifesting severe complications related to ABP should most likely not be considered for EC