Transplant coronary heart disease: Challenges and solutions

Cardiac allograft vasculopathy (CAV) remains one of the leading causes of death and graft failure after heart transplantation. A variety of causes, including donor heart characteristics, recipient risk factors, and immune-mediated influences, are associated with developing CAV. In this review, we will focus on the pathophysiology of developing CAV and various methods to screen for this condition. The pathogenesis of CAV likely involves repeated injuries to the endothelium from a variety of factors such as cellular-mediated rejection, and alloimmune factors, including antibody-mediated injury, ischemia-reperfusion injury at time of transplant, cytomegalovirus infections, immunosuppression medications, systemic inflammation, and tra­ditional atherosclerosis risk factors. Patients with significant CAV are often asymptomatic, and therefore early detection by routine screening prior to graft dysfunction is crucial. There are a variety of invasive, noninvasive, and blood tests that have been studied as screening methods, and we will discuss the role of each of these in this review article. Although some treatment regimens have been established for CAV, this is an area where further studies and research are necessary

SCAI SHOCK: Does the Stage Help with Management Decisions?

No abstract for an Editorial

Etude d'un procédé d'extraction en continu des glycosides de stéviol à partir des feuilles de Stévia (Stevia rebaudiana Bertoni)

L’alimentation des pays industrialisés, souvent trop riche en glucides et en lipides, a engendré une augmentation marquée de l’obésité et favorisé le risque de diabète. Face à ce constat, l’industrie agroalimentaire s’est efforcée de développer des produits allégés. Au sucre, ont ainsi été substitués les édulcorants acaloriques, molécules au goût sucré non métabolisées par le corps humain. Ces édulcorants sont souvent obtenus par voie de synthèse chimique comme l’aspartame, l’acésulfame K ou encore le sucralose. S’ils sont autorisés dans la confection de produits alimentaires, la toxicité de ces édulcorants et leur impact sur la santé humaine nourrissent cependant les débats au sein de la communauté scientifique, ainsi des solutions alternatives sont envisagées. Stevia rebaudiana Bertoni est une plante originaire du Paraguay. Son intérêt principal réside dans le fait qu’elle contient des molécules acaloriques au goût sucré, les glycosides de stéviol, dont les plus connus sont le rébaudioside A et le stévioside. Les études effectuées sur ces diterpènes glycosilés tendent à souligner leur innocuité. Ils présenteraient même des vertus thérapeutiques, comme des propriétés anti-hypertensive ou antidiabétique, et semblent ainsi être une alternative prometteuse au sucre et aux édulcorants artificiels. Notre étude s’est orientée sur l’extraction aqueuse des glycosides de stéviol des feuilles de Stévia. A l’échelle laboratoire, nous avons pu mettre en évidence que la cinétique d’extraction des molécules cibles est principalement limitée par la diffusion des solutés dans la matrice solide végétale. Il n’y aurait pas de réaction chimique, de gonflement de la matière ou de modification de la porosité pendant le processus d’extraction. Nous avons également pu souligner que la préparation de la matière (séchage et broyage) et les conditions opératoires (température, ratio liquide-solide et agitation) sont des facteurs prépondérants sur l’efficacité d’extraction des édulcorants. A l’échelle pilote, les résultats obtenus en systèmes discontinu et continu ont pu mettre en exergue des influences similaires de la préparation de la matière et des conditions opératoires ; nous avons de plus pu démontrer que la qualité du mélange des phases solide et liquide était un facteur clé à l’efficacité de l’extraction. Fort de ces résultats nous avons pu développer un procédé d’extraction en système continu, adapté à l’extraction des glycosides de stéviol des feuilles de Stévia, et combiné à une étape de séparation solide-liquide. Au travers de nos différentes expériences, nous avons pu décrire précisément son fonctionnement et optimiser l’extraction afin de pouvoir envisager une transposition à l’échelle industrielle

High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure: The FLORALI study

An evaluation of a recent study by Frat JP, Thille AW, Mercat A et al: High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure. New England Journal of Medicine 2015;372(23):2185-96. PubMed PMID: 25981908. Clinicaltrials.gov number NCT01320384

Effect of monovalency on anti-contactin-1 IgG4

Altres ajuts: Agence Nationale pour le Développement de la Recherche en Santé ; Association Française contre les Myopathies ; ArgenxAutoimmune nodopathies (AN) have been diagnosed in a subset of patients fulfilling criteria for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) who display no or poor response to intravenous immunoglobulins. Biomarkers of AN are autoantibodies, mainly IgG4, directed against the ternary paranodal complex composed by neurofascin-155, contactin-1 (CNTN1), and Contactin-associated-protein-1 (CASPR1) or against the nodal isoforms of neurofascin. IgG4 can undergo a Fab-arm exchange (FAE) which results in functionally monovalent antibody. This phenomenon differentially affects the pathogenicity of IgG4 depending on the target of autoantibodies. Here, we have evaluated this issue by examining the impact of valency on anti-CNTN1 IgG4 which induces paranodal destruction through a function blocking activity. Sera were obtained from 20 patients with AN associated with anti-CNTN1 antibodies. The proportion of monospecific/bispecific anti-CNTN1 antibodies was estimated in each patient by ELISA by examining the ability of serum antibodies to cross-link untagged CNTN1 with biotinylated CNTN1. To determine the impact of monovalency, anti-CNTN1 IgG4 were enzymatically digested into monovalent Fab and tested in vitro on cell aggregation assay. Also, intraneural injections were performed to determine whether monovalent Fab and native IgG4 may penetrate paranode, and antibody infiltration was monitored 1- and 3-days post injection. We found that the percentage of monospecific antibodies were lower than 5% in 14 out of 20 patients (70%), suggesting that IgG4 have undergone extensive FAE in situ. The levels of monospecific antibodies correlated with the titers of anti-CNTN1 antibodies. However, no correlation was found with clinical severity, and patients with low or high percentage of monospecific antibodies similarly showed a severe phenotype. Native anti-CNTN1 IgG4 were shown to inhibit the interaction between cells expressing CNTN1/CASPR1 and cells expressing neurofascin-155 using an in vitro aggregation assay. Similarly, monovalent Fab significantly inhibited the interaction between CNTN1/CASPR1 and neurofascin-155. Intraneural injections of Fab and native anti-CNTN1 IgG4 indicated that both mono- and bivalent anti-CNTN1 IgG4 potently penetrated the paranodal regions and completely invaded this region by day 3. Altogether, these data indicate anti-CNTN1 IgG4 are mostly bispecific in patients, and that functionally monovalent anti-CNTN1 antibodies have the pathogenic potency to alter paranode

IgG4 Valency Modulates the Pathogenicity of Anti-Neurofascin-155 IgG4 in Autoimmune Nodopathy

Altres ajuts: Agence Nationale pour la Recherche; Association Française contre les Myopathies (23593).Background and Objective s : IgG4 autoantibodies to neurofascin-155 (Nfasc155) are associated with a subgroup of patients with chronic inflammatory demyelinating polyneuropathy (CIDP), currently named autoimmune nodopathy. We previously demonstrated that those antibodies alter conduction along myelinated axons by inducing Nfasc155 depletion and paranode destruction. In blood, IgG4 have the potency to exchange their moiety with other unrelated IgG4 through a process called Fab-arm exchange (FAE). This process results in functionally monovalent antibodies and may affect the pathogenicity of autoantibodies. Here, we examined this issue and whether FAE is beneficial or detrimental for Nfasc155 autoimmune nodopathy. Methods : The bivalency and monospecificity of anti-Nfasc155 were examined by sandwich ELISA in 10 reactive patients, 10 unreactive CIDP patients, and 10 healthy controls. FAE was induced in vitro using reduced glutathione and unreactive IgG4, and the ratio of the : light chain was monitored. To determine the pathogenic potential of bivalent anti-Nfasc155 IgG4, autoantibodies derived from patients were enzymatically cleaved into monovalent Fab and bivalent F(ab')2 or swapped with unreactive IgG4 and then were injected in neonatal animals. Results : Monospecific bivalent IgG4 against Nfasc155 were detected in the serum of all reactive patients, indicating that a fraction of IgG4 have not undergone FAE in situ. These IgG4 were, nonetheless, capable of engaging into FAE with unreactive IgG4 in vitro, and this decreased the levels of monospecific antibodies and modulated the ratio of the : light chain. When injected in animals, monovalent anti-Nfasc155 Fab did not alter the formation of paranodes; by contrast, both native anti-Nfasc155 IgG4 and F(ab')2 fragments strongly impaired paranode formation. The promotion of FAE with unreactive IgG4 also strongly diminished the pathogenic potential of anti-Nfasc155 IgG4 in animals and decreased IgG4 clustering on Schwann cells. Discussion : Our findings demonstrate that monospecific and bivalent anti-Nfasc155 IgG4 are detected in patients and that those autoantibodies are the pathogenic ones. The transformation of anti-Nfasc155 IgG4 into monovalent Fab or functionally monovalent IgG4 through FAE strongly decreases paranodal alterations. Bivalency thus appears crucial for Nfasc155 clustering and paranode destruction

Response surface methodology to optimise Accelerated Solvent Extraction of steviol glycosides from Stevia rebaudiana Bertoni leaves

Following the approval of steviol glycosides as a food additive in Europe in December 2011, large-scale stevia cultivation will have to be developed within the EU. Thus there is a need to increase the efficiency of stevia evaluation through germplasm enhancement and agronomic improvement programs. To address the need for faster and reproducible sample throughput, conditions for automated extraction of dried stevia leaves using Accelerated Solvent Extraction were optimised. A response surface methodology was used to investigate the influence of three factors: extraction temperature, static time and cycle number on the stevioside and rebaudioside A extraction yields. The model showed that all the factors had an individual influence on the yield. Optimum extraction conditions were set at 100°C, 4min and 1 cycle, which yielded 91.8%±3.4% of total extractable steviol glycosides analysed. An additional optimisation was achieved by reducing the grind size of the leaves giving a final yield of 100.8%±3.3%

Effect of a fungal chitosan preparation on Brettanomyces bruxellensis,a wine contaminant

To investigate the action mechanisms of a specific fungal origin chitosan preparation on Brettanomyces bruxellensis. METHODS AND RESULTS: Different approaches in a wine-model synthetic medium were carried out: optical and electronic microscopy, flow cytometry, ATP flow measurements and zeta potential characterization. The inactivation effect was confirmed. Moreover, fungal origin chitosan induced both physical and biological effects on B. bruxellensis cells. Physical effect led to aggregation of cells with chitosan likely due to charge interactions. At the same time, a biological effect induced a leakage of ATP and thus a viability loss of B. bruxellensis cells. CONCLUSIONS: The antimicrobial action mode of chitosan against B. bruxellensis is not a simple mechanism but the result of several mechanisms acting together. SIGNIFICANCE AND IMPACT OF THE STUDY: Brettanomyces bruxellensis, a yeast responsible for the production of undesirable aromatic compounds (volatile phenols), is a permanent threat to wine quality. Today, different means are implemented to fight against B. bruxellensis, but are not always sufficient. The chitosan of fungal origin is introduced as a new tool to control B. bruxellensis in winemaking and has poorly been studied before for this application

Green extraction of glycosides from Stevia rebaudiana (Bert.) with low solvent consumption: A desirability approach

AbstractThe sweet flavor of Stevia rebaudiana (Bert.) leaf extract is well known and has raised the interest of huge food companies due to its natural bid. The extraction of their main glycosides stevioside and rebaudioside A is an important step on the preparation of final Stevia granules. The aim of the work reported here was to study and optimize the dynamic maceration of Stevia leaves using water and ethanol as green solvents. For instance, a fractional factorial design was chosen to evaluate the individual effects of the drug powder size, weight ratio of drug to solvent, temperature, agitation, and time on the yield of these glycosides. The glycosides were quantified by high pressure liquid chromatography. An exhaustive extraction by successive maceration steps showed that ethanol 70% was superior to water and ethanol 90% for stevioside and rebaudioside extraction. The liquid extract composition in dry basis and the yield of stevioside and rebaudioside A were significantly affected by the drug to solvent weight ratio, showing that larger volumes of solvent should be used. Furthermore, increasing solvent volume favors the extraction of the stevioside by a twofold factor as compared to rebaudioside A. Among the other factors, only drug powder size affected the yield of rebaudioside A significantly. The optimal solution for S. rebaudiana leaves dynamic extraction estimated by desirability functions methodology led to a condition which allows obtaining extraction yields of 2.31 and 1.24% for stevioside and rebaudioside A and their concentrations in dried extract corresponding to 8.38 and 4.51%, respectively. These high yields were obtained with drug to solvent ratio (1:10, w/w) much higher than previous works, thus resulting in a more sustainable and green process

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

BackgroundAdult critically ill patients often suffer from acute circulatory failure and those with low cardiac output may be treated with inotropic agents. The aim of this Scandinavian Society of Anaesthesiology and Intensive Care Medicine guideline was to present patient-important treatment recommendations on this topic. MethodsThis guideline was developed according to GRADE. We assessed the following subpopulations of patients with shock: (1) shock in general, (2) septic shock, (3) cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery, and (6) other types of shock, including vasodilatory shock. We assessed patient-important outcome measures, including mortality and serious adverse reactions. ResultsFor all patients, we suggest against the routine use of any inotropic agent, including dobutamine, as compared to placebo/no treatment (very low quality of evidence). For patients with shock in general, and in those with septic and other types of shock, we suggest using dobutamine rather than levosimendan or epinephrine (very low quality of evidence). For patients with cardiogenic shock and in those with shock after cardiac surgery, we suggest using dobutamine rather than milrinone (very low quality of evidence). For the other clinical questions, we refrained from giving any recommendations or suggestions. ConclusionsWe suggest against the routine use of any inotropic agent in adult patients with shock. If used, we suggest using dobutamine rather than other inotropic agents for the majority of patients, however, the quality of evidence was very low, implying high uncertainty on the balance between the benefits and harms of inotropic agents.Peer reviewe