Immune monitoring and modulating hypoxia-mediated injury in pancreatic islet transplantation

Le diabète de type 1 (DT1) est une maladie auto-immune caractérisée par la destruction des cellules β du pancréas responsables de la sécrétion d'insuline. Certains patients présentent une forme de diabète dit « instable » comportant des hypoglycémies souvent sévères. C'est pour ces patients que la greffe d'îlots pancréatiques est indiquée et la plus efficace à ce jour. Néanmoins, la voie portale de transplantation est en proie à des causes multifactorielles de destruction aiguë des îlots et de perte tardive de fonction du greffon. Nous avons premièrement tenté de détecter précocement le rejet allo-immun cellulaire à partir du sang périphérique de receveurs d'îlots. Nous avons ensuite exploré le rôle du microenvironnement hépatique dans la perte précoce du greffon. Enfin, nous avons mené deux études ayant pour but d'augmenter la résistance du greffon à l'hypoxie et de moduler la réponse de l'immunité innée après la transplantation d'îlots

Intraportal islet transplantation: the impact of the liver microenvironment

The portal vein remains the preferred site for pancreatic islet transplantation due to its easy access and low morbidity. However, despite great progress in isolation and transplantation protocols over the past few years, it is still associated with the early loss of some 50-70% of transplanted islets. The complex liver microenvironment itself presumably plays an important role in this loss. The present review focuses on the specifics of the liver microenvironment, notably the localized hepatic ischemia/reperfusion injury following transplantation, the low oxygenation of the portal vein, the instant blood-mediated inflammatory reaction, the endogenous liver immune system, and the gut-liver axis, and how they can each have an impact on the transplanted islets. It identifies the potential, or already applied, clinical interventions for improving intraportal islet survival, and pinpoints those promising areas still lacking preclinical research. Future interventions on clinical intraportal islet transplantation need to take into account the global context of the liver microenvironment, with multi-point interventions being most likely to improve early islet survival and engraftment

Artificial Intelligence: Present and Future Potential for Solid Organ Transplantation

Artificial intelligence (AI) refers to computer algorithms used to complete tasks that usually require human intelligence. Typical examples include complex decision-making and- image or speech analysis. AI application in healthcare is rapidly evolving and it undoubtedly holds an enormous potential for the field of solid organ transplantation. In this review, we provide an overview of AI-based approaches in solid organ transplantation. Particularly, we identified four key areas of transplantation which could be facilitated by AI: organ allocation and donor-recipient pairing, transplant oncology, real-time immunosuppression regimes, and precision transplant pathology. The potential implementations are vast-from improved allocation algorithms, smart donor-recipient matching and dynamic adaptation of immunosuppression to automated analysis of transplant pathology. We are convinced that we are at the beginning of a new digital era in transplantation, and that AI has the potential to improve graft and patient survival. This manuscript provides a glimpse into how AI innovations could shape an exciting future for the transplantation community

Exercise-based Interventions for Nonalcoholic Fatty Liver Disease: A Meta-analysis and Meta-regression

The burden of nonalcoholic fatty liver disease (NAFLD) is increasing worldwide. We performed a meta-analysis to determine the effectiveness of exercise-based lifestyle interventions on liver-specific end points in populations with NAFLD and underlying metabolic disorders such as obesity, type 2 diabetes, or metabolic syndrome

Maladie hémorroïdaire en 2022 : comment choisir le traitement adapté ?

Hemorrhoidal disease is frequent and can lead to major alteration of quality of life. Conservative treatment, instrumental therapies and surgical approach play a complementary role in the management of hemorrhoidal disease. Understanding all techniques is mandatory to guide the patient and offer the best individualized treatment. Guidelines issued by scientific societies can facilitate the therapeutic decision.La maladie hémorroïdaire est fréquente et ses répercussions sur la qualité de vie peuvent être majeures. Traitement conservateur, procédés non chirurgicaux et interventions chirurgicales jouent un rôle complémentaire dans le traitement d’une maladie hémorroïdaire symptomatique. Pour guider le patient et lui offrir la prise en charge la plus adaptée à sa situation, une connaissance des différents traitements est indispensable. Les recommandations des sociétés savantes, basées sur des avis d’experts, peuvent faciliter la décision thérapeutique

PROphylactic MESH (PROMESH) for stoma closure: does it reduce the incidence of incisional hernia? Protocol for a triple-blinded randomised controlled trial

Introduction: Application of a prophylactic mesh during stoma closure was shown to reduce the incidence of incisional hernia at the site of stoma closure. Our objective is to provide high quality evidence to validate this finding.Methods and analysis: The study will be a randomised controlled triple-blinded superiority parallel monocentric trial. Patients undergoing elective ileostomy or colostomy closure after surgery for digestive cancer will be eligible for inclusion. Patients allergic to the mesh, immunosuppressed or refusing to participate will be excluded. Randomisation will be performed based on a 1:1 allocation ratio between stoma closure with application of a non-absorbable mesh in the sublay position (intervention) and stoma closure without a mesh (control). The primary outcome will be the 1-year incidence of incisional hernia at the site of stoma closure, determined clinically and by CT. Secondary outcomes will be the 31-day incidence of surgical site infection and the modified Carolinas Comfort Scale. Patients, radiologists and investigators performing the assessment at 1 year will be blinded for the allocated study group. Analysis will be performed in intention-to-treat. The trial will include 68 patients (34 with mesh, 34 without mesh).Ethics and dissemination: The present randomised controlled trial was registered into clinicaltrials.gov (NCT04510558) and was accepted by the local ethic committee (Geneva, Switzerland: CCER 2021-00053). The results will be presented at national and international congresses in the fields of colorectal surgery and general surgery, and published in a peer-reviewed journal.</p

The 14th European Colorectal Congress (#ECCStGallen), 29 November-2 December 2020, St. Gallen, Switzerland

With the second wave of the COVID-19 pandemic in full swing in Europe, organizers of the 14th European Colorectal Congress (ECC) had to think on their feet and hastily rearrange this year's congress, held from November 29th to December 2nd 2020, in its first ever virtual format

Fecal microbiota transplantation: a promising strategy in preventing the progression of non-alcoholic steatohepatitis and improving the anti-cancer immune response

Non-alcoholic fatty liver disease (NAFLD) has the potential to progress to hepatocellular carcinoma (HCC). However, limited therapies are currently available for the treatment of advanced HCC, and one must strive to search for novel strategies. Areas covered: We provide insight on current knowledge related to gut microbiota and NAFLD, summarize the sequence linking obesity to HCC and highlight gut dysbiosis in obesity and its consequences on the liver. We detail the impact of the gut microbiota on immune checkpoint inhibitors, and speculate on the role of fecal microbiota transplantation (FMT) in NAFLD and in improving anti-neoplastic immune response. Expert Opinion: Manipulation of the gut microbiota seems promising in the secondary prevention of NAFLD/NASH and/or in potentiating anti-cancer immune response, notably by a global 'resetting' using FMT. However, the composition of a 'harmful' gut microbiome in HCC still needs to be characterized, and the impact of FMT on HCC growth needs to be assessed