Lessons Learned from the Amputation of a Bilateral Hand Grafted Patient due to Psychiatric Disorders

The importance of psychosocial aspects in upper extremity transplantation (UET) has been emphasized since the beginning of the vascularized composite allotransplantation era. Herein a long-term UET failure mainly due to psychiatric disorders is reported. A young woman amputated in 2004 (electrocution) underwent bilateral UET in 2007. At the time of transplantation the patient underwent a psychological evaluation, which did not completely consider some traits of her personality. Indeed, she had an anxious personality and a tendency to idealize. The trauma of amputation, the injuries associated with the accident, and the short delay between the accident and the transplantation elicited vindictiveness, entitlement, and impulsivity. Following transplantation, she had a high anxiety level, panic attacks, depression, and hypomanic episodes. She was poorly compliant to the rehabilitation program and the immunosuppressive treatment. She developed 13 acute rejection episodes (reversed by appropriate treatment) but neither clinical signs of chronic rejection nor donor specific antibiodies. She developed many severe complications due to the treatment and the psychiatric disorders. At her request, after many interviews, the allografts were removed in 2018. Pathological examination and an angiography performed post-amputation revealed signs of graft vasculopathy of varying severity, in the absence of clinically overt chronic rejection. This case highlights the need to detect during the initial patients’ assessment even mild traits of personality disorders, which could herald psychiatric complications after the transplantation, compromising UET outcomes. It further confirms that skin and vessels are the main targets of the alloimmune response in the UET setting

Lipogenesis in arterial wall and vascular smooth muscular cells: regulation and abnormalities in insulin-resistance

<p>Abstract</p> <p>Background</p> <p>Vascular smooth muscular cells (VSMC) express lipogenic genes. Therefore <it>in situ </it>lipogenesis could provide fatty acids for triglycerides synthesis and cholesterol esterification and contribute to lipid accumulation in arterial wall with aging and during atheroma.</p> <p>Methods</p> <p>We investigated expression of lipogenic genes in human and rat arterial walls, its regulation in cultured VSMC and determined if it is modified during insulin-resistance and diabetes, situations with increased risk for atheroma.</p> <p>Results</p> <p>Zucker obese (ZO) and diabetic (ZDF) rats accumulated more triglycerides in their aortas than their respective control rats, and this triglycerides content increased with age in ZDF and control rats. However the expression in aortas of lipogenic genes, or of genes involved in fatty acids uptake, was not higher in ZDF and ZO rats and did not increase with age. Expression of lipogenesis-related genes was not increased in human arterial wall (carotid endarterectomy) of diabetic compared to non-diabetic patients. <it>In vitro</it>, glucose and adipogenic medium (ADM) stimulated moderately the expression and activity of lipogenesis in VSMC from control rats. LXR agonists, but not PXR agonist, stimulated also lipogenesis in VSMC but not in arterial wall <it>in vivo</it>. Lipogenic genes expression was lower in VSMC from ZO rats and not stimulated by glucose or ADM.</p> <p>Conclusion</p> <p>Lipogenic genes are expressed in arterial wall and VSMC; this expression is stimulated (VSMC) by glucose, ADM and LXR agonists. During insulin-resistance and diabetes, this expression is not increased and resists to the actions of glucose and ADM. It is unlikely that this metabolic pathway contribute to lipid accumulation of arterial wall during insulin-resistance and diabetes and thus to the increased risk of atheroma observed in these situations.</p

Etude pour le développement de l'endothélialisation des prothèses vasculaires (adaptation dynamique de fibroblastes et de cellules endothétiales humaines ensemencées sur des biomatériaux vasculaires, après exposition à des forces rhéologiques physiologiques)

L'obtention d'une adhérence persistante de cellules endothéliales humaines (ECs) à la surface d'un polymère en présence de contraintes rhéologiques est un important prérequis au développement de l'endothélialisation des prothèses vasculaires. L'adhérence primaire et la surface d'ancrage de fibroblastes et d'ECs ensemencés étaient déterminées pour 3 biomatériaux différents (prothèses en polytetrafluoroethylene, polyurethane et polyethylene terephthalate). Les cellules étaient incubées pendant 7 jours sur les polymères enduits de collagène I/III. Après l'incubation, l'ancrage cellulaire, le nombre de cellules restantes, leurs caractéristiques morphométriques ainsi que l'expression des molécules d'adhésion cellulaire (CAM) étaient évalués en présence de forces de cisaillement de 0, 10 et 20 dynes/cm2 caractéristiques d'un pontage fémoro-poplité. Ces contraintes rhéologiques étaient créées par un appareil expérimental rotatif et étaient maintenues pendant 1h. L'adhérence maximale initiale était observée sur tous les supports enduits en condition statique. Après l'exposition, nous avons noté que le pourcentage de cellules adhérantes, la surface de couverture cellulaire et la surface des cellules restantes dépendaient du phénotype cellulaire, de la présence de collagène, des forces rhéologiques appliquées et du biomatériau. Après 1h d'exposition, plus de 70% des ECs sur l'ePTFE, de 55% des ECs sur le PET et de 55% des ECs sur le PU étaient capables de résister à une force de 10 dynes/cm2. Utilisant un procédé quantitatif immuno-enzymatique, nous n'avons pas observé que l'expression des CAM se modifiait avec l'augmentation des forces de cisaillement. La compréhension et l'amélioration de certains paramètres physico-chimiques, devraient pouvoir permettre de créer à la surface des biomatériaux vasculaires, un néo-endothélium efficace.LYON1-BU Santé (693882101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Multiscale bio-chemo-mechanical model of intimal hyperplasia

