Rerouting in vascular access infections using a biosynthetic vascular graft (Omniflow® II)

Background Surgical treatment of infected arteriovenous grafts (AVG) while preserving the hemodialysis access remains a challenge. Partial graft excision (PGE) directly followed by interposition grafting (IG) is an established method but is associated with a high rate of local reinfection. This retrospective study investigated the technique of rerouting using a biosynthetic vascular graft (Omniflow® II). Methods This was a retrospective analysis of all patients at a tertiary referral center undergoing surgical treatment for AVG infections using PGE and IG with the rerouting technique using Omniflow® II between January 2009 and December 2018. Follow-up data were collected until May 2021. Results Fifteen patients (53% male, median age 62 years [range 49-81]) were identified for further analysis, thereof twelve received an Omniflow® II vascular graft. Eleven patients had positive local microbial cultures, with Staphylococcus aureus being the most frequently identified pathogen (9 cases). Mortality and reoperation rates within 30 days were both 0%. Median follow-up was 32 months (range 2–101 months) with a median follow-up index of 0.92 (range 0.18–1). During follow-up a surgical intervention for reinfection was necessary in 3 patients with Omniflow® II at a median of 304 days (range 298–485 days). Conclusion Partial graft excision and direct interposition grafting using a biosynthetic Omniflow® II vascular graft is a valid treatment option in selected patients with AVG infections when total graft excision can be avoided. Using a careful rerouting technique, while preserving clinically noninfected graft sections the risk of early reinfection can be minimized and the dialysis access maintained

Pralina: Practices about Nonalcoholic Fatty Liver Disease among French gastroenterologists

Biology, biomarkers of hepatic fibrosis, imaging and Fibroscan® have opened new perspectives to differentiate common steatosis from steatohepatitis potentially contributing to the development of fibrosis. Liver puncture biopsy remains inevitable if a discrepancy arises between the tests and in the case of an advanced stage. It thus allows for intensifying the medical treatment combining insulin-sensitizing agents and antifibrotic therapy.La biologie, les marqueurs biologiques de fibrose hépatique, l'imagerie et le Fibroscan® offrent de nouvelles perspectives pour différencier la banale stéatose de la stéatohépatite dont l'évolution fibrosante est rappelée. La ponction biopsie hépatique reste encore incontournable lorsqu'il existe une discordance entre les tests et en cas de forme avancée. Elle permet alors d'intensifier le traitement médical jouant sur l'insulino-résistance et les agents antifibrosants

The Effect of Single Versus Group μCT on the Detection of Trabecular and Cortical Disease Phenotypes in Mouse Bones

Micro‐computed tomography is a critical assessment tool for bone‐related preclinical research, especially in murine models. To expedite the scanning process, researchers often image multiple bones simultaneously; however, it is unknown if this impacts scan quality and alters the ability to detect differences between experimental groups. The purpose of this study was to assess the effect of multibone scanning on detecting disease‐induced changes in bone microarchitecture and mineral density by group scanning two murine models with known skeletal defects: the Col1a2 G610C/+ model of osteogenesis imperfecta and an adenine‐induced model of chronic kidney disease. Adult male femurs were scanned individually and in random groups of three and eight in a Bruker Skyscan 1172 and 1176, respectively, then assessed for standard trabecular and cortical bone measures. Although scanning methodology altered raw values, with trabecular microarchitecture values more affected than cortical properties, a disease phenotype was still detectable in both group and solo scans. However, tissue mineral density in both trabecular and cortical bone was significantly impacted by group versus solo scanning. Researchers may be able to use small groupings in a single μCT scan to expedite preclinical analyses when the overall bone phenotype is large to decrease costs and increase speed of discoveries; however the details of scanning (single or group) should always be reported

Périgord black truffle genome uncovers evolutionary origins and mechanisms of symbiosis

LetterInternational audienceThe Périgord black truffle ($Tuber\ melanosporum$ Vittad.) and the Piedmont white truffle dominate today's truffle market. The hypogeous fruiting body of $T.\ melanosporum$ is a gastronomic delicacy produced by an ectomycorrhizal symbiont endemic to calcareous soils in southern Europe. The worldwide demand for this truffle has fuelled intense efforts at cultivation. Identification of processes that condition and trigger fruit body and symbiosis formation, ultimately leading to efficient crop production, will be facilitated by a thorough analysis of truffle genomic traits. In the ectomycorrhizal $Laccaria\ bicolor$, the expansion of gene families may have acted as a 'symbiosis toolbox'. This feature may however reflect evolution of this particular taxon and not a general trait shared by all ectomycorrhizal species. To get a better understanding of the biology and evolution of the ectomycorrhizal symbiosis, we report here the sequence of the haploid genome of $T.\ melanosporum$, which at $\sim$125 megabases is the largest and most complex fungal genome sequenced so far. This expansion results from a proliferation of transposable elements accounting for $\sim$58% of the genome. In contrast, this genome only contains $\sim$7,500 protein-coding genes with very rare multigene families. It lacks large sets of carbohydrate cleaving enzymes, but a few of them involved in degradation of plant cell walls are induced in symbiotic tissues. The latter feature and the upregulation of genes encoding for lipases and multicopper oxidases suggest that $T.\ melanosporum$ degrades its host cell walls during colonization. Symbiosis induces an increased expression of carbohydrate and amino acid transporters in both $L.\ bicolor$ and $T.\ melanosporum$, but the comparison of genomic traits in the two ectomycorrhizal fungi showed that genetic predispositions for symbiosis $-$'the symbiosis toolbox'$-$ evolved along different ways in ascomycetes and basidiomycete

Eight years after an international workshop on myotonic dystrophy patient registries: case study of a global collaboration for a rare disease.

Background Myotonic Dystrophy is the most common form of muscular dystrophy in adults, affecting an estimated 10 per 100,000 people. It is a multisystemic disorder affecting multiple generations with increasing severity. There are currently no licenced therapies to reverse, slow down or cure its symptoms. In 2009 TREAT-NMD (a global alliance with the mission of improving trial readiness for neuromuscular diseases) and the Marigold Foundation held a workshop of key opinion leaders to agree a minimal dataset for patient registries in myotonic dystrophy. Eight years after this workshop, we surveyed 22 registries collecting information on myotonic dystrophy patients to assess the proliferation and utility the dataset agreed in 2009. These registries represent over 10,000 myotonic dystrophy patients worldwide (Europe, North America, Asia and Oceania). Results The registries use a variety of data collection methods (e.g. online patient surveys or clinician led) and have a variety of budgets (from being run by volunteers to annual budgets over €200,000). All registries collect at least some of the originally agreed data items, and a number of additional items have been suggested in particular items on cognitive impact. Conclusions The community should consider how to maximise this collective resource in future therapeutic programmes

Management der akuten Ischämie der unteren Extremitäten

Die Behandlung der akuten Extremitätenischämie (ALI) sollte in Zentren mit umfassender Expertise in endovaskulärer wie chirurgischer Behandlung erfolgen und stellt immer eine Notfallsituation dar. Die Initialbehandlung umfasst eine Analgesie, ausreichende intravenöse Flüssigkeitszufuhr, Sauerstoffgabe, Anti-Trendelenburg-Position und intravenöse Gabe von unfraktioniertem Heparin (UFH). Das Management richtet sich nach dem Schweregrad der akuten Extremitätenischämie (ALI) entsprechend Rutherford Stadium. Die klassische chirurgische Behandlung ist die Thrombembolektomie nach Fogarty mit oder ohne Patchplastik. Die endovaskulären Therapieoptionen stehen aufgrund vergleichbarer Ergebnisse bei geringerer Mortalitätsrate zunehmend im Vordergrund. Technisch sind die Beherrschung der perkutanen loko-regionalen Katheterthrombolyse (catheter-directed thrombolysis, CDT), der perkutanen mechanischen Katheter-Thrombusaspiration (PMT, mit oder ohne Thrombolyse), und die Möglichkeit endovaskulär-chirurgische Hybridverfahren Grundvoraussetzungen zur Behandlung der akuten Extremitätenischämie (ALI)

Klinisches Bild und diagnostisches Vorgehen bei akuter Ischämie der unteren Extremitäten

Die akute Extremitätenischämie (ALI) ist eine vaskuläre Notfallsituation. Die klinisch wichtigen Zeichen der ALI sind Schmerz (pain), Sensibilitätsstörung (paraesthesia), Pulslosigkeit (pulslessness), Hautblässe (palor), motorischer Ausfall (paralysis) und Schockzustand (prostration), die auch als die 6 P’s nach Pratt bezeichnet werden. Dringlichkeit und Prognose werden entsprechend des Rutherford Klassifikationssystems beurteilt. Die apparative Diagnostik darf keine relevante Verzögerung der Therapie mit sich führen. Die continuous wave (CW)-Dopplerdruckmessung auf Knöchelhöhe sowie die Duplexsonografie erlauben eine rasche Diagnostik am Patientenbett. Die kontrastmittelverstärkte computertomografische Angiografie ist aufgrund ihrer praktisch ubiquitären, durchgehenden Verfügbarkeit die häufigste bildgebende Notfalldiagnostik. Laborchemisch geben erhöhtes Kalium, Laktat, Myoglobin und Lactatdehydrogenase (LDH) Hinweise für eine bereits relevante ischämische Gewebeschädigung

Definition, Epidemiologie und spezielle Pathophysiologie der der unteren Extremitäten

Die akute Extremitätenischämie (ALI) ist eine Reduktion der arteriellen Perfusion mit potenzieller Bedrohung der Extremität und einer Symptomdauer von bis zu 14 Tagen. Die akute Extremitätenischämie (ALI) ist ein vaskulärer Notfall. Die Mortalitäts (10 %)- und Amputationsraten (6–8 %) während des stationären Aufenthaltes sind hoch. Die häufigsten Ursachen sind kardial embolisch oder ein lokal thrombotischer Verschluss (in-situ Thrombose). Die Differenzierung der dilatativ-aneurysmatischen Gefässkrankheit als Ursache der akuten Extremitätenischämie (ALI) ist wichtig, da sich die Therapie unterscheidet. Eine primär lebensbedrohliche Sonderform ist der akute Verschluss der Aorta abdominalis (Leriche Syndrom). Pathophysiologisch sind das Ausmass der Hypoxämie und die Dauer für die Entstehung von Gewebeuntergang prognostisch entscheidend. Der Grad der Gewebeschädigung hängt von der Reichweite des Kollateralzirkulation ab. Systemisch können komplizierend eine Rhabdomyolyse, akutes Nierenversagen sowie ein konsekutives Lungenödem hinzukommen