3 research outputs found
Π‘ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ ΠΈ ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠΊΠ°Π½Π΅ΠΉ ΠΌΠΎΠ·Π³Π° ΠΈ Π³Π΅ΠΌΠ°ΡΠΎΡΠ½ΡΠ΅ΡΠ°Π»ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π±Π°ΡΡΠ΅ΡΠ° 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 NVUβon-chip or BBBβon-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 potentialsΠΠ΅ΠΉΡΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½Π°Ρ Π΅Π΄ΠΈΠ½ΠΈΡΠ° (ΠΠΠ) β ΡΡΠΎ ΡΠΎΠ²ΠΎΠΊΡΠΏΠ½ΠΎΡΡΡ ΠΊΠ»Π΅ΡΠΎΠΊ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°
(ΡΠ΅ΡΠ΅Π±ΡΠ°Π»ΡΠ½ΡΠ΅ ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΠ°Π»ΡΠ½ΡΠ΅ ΠΊΠ»Π΅ΡΠΊΠΈ, Π°ΡΡΡΠΎΡΠΈΡΡ, ΠΏΠ΅ΡΠΈΡΠΈΡΡ, Π½Π΅ΠΉΡΠΎΠ½Ρ, ΠΌΠΈΠΊΡΠΎΠ³Π»ΠΈΡ), ΠΊΠΎΡΠΎΡΡΠ΅
ΡΠ΅Π³ΡΠ»ΠΈΡΡΡΡ ΠΏΡΠΎΡΠ΅ΡΡΡ ΡΡΠ°Π½ΡΠΏΠΎΡΡΠ° ΡΠ΅ΡΠ΅Π· Π³Π΅ΠΌΠ°ΡΠΎΡΠ½ΡΠ΅ΡΠ°Π»ΠΈΡΠ΅ΡΠΊΠΈΠΉ Π±Π°ΡΡΠ΅Ρ (ΠΠΠ), ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈΡΡΡΡ
ΠΌΠ΅ΡΡΠ½ΡΡ ΠΌΠΈΠΊΡΠΎΡΠΈΡΠΊΡΠ»ΡΡΠΈΡ, ΠΌΠ΅ΠΆΠΊΠ»Π΅ΡΠΎΡΠ½ΡΡ ΠΌΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΡΡ ΡΠ²ΡΠ·Ρ. ΠΠΈΡΡΡΠ½ΠΊΡΠΈΡ ΠΠΠ ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΡΠ΅Ρ
Π²ΠΎΠ·Π½ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΈΡ ΠΌΠ½ΠΎΠ³ΠΈΡ
ΡΠΈΠΏΠΎΠ² ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΡΠ΅Π½ΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΠ²Π½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ. ΠΠ°ΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡ ΠΠΠ
ΡΠΈΡΠΎΠΊΠΎ ΠΈΠ·ΡΡΠ΅Π½Π° Π½Π° ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΠΌΠΎΠ΄Π΅Π»ΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ ΠΌΠΎΠ·Π³Π° Π½Π° ΠΆΠΈΠ²ΠΎΡΠ½ΡΡ
. Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ
ΠΏΠΎΡΠ²Π»ΡΠ΅ΡΡΡ Π²ΡΠ΅ Π±ΠΎΠ»ΡΡΠ΅ ΡΠ²ΠΈΠ΄Π΅ΡΠ΅Π»ΡΡΡΠ² ΡΠΎΠ³ΠΎ, ΡΡΠΎ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Ρ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΌΠΎΠ΄Π΅Π»Π΅ΠΉ in
vitro Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Π½Ρ Π΄Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΠΌΠ΅ΠΆΠΊΠ»Π΅ΡΠΎΡΠ½ΡΡ
ΠΊΠΎΠΌΠΌΡΠ½ΠΈΠΊΠ°ΡΠΈΠΉ Π²Π½ΡΡΡΠΈ ΠΠΠ. Π Π°Π·ΡΠ°Π±ΠΎΡΠΊΠ°
ΡΠΎΡΡΠ΄ΠΈΡΡΠΎ-Π½Π΅ΡΠ²Π½ΡΡ
Π΅Π΄ΠΈΠ½ΠΈΡ Π½Π° ΡΠΈΠΏΠ΅ ΠΈΠ»ΠΈ ΠΠΠ Π½Π° ΡΠΈΠΏΠ΅, Π° ΡΠ°ΠΊΠΆΠ΅ 3D ΠΠΠ ΠΈ ΠΌΠΎΠ΄Π΅Π»ΠΈ ΡΠΊΠ°Π½ΠΈ ΠΌΠΎΠ·Π³Π°
ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΠ²Π°ΡΡ Π½ΠΎΠ²ΡΠ΅ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Ρ ΠΊ ΠΏΠΎΠ½ΠΈΠΌΠ°Π½ΠΈΡ ΠΌΠ΅ΠΆΠΊΠ»Π΅ΡΠΎΡΠ½ΡΡ
Π²Π·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉΡΡΠ²ΠΈΠΉ, ΠΊΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π΄Π»Ρ
ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΌΠΎΠ·Π³Π°, ΠΏΠΎΡΡΠΎΠΌΡ ΠΎΠ½ΠΈ ΠΎΡΠ΅Π½Ρ Π²Π°ΠΆΠ½Ρ Π΄Π»Ρ ΡΡΠ°Π½ΡΠ»ΡΡΠΈΠΎΠ½Π½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ,
ΠΎΡΠΊΡΡΡΠΈΡ Π»Π΅ΠΊΠ°ΡΡΡΠ² ΠΈ ΡΠΎΠ·Π΄Π°Π½ΠΈΡ Π½ΠΎΠ²ΡΡ
Π°Π½Π°Π»ΠΈΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠ»Π°ΡΡΠΎΡΠΌ. ΠΠ΄Π½ΠΈΠΌ ΠΈΠ· ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΉ
ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈΡΡΠ΅ΡΡΡ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΡ ΠΠΠ, ΡΠ²Π»ΡΠ΅ΡΡΡ Π½Π΅ΠΉΡΠΎΠ³Π΅Π½Π΅Π· Π² ΡΠ·ΠΊΠΎΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΎΠ±Π»Π°ΡΡΡΡ
ΠΌΠΎΠ·Π³Π° (Π½Π΅ΠΉΡΠΎΠ³Π΅Π½Π½ΡΠ΅ Π½ΠΈΡΠΈ, ΠΠ), ΠΊΠΎΡΠΎΡΡΠ΅ ΡΠ»ΡΠΆΠ°Ρ ΠΈΡΡΠΎΡΠ½ΠΈΠΊΠΎΠΌ Π΄Π»Ρ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠ°Π½ΠΈΡ ΠΏΡΠ»Π° ΡΡΠ²ΠΎΠ»ΠΎΠ²ΡΡ
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ΠΏΡΠΎΠ³Π΅Π½ΠΈΡΠΎΡΠ½ΡΡ
ΠΊΠ»Π΅ΡΠΎΠΊ, ΠΏΡΠΎΠ»ΠΈΡΠ΅ΡΠ°ΡΠΈΠΈ, Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°ΡΠΈΠΈ ΠΈ ΠΌΠΈΠ³ΡΠ°ΡΠΈΠΈ Π½ΠΎΠ²ΠΎΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½Π½ΡΡ
Π½Π΅ΠΉΡΠΎΠ½ΠΎΠ²
ΠΈ Π³Π»ΠΈΠ°Π»ΡΠ½ΡΡ
ΠΊΠ»Π΅ΡΠΎΠΊ. Π‘ΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ²ΠΎΠΉΡΡΠ²Π°
ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΠ°Π»ΡΠ½ΡΡ
ΠΊΠ»Π΅ΡΠΎΠΊ ΠΌΠΈΠΊΡΠΎΡΠΎΡΡΠ΄ΠΎΠ² Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ
ΠΌΠΎΠ·Π³Π°, Π² ΡΠ°ΡΡΠ½ΠΎΡΡΠΈ Π²ΡΡΠΎΠΊΠΎΠ΅ ΡΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅ ΠΌΠΈΡΠΎΡ
ΠΎΠ½Π΄ΡΠΈΠΉ, Π²Π°ΠΆΠ½Ρ Π΄Π»Ρ ΡΠΎΠ·Π΄Π°Π½ΠΈΡ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ
ΠΏΡΠΈ ΠΠΠ ΠΈ ΠΠ. ΠΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠ°Ρ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΊΠ»Π΅ΡΠΎΠΊ Π²Π½ΡΡΡΠΈ ΠΠ ΠΈ ΠΠΠ ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΡΠ΅Ρ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠ°Π½ΠΈΡ
ΠΌΠ΅ΠΆΠΊΠ»Π΅ΡΠΎΡΠ½ΡΡ
ΠΊΠΎΠΌΠΌΡΠ½ΠΈΠΊΠ°ΡΠΈΠΉ, ΠΊΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈ Π²Π°ΠΆΠ½ΡΡ
Π΄Π»Ρ ΡΠ΅Π»ΠΎΡΡΠ½ΠΎΡΡΠΈ ΠΌΠ½ΠΎΠ³ΠΎΠΊΠ»Π΅ΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΌΠΎΠ΄ΡΠ»Ρ.
Π ΡΠ°Π±ΠΎΡΠ΅ ΠΎΠ±ΡΡΠΆΠ΄Π°ΡΡΡΡ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Ρ ΠΊ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠ΅ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠΈΠΊΡΠΎΡΡΠ΅Π΄Ρ Π΄Π»Ρ in vitro
ΠΌΠΎΠ΄Π΅Π»Π΅ΠΉ ΠΠΠ, ΠΠΠ ΠΈ ΠΠ. ΠΡΠΎΠ±ΠΎΠ΅ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ ΡΠ΄Π΅Π»Π΅Π½ΠΎ ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Π°ΠΌ Π½Π΅ΠΉΡΠΎΠΈΠ½ΠΆΠ΅Π½Π΅ΡΠΈΠΈ ΠΈ Π±ΠΈΠΎΠΏΠ΅ΡΠ°Ρ
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%, Ο2 6.71, P = 0.081), use of prophylactic antibiotics (44.2%, Ο2 221.05, P < 0.00001), early enteral feeding (33.2%, Ο2 11.51, P = 0.009), and the implementation of early cholecystectomy strategies (29%, Ο2 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 1.135β15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359β5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138β5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184β5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598β9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090β6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286β5.712; 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 1.912β7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138β0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143β0.716; 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.]