International audienceWe consider a computational multiscale framework of a bio-chemo-mechanical model for intimal hyperplasia. With respect to existing models, we investigate the interactions between hemodynamics, cellular dynamics and biochemistry on the development of the pathology. Within the arterial wall, we propose a mathematical model consisting of kinetic differential equations for key vascular cell types, collagen and growth factors. The luminal hemodynamics is modelled with the Navier-Stokes equations. Coupling hypothesis among time and space scales are proposed to build a tractable modelling of such a complex multifactorial and multiscale pathology. A one-dimensional numerical test-case is presented for validation by comparing the results of the framework with experiments at short and long timescales. Our model permits to capture many cellular phenomena which have a central role in the physiopathology of intimal hyperplasia. Results are quantitatively and qualitatively consistent with experimental findings at both short and long timescales

Etude topochimique des bois de réaction à l'échelle ultrastructurale

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Effects on Mortality and Cardiovascular Events of Adherence to Guideline-Recommended Therapy 4 Years after Lower Extremity Arterial Revascularization

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How Admission to a Vascular Surgery Department Improves Medical Treatment in Patients with Lower Extremity Peripheral Arterial Disease

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Résultats du traitement chirurgical des syndromes de loges chroniques des membres inférieurs

Contexte : Le traitement de référence du syndrome de loge chronique des membres inférieurs est le traitement chirurgical. Cependant, la pratique clinique révèle parfois une symptomatologie douloureuse postopératoire persistante avec une limitation du niveau d’activité. Objectifs : Évaluer le résultat de la prise en charge chirurgicale et d’en chercher des facteurs prédictifs. Méthode : Étude rétrospective sur une population composée de 16 sujets, d’âge moyen 27 ans trois quarts. Le délai postopératoire était compris entre trois mois et deux ans avec une médiane de dix mois. L’évaluation du résultat du traitement a été effectuée par contact téléphonique avec les patients à l’aide d’un questionnaire. Résultats : Pamis les patients, 37,5 % ont une indolence totale et 62,5 % ont retrouvé un niveau d’activités équivalent à leur pratique antérieure. Le niveau de retour aux activités est diminué lorsque la loge postérieure est atteinte (p = 0,008) et lorsque le tableau clinique initial est atypique (p = 0,035). Un tableau clinique initial atypique est également en faveur d’une disparition incomplète des douleurs (p = 0,011). Conclusion : Les résultats du traitement chirurgical ne sont pas uniformes, tant sur la douleur que sur le niveau de retour aux activités en fonction du type de loge atteinte et de la présentation clinique initiale. Dans ces circonstances, la recherche des diagnostics différentiels est fondamentale

Preliminary Experience with the GORE® EXCLUDER® Iliac Branch Endoprosthesis for Common Iliac Aneurysm Endovascular Treatment

International audienceBACKGROUND:The aim of this study is to assess the safety and the short-term results of endovascular treatment of common iliac artery (CIA) aneurysms using the new GORE EXCLUDER iliac branch endoprosthesis (IBE) device.METHODS:The study is a retrospective with prospective follow-up nonrandomized, single-arm evaluation. Patients with a CIA aneurysm (diameter >30 mm) extending to the iliac bifurcation underwent endovascular treatment with the Gore IBE. Anatomic and procedural data were collected. Computed tomography angiography (CTA) was performed within the 30 days after the procedure and every 6 month. Thirty-day and at least 6-months outcomes were investigated.RESULTS:From February 2014 to December 2014, 10 male patients with aneurysmal CIA (mean age 75 years old) underwent consecutive endovascular treatment with the Gore IBE. The CIA aneurysm (mean diameter 43.2 mm, range 32-49) treated with the Gore IBE was associated with an abdominal aortic aneurysm (AAA) in 5 patients. One patient had a previous AAA open repair. CIA aneurysm was bilateral in 5 patients. Preliminary procedure of internal iliac artery embolization was performed in 3 patients. Technical success rate of the Gore IBE implantation was 100% with a median fluoroscopy time of 35 min (range 12-64, ±16) and median contrast load of 150 mL (range 100-250, ±45). No perioperative complications were observed. Median length of stay was 4 days (range 3-7, ±2). One aortic type Ia endoleak was observed on the postoperative CT scan requiring an aortic extension at day 3. Branch patency was observed in all 10 patients at 1 month and 9 patients at 6 month. All CIA aneurysms were excluded without type Ib or type III endoleak.CONCLUSIONS:The technical success and short-term results demonstrate encouraging results and clinical benefits of the new GORE EXCLUDER IBE. A longer follow-up is needed to assess midterm and long-term